Terminally ill Covid-19 patients who wish to die at home should be allowed to do so whenever possible: Experts, Health News & Top Stories

SINGAPORE – Terminally ill patients who test positive for Covid-19 should be given support to stay home if they choose, Professor Dale Fisher, senior consultant at the Division, told The Straits Times on Tuesday (November 2) of infectious diseases from National University Hospital. ).

Stressing that he was not referring to any specific case, Professor Fisher, who is also a professor of medicine at the Yong Loo Lin School of Medicine at the National University of Singapore (NUS), said, “Now Singapore is in its transitional phase, it is not enforcing isolation of positive cases as strictly, so I believe terminally positive people for Covid-19 should be given the necessary support to stay at home. It is better for the individual, for families and for the health care system. “

On Monday, ST reported the case of a 99-year-old terminally ill man who asked to die at home, but he tested positive in a rapid antigen test shortly before he died. The family kept him at home until his death, according to his wishes.

The man’s doctor and family pointed out the lack of clear protocols on what to do during the episode.

While the official protocol is unclear, Covid-19 patients aged 80 and over are generally not eligible for the home recovery program and should be transferred to outpatient facilities.

But the man had previously made his family promise that he would be allowed to die at home.

In addition, the doctor who handled the case, Dr Choo Wei Chieh, told ST that sending the man to hospital “would increase the burden on already occupied hospitals.”

Dr Choo, co-founder and managing director of home care provider Ninkatec, added that given the man’s unstable condition, he likely would have ended up in the intensive care unit, which would have exacerbated the load. of work.

An expert from the NUS Center for Biomedical Ethics, Dr Anita Lim, pointed out that there is no legal mandate for the hospitalization of Covid-19 patients.

“It is a medical decision, based on the clinical condition of the patient and weighing all the relevant factors,” she said.

End-of-life conversations for terminally ill patients will involve discussions about their preferred place of death and the stresses to be addressed, Dr Lim said.

But she added that any flexibility in decision-making must take into account the safety of the patient’s caregivers.

When asked who should have the final say on what happens to terminally ill patients, Dr Lim said that while the wishes of the patient and those of his or her caregivers should always be discussed, considered and recorded, the decisions should be made by the most qualified caregiver, who is usually the senior clinician.

This decision should be made in consultation with other clinicians, she said, adding that a second opinion can sometimes be beneficial.

But she acknowledged that in emergency situations it may not be possible to get all the information you need.

“In these circumstances, decisions must be made based on the best interests of the patient, following ethical principles as fully as possible,” she said.

Some readers had also raised the question of why the body of the 99-year-old man had to be bagged, given the high vaccination rates in Singapore and the transition to life with rampant Covid-19.

The National Environment Agency had previously told ST this was done for safety. In addition to being bagged by health workers, bodies must be placed in sealed coffins and then collected by funeral service providers who have been trained by the National Center for Infectious Diseases.

Professor Fisher noted that as Singapore moves on to living with endemic Covid-19, it is gradually removing various restrictions.

“At the end of the day, the management of corpses has to go back to standard precautions. Like everything else, I would be confident that these measures will be normalized in time,” he said.

He added that while the risk of infection from a cadaver is relatively low, it is not zero.

Covid-19 is spread primarily through droplets, such as when a person sneezes or coughs. But the virus could still be on the surface of a body or in its secretions, Professor Fisher warned.

Still, he added: “These are certainly restrictions that can be lifted now that we are in a new phase.”

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