Experts’ perspective on the ethical issues raised in geriatric care during the SARS-CoV-2 pandemic and possible solutions for the future: a systematic review

The unpreparedness of health care systems around the world as well as the inadequacy of emergency intervention protocols have led world leaders to make ethically questionable or controversial emergency decisions in hopes of controlling and minimizing the health and economic effects of the pandemic. These decisions seem to have left healthcare professionals around the world facing ethical dilemmas surrounding care of older adults during the pandemic. Healthcare experts around the world spoke out and expressed their opinions about the ethical implications of these decisions for elderly health care and for healthcare professionals. As such, the goal of this review is to explore experts’ perspectives on the ethical issues raised in Geriatric Care during the early phase (first wave) of the SARS-CoV-2 pandemic and the potential solutions that might have been proposed. A systematic review of the literature published between 2019 and October 2021 was performed on data extracted from 7 databases and the Google Scholar web search engine. From the 69 articles that met the inclusion criteria of our parent systematic review (17 scientific studies + 52 expert opinion pieces), the present paper analyses exclusively the 52 expert opinion pieces. The analysis of the extracted data allowed us to detect 2 main themes of ethical dilemmas related to health care of older adults during the pandemic as perceived by health care experts. The first theme was access to care, which was divided into 3 main subthemes: A) triage decisions for admission, B) access to the intensive care unit and life-saving resources and C) vaccine allocation. The second theme was infection control decisions between isolation and autonomy. Our results also revealed 3 categories of recommendations suggested by health care experts to help mitigate raised ethical dilemmas, namely, optimal protocols, enhanced communication, and technological assistance (telehealth and virtual communication). In conclusion, this review identified key ethical dilemmas and several potential recommendations from the perspective of health care experts on government and stakeholders’ emergency decisions. As such, future research is needed to examine the feasibility of these recommendations in different contexts around the world.