Chapitre 5. COVID et privation du droit de visites en établissement sanitaire et médico-social : Maintenir la relation et penser l'usage des outils numériques.

The right to visit our next of kin and friends has been challenged since the beginning of COVID epidemic. In Health and social care services, the visits’ limitation has and continues to have consequences on the persons under care, their relatives and the care workers. This article aims to review the investigations of the Normandy Ethical Support Unit who has set up at the beginning of the COVID crisis, in response to the referrals from the fields in connection with the visits’ restrictions. This crisis served as a reminder of the importance of physical contact in maintaining social interactions. It also drew collective attention to the implementation of digital tools to counterbalance geographical distance, lack of time, and more broadly the evolution of society. The deployment of the digital tool raises many ethical questions and must be considered without neglecting physical contact.

Perceptions et connaissances concernant la décision de réaliser le dépistage du cancer de la prostate.

BACKGROUND: Because of the benefit-risk ratio, the French health authorities recommend that patients make an informed choice concerning prostate cancer screening. The aim of this study was to investigate men's decision process. The process was explored by assessing information-seeking behavior, knowledge on prostate cancer, and men's involvement in screening decisions. METHODS: Nineteen men aged 50 to 75 years old were included in the study in 2018. Semi structured face-to-face interviews were performed. Interviews were audio-recorded and then transcribed verbatim. A thematic analysis was performed. RESULTS: In some cases, men's knowledge about prostate anatomy, prostate physiology, and prostate cancer screening modalities (procedure and risks) was poor. Moreover, despite international recommendations about shared decision-making, several GPs (General Practitioner) prescribed prostate cancer screening without discussing the matter with their patients. CONCLUSION: French men should receive better information so that they can make an informed choice about prostate cancer screening and share the decision with their GP.

[Clinical management of intersex conditions in France]. / Prise en charge de l'intersexuation en France.

Clinical management of intersex conditions in france. Although a better understanding of the nuances of the spectrum linking the normal to the pathological seems to be acquired today, some situations such as intersexuality remain problematic and impose legitimate questions about intervention modalities by medical profession. It is characterized by variations in sexual development both in the genital organs and overall sexual characteristics. Since the 1950s, its clinical management has been based on heavy medical procedures in the first years of life and throughout childhood and adolescence. These procedures such as repeated surgical operations, hormonal treatments and vaginal dilations are often not agreed by the child. In the early 2000s, there was an emergence of associations promoting interests of intersex people and a dissemination of intersex testimonies. They aiming to alert the public opinion by showing consequences and limitations of early systematic sexual conformation. These procedures, practiced and defended today by some specialists, are a subject of debate. Therefore, we propose an analysis of ethical stakes of this situation, which is part of the current debate on patient care modalities. A reorganisation of care pathway based on a well-reasoned and supervised bio-psycho-social approach would therefore emerge. This approach avoids systematic interventionism and allows patients to make free choices.

Prise en charge de l'intersexuation en france. Si une meilleure appréhension des nuances du spectre reliant le normal au pathologique semble acquise aujourd'hui, certaines situations comme celles de l'intersexuation demeurent problématiques et imposent des interrogations légitimes sur les modalités d'intervention du corps médical. Elle se caractérise par des variations du développement sexuel tant au niveau des organes génitaux que des caractéristiques sexuelles globales. Depuis les années 1950, sa prise en charge repose sur des actes médicaux lourds dans les premières années de vie et tout au long de l'enfance et l'adolescence, souvent non consentis par l'enfant, tels que des opérations chirurgicales répétées, des traitements hormonaux et des dilatations vaginales. Au début des années 2000, la naissance d'associations portant les intérêts de personnes intersexes et la diffusion de témoignages visant à alerter l'opinion publique ont mis en lumière les conséquences et limites de ce paradigme de conformation sexuée précoce systématique. Ces actes, pratiqués et défendus par certains spécialistes aujourd'hui, font donc l'objet de débats. C'est pourquoi nous proposons une analyse des enjeux éthiques de la situation s'inscrivant dans le débat actuel sur les modalités de prise en charge. Se dessinerait donc une réorganisation du parcours de soin fondé sur une approche bio-psycho-sociale raisonnée et encadrée permettant d'éviter l'interventionnisme systématique et de permettre un réel libre choix des patients.

A micro-costing evaluation of lobectomy by thoracotomy versus thoracoscopy.

BACKGROUND: Two surgical strategies called video-assisted thoracoscopy surgery (VATS) and thoracotomy are used for lobectomy following lung cancer diagnosis. The aim of this study was to assess the total cost of each technique (thoracotomy and VATS) during hospitalization in France. METHODS: A micro-costing methodology from the hospital perspective was implemented to assess the hospitalization costs, using direct observations, interviews, and data collection based on medical records in four hospitals. The average real cost of each technique was compared. RESULTS: From the hospital perspective, VATS was more expensive than thoracotomy but the difference was not significant (€6,941.30 vs. €5,950.11). CONCLUSIONS: According to this micro-costing study, thoracotomy seems to be the less expensive technique for the hospital. Our data will be included in a cost-utility analysis to assess the medico-economic impact of the VATS strategy.