Ethical Issues in Dysphagia: When Patients Refuse Assessment or Treatment

Helen M. Sharp; Karen N. Bryant

doi:10.1055/s-2004-815578

Seminars in Speech and Language, Table of Contents

Semin Speech Lang 2003; 24(4): 285-300
DOI: 10.1055/s-2004-815578

Ethical Issues in Dysphagia: When Patients Refuse Assessment or Treatment

Helen M. Sharp¹ , Karen N. Bryant²

¹Department of Speech Pathology and Audiology, Department of Preventive and Community Dentistry, and the Program in Biomedical Ethics and Medical Humanities, The University of Iowa, Iowa City, Iowa
²Department of Speech Pathology and Audiology, The University of Iowa, Iowa City, Iowa

Abstract

ABSTRACT

The primary goal of intervention for patients with dysphagia is to restore oral feeding. When patients are unable to achieve adequate nutrition, hydration, or safety with oral feeding, then nonoral approaches are often recommended. Although patients' rights to accept or refuse clinical recommendations are widely recognized, when a patient refuses tube feeding or other recommendations, dysphagia specialists are left with a host of practical questions about their role in caring for the patient. We review the criteria for assessing patients' capacity to make informed choices, approaches to decision making when patients lack capacity, and the roles and responsibilities of clinicians when patients choose high-risk treatment options.

KEYWORDS

Deglutition disorders - enteral nutrition - clinical decision making - advance directives - withholding and withdrawing treatment

Full Text

References

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