Les libertés en EHPAD, à l’épreuve du confinement

The COVID-19 pandemic has limited the freedom of any citizen, further increased constraint for people in EHPAD - the most widespread type of French Residential care for senior citizens with a high level of dependency, often very aged, suffering multiple pathologies and sometimes psycho-behavioral disorders. “Golden” containment rule was 24/7 confinement in their room, with the very restrictive framework – up to NO visiting by relatives - and very often with a total absence of consent as for screening sample decisions. We can then question the fundamentals of such restriction of freedom, which is a constitutional right for everybody, including for residents in EHPAD, especially non-compliance with self-determination and consent. The principal objective has been a collective interest, before the individual right and the benefit for the patient itself. Nothing would have been justifying to create a possible risk to other residents, generated by another resident's behavior or one of his relatives. But these safety measures were taken despite the underlying risk of deteriorating individual situations through social and emotional isolation, and thus to further reduce autonomy capacities. “Luckily” the know-how and creative spirit of EHPAD professionals limited the consequences of this restriction of freedom. Hard lessons should be learned from share experiences if such a context were to occur again. But above all arises the question of the place of these dependent people in our society. It is essential to think collectively about these living spaces including protocols that should reflect people's choice and on-location adapted to be more open to the outside/foreigners visits. Spaces shall be adapted to their vulnerability, designed to reduce isolation, to repeat such extreme restrictive measures in the event if it shall occur. Of course, rigorous confinement rules allowed to limit deaths linked to the COVID infection, but at the risk of dying in loneliness and grief.