Ethical dilemmas, Covid19 and older people
By Bridget Penhale, University of East Anglia
It appears important to outline the types of dilemmas that are likely to occur when there is consideration of achieving a balance between familial behaviours relating to isolation of individuals within a household, and meeting care needs.
Within (multi-generational) households if a person becomes infected with Covid19 there will be a need to isolate the person from other family members to reduce the risk of spread of infection if at all possible. However, some individuals are likely to require assistance and support with care needs from family members during the course of an infection.
If it is an older person who is infected, the balance of isolation vs. care will be to provide care rather than total isolation. There are 3 main reasons for this:
a) An older person is at increased risk of or will likely experience more severe consequences from contracting the virus and is at a higher risk of mortality than otherwise healthy younger family members in a similar position (in terms of infection)
b) Older people are more likely to have needs for care relating to other, non-virus related morbidities (or co-morbidities), so may already have been receiving care prior to development of the infection – such care needs are likely to increase with infection rather than to diminish.
c) A younger person exposing themselves to increased risk of contracting infection via care-related activities of an older family member affected by the virus is likely to experience less severe consequences – in the absence of any pre-existing underlying health problems that they themselves may have.
If it is a younger person in the household who is infected, (who has been otherwise healthy prior to contracting the virus), the balance of isolation vs. care will be to isolate the individual from other family members.
This would entail minimisation and restriction of contact with others in the household, but where essential needs (for example hydration, nutrition and hygiene) can be provided for without increased risk for other family members (separate provision of food and drink, for example). The aim of this will be minimise the risks to and potential for more severe consequences for any older household members who do not have infection and who should avoid contagion if at all possible.