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Semin Speech Lang 2003; 24(4): 285-300
DOI: 10.1055/s-2004-815578
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

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
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Publication History

Publication Date:
14 January 2004 (online)

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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

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