On 11 December, Jan Steyaert, Jurn Verschraegen and Leentje de Wachter of the Flanders Centre of Expertise on Dementia published an article on Sociaal.net (and translated into English on the LTC COVID website), following on from the announcement that the COVID-19 vaccination programme will shortly be rolled out in Belgium. The Belgian authorities published a first version of their vaccination strategy earlier this month, which prioritises people living in care homes, and particularly those with conditions that increase the likelihood of severe COVID-19.
In their article, the authors discuss some of the ethical considerations for COVID-19 vaccination of people with dementia in the care home setting. These include the question of mandatory vs optional vaccination, as well as considerations around dementia and mental capacity to accept or refuse vaccination. They highlight the benefits of approaches such as advance directives, which help ensure individuals’ wishes are respected, whilst emphasizing that when it comes to contagious pathogens such as coronavirus, individual choices can have collective consequences. This is of particular importance in residental care homes, where people live in close proximity and where broad vaccination uptake – including staff, volunteers and visitors - may be particularly important to stem the tide of COVID-19.
Importantly, the authors call for the voices of people with dementia to be listened to as much as possible; for example, by taking into account previous statements regarding flu or other types of vaccination. Where there are no previous statements or advance directives to rely on, legal representatives or family members with power of attorney could be consulted. Tools such as the “Framework for weighing previously expressed preferences vs Best Interests” may also be of use in this context.
