L’obstination déraisonnable, un concept pour questionner l’utilisation des contentions physiques auprès des personnes âgées présentant des troubles neurocognitifs majeurs

Summary :

Applying physical restraints to an elderly person with Major Neuro-Cognitive Disorders (MNCD) is a concern for occupational therapists working in Establishments for Elderly Dependent People (EHPAD). It compromises occupational therapy’s values of autonomy and human dignity for an illusory physical safety. Alongside, the Clayes-Leonetti law created new end-of-life rights for patients. It now prohibits unreasonable obstinacy. Could the concept of unreasonable obstinacy, with the three criteria defining it, be applicable to situations that do not involve end-of-life situations, as the one regarding the use of physical restraints? This issue will be tackled, based on a case study, in order to connect the concept of unreasonable obstinacy to the use of physical restraint of an elderly person with MNCD. The analysis of scientific and philosophical literature and the following discussion reveal that physical restraints meet the three criteria of unreasonable obstinacy. Therefore, it should not be undertaken nor pursued. In alignment with the EHPAD health care team, solutions have been suggested by the occupational therapist in order to address safety issues while respecting the autonomy and dignity of the patient. These solutions are not prescriptives and need to be adjusted over time to the person, as the process of reflection in clinical ethics requires.

Article rédigé par :

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  Dorothée Pedneault

  Ergothérapeute DE
  CH de la Haute Côte-d’Or
  21400 Châtillon-sur-Seine
  dorothee.pedneault@ch-hco.fr