Are our elders officially being pushed aside (and threatened) in the hospital? This is what we might fear when reading a tweet stating that hospitals are instructed to no longer resuscitate patients over 90 years old. This new “measure” relayed on X, would therefore endanger the oldest. Info or fake?
At the origin of the rumor, a personal testimony
The misinformation was born from a misappropriation of the testimony of Mathieu Coache, journalist at BFMTV, who described on the air “the inhuman welcome” reserved for his grandmother, suffering from Alzheimer’s and hospitalized for a lung infection. When he arrived at the emergency room, a doctor quickly explained to the journalist and his aunt that, if his condition deteriorated, resuscitation would not be considered. A decision, he specifies, taken in a “collegial” manner, as provided for in the Claeys-Leonetti law of 2016 on the end of life.
A painful episode, certainly, but diverted on Problem is, at no time did Mathieu Coache mention a directive of this type, nor even suggest that a general measure existed.
“Age is not a single or official criterion”
Consulted on the issue, Dr. Gérald Kierzek, emergency physician and medical director of True Medical assures us:
“No, age is never a single or official criterion for deciding on admission to intensive care, even if, in fact, it greatly influences decisions and prognoses.”
In reality, advanced age is a prognostic factor (higher mortality, shorter median survival after intensive care stay after 80 years), but there is no legal age threshold in France beyond which intensive care would be prohibited. “Above all, studies show a great variability between services in the admission of the very elderly, which confirms that age is one element among others, not an ax. underlines the emergency doctor.
The criteria which decide on resuscitation (or not)
On the other hand, the question of resuscitation can arise on a case-by-case basis, depending on the patient and their condition. But then, decisions are based in practice on a range of elements:
- Gravity and reversibility
of the acute episode (shock, respiratory distress, sepsis, etc.); - The previous state : serious comorbidities, degree of dependence, fragility, cognitive state;
- The short and medium term survival prognosisbut also the anticipated quality of life after the acute phase;
- The patient’s wishes
(advance directives, trusted person) and discussion with the family when the patient cannot express himself.
Resuscitation is justified if the expected benefits (i.e. the reasonable chance of survival with an acceptable quality of life according to the patient’s values) outweigh two criteria:
- Immediate risks (functional after-effects, cognitive decline, loss of autonomy);
- The prolongation of a situation without prospect of recovery or with major suffering.
“Severity scores (SAPS, SOFA), age, frailty and comorbidities are combined to estimate this balance, but they remain decision aids, not “decision machines” calls back the doctor.
Avoiding unreasonable obstinacy is enshrined in law
On the other hand, the law mentioned by the journalist in his family case does exist. In the Claeys-Leonetti law, on the end of life, unreasonable obstinacy replaces the notion of therapeutic relentlessness. Doctors believe that there is unreasonable obstinacy when actions are useless (no effect on the progression of the illness or comfort), disproportionate (burden and suffering unrelated to the expected benefit), or have no other effect than the artificial maintenance of life.
“In these situations, the law requires avoiding or stopping these treatments, after a collegial procedure, and prioritizing comfort and support.”
In clinical practice, this is done on a case-by-case basis, assessing age, fragility, life plan, reversibility of the episode and the patient’s wishes. But also in a collegial manner as a team, by documenting the decision and clearly explaining to loved ones the benefit/risk logic and the desire to avoid unreasonable obstinacy.
A difficult decision, for many. But which does not specifically target patients because of their year of birth.