This table, while not exhaustive, shows:
- in the left-hand column, the healthcare chain and its various links in which the patient may be led through 2 networks, that of the proximity private medical practice in city and countryside areas and that of hospital care
- in the middle, the crisis governance column for which we point out the simultaneous management of the protection of the Human being, individual freedoms and necessary resources
- and finally on the right, according to our usual method, the three ethical principles most under threat, at each level of the healthcare chain, and in relation to which each of us has a free and well-argued choice.
You will find this table in the "Actualités" tab of Fertile Vision website to think about it in your own time, crossing the horizontal lines corresponding to the patient, the referring physician and his network of caregivers and specialists, the hospital short and medium stay departments, intensive care and resuscitation.
For example, in the upward slope of the pandemic:
the first link in the chain is the symptomatic or non-symptomatic patient whose first protection is confinement, his individual freedom lies in the choice of his referring physician and he might be granted social benefits.
the second link is the general practitioner, whose pivotal role justifies that he must be protected from contamination (masks, hydroalcoholic gels...), free to practice and prescribe under his sole responsibility, to guide the patient and may be his family at home or if necessary, to hospitalization according to the pre-established pathways.
For the hospital chain we will retain the governance of the two networks COVID-19 and not COVID-19 in order to ensure continuity of care, especially in the field of emergencies in the first instance. Everyone acknowledges the risks of overflowing in terms of hospitalization needs and especially intensive care with resuscitation, hence the interest of pooling public and private sectoral capacities in order to avoid the difficulties of unequal access to care and even more so of the extreme situation of prioritization.
Finally, clinical research, inseparable from care activity especially for severe forms escaping the first therapeutic attempts. In view of the mortality of the pandemic, it deals with evolving protocols whose ethical validation must be done on time and according to standards adapted to the crisis.
Equitable access to care for as many people as possible and at the highest level is a matter of proportional health security provisions for caregivers and cared for, as well as sanitary and social protection for the most vulnerable. At every stage of the epidemic, there is an ethics of responsibility for governance attached to respect for civil rights and individual freedoms.
