Non, cette maladie n’est pas pour le vieil homme

PRINCETON – La pneumonie était autrefois qualifiée de “meilleure amie du vieillard” parce qu’elle mettait fin de façon relativement rapide et sans douleur à une vie qui avait déjà été difficile et qui, sans elle, aurait continué à se dégrader. Aujourd’hui, une étude menée dans les hospices de la région de Boston sur des patients atteints de démence sévère montre que “l’amie” en question est souvent combattue à grands renforts d’antibiotiques. De telles pratiques soulèvent une question évidente : traitons-nous les maladies parce que nous en avons le devoir ou bien parce que nous en avons la possibilité ?

Cette étude d’Erika D’Agata et Susan Mitchell, récemment publiée dans les Archives of Internal Medicine, montre que, sur 18 mois, deux tiers des 214 patients souffrant de démence sévère ont été soignés avec des antibiotiques. Les patients avaient en moyenne 85 ans. Au Test for Severe Impairment (TSI, test de déficience sévère), où les résultats peuvent aller de zéro à 24, trois quarts d’entre eux obtenaient zéro. Leur capacité à communiquer verbalement était nulle ou, au mieux, minimale.

Il n’est pas certain que l’utilisation d’antibiotiques dans ces circonstances prolonge la vie, mais même si c’était le cas, on serait en droit de se demander quelle en est l’utilité. Combien de personnes voudraient voir leur vie prolongée si elles étaient devenus incontinentes, incapables de s’alimenter seules, incapables de marcher, de parler et de reconnaître leurs enfants tant leurs facultés mentales se seraient irrémédiablement dégradées ? Dans de nombreux cas, les antibiotiques avaient été administrés par intraveineuse, ce qui peut entraîner une gêne.

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