| 1992 |
Serradura- Russell A15
|
“Ethical dilemmas in dysphagia management and the right to a natural death” |
Discuss the bioethical dilemmas faced by the speech therapist in the management of dysphagic patients. |
Autonomy; informed consent; terminal illness; living will; deglutition; deglutition disorders. |
Patient’s refusal of speech therapy; acceptance of changes in food consistency by the capable patient; management of the incapable patient’s feeding. |
The speech therapist cannot decide to interrupt artificial nutrition and hydration (ANH). The family and the multidisciplinary team must analyze ethical issues, risks and benefits. |
| 1996 |
Kirschner KL, Sorties BC 16
|
“Ethical dilemmas in dysphagia practice” |
Discuss two scenarios that contain many ethical dilemmas. |
Clinical practice; conflict; dysphagia. |
A capable patient refuses to eat and does not adhere to the proposed treatment. A family member decides that the speech therapist’s services are dispensable. |
Stimulate discussions about medical procedures, patient and family preferences, and quality of life. Use of the country’s Code of Ethics and professional help in the decision-making process. Ethical decisions always generate conflicts. The more severe the state of the dysphagic patient, the more frequent the ethical dilemmas involving the care process. |
| 2003 |
Sharp HM, Bryant KN 17
|
“Ethical issues in dysphagia: when patients refuse assessment or treatment” |
Review criteria to assess the patient’s ability to make autonomous choices and participate in decision-making. |
Deglutition disorders; enteral nutrition; clinical decision- making; advance directives; withholding and withdrawing treatment. |
Introduction to oral nutrition; acceptance or refusal of clinical recommendations; the challenge of obtaining informed consent from patients with limited capacity to participate in decision-making; clinical staff responsibilities when the patient chooses high-risk treatment options. |
Balance ethical duties to respect patients’ autonomy; weigh ANH risks and benefits. Prior informed consent to assess deglutition; assessment of the patient’s refusal and its impacts. It is necessary to consult the advance directives of the patient without autonomy to decide at the moment. |
| 2006 |
Sharp HM 18
|
“Ethical issues in the management of dysphagia after stroke” |
Analyze ethical issues in the management of dysphagic patients after stroke. |
Advance directives; artificially administered nutrition and hydration; deglutition disorders; tube feeding. |
Use of an alternative feeding route after stroke; decrease in the patient’s ability to choose or have their will respected; absence of advance directives. |
Good communication between the multidisciplinary team. Health professionals and patients benefit from clear guidelines, which encourage staff to resolve the moral and ethical dilemmas of clinical care. |
| 2007 |
Sharp HM, Wagner LB 19
|
“Ethics, informed consent, and decisions about non-oral feeding for patients with dysphagia” |
Discuss requirements for informed consent to food and artificial hydration, offering practical solutions to ethical issues related to the rehabilitation of dysphagic patients. |
Advance directives; deglutition disorders; enteral nutrition; informed consent; speech-language pathology. |
Absence of informed consent, or informed refusal, by the incapable patient; lack of care plan and advance directives. |
Ethical dilemmas can be avoided with clarifications to the family and patient. The patient has to be informed about the negative impacts of dysphagia on quality of life and general health. The fasting patient may continue aspirating oral secretions and stomach contents. Patient and family can indicate prior preferences for or against the use of ANH. Speech therapists should offer a decision-making model that addresses the risks and benefits of oral and non-oral feeding. |
| 2012 |
Groher ME, Groher TP 20
|
“When safe oral feeding is threatened: end-of-life options and decisions” |
Discuss dysphagia as a manifestation of diseases that anticipate end-of-life decisions. |
Aspiration pneumonia; dysphagia; end-of-life; medical ethics; speech-language pathologist; tube feeding. |
Problems involving the safety of deglutition and the ingestion of food and liquids for end-of-life dysphagic patients. Are there possibilities for ANH (end-of-life consensus)? The patient, the team and the family must assess eating behavior, which is important for human existence. Use of principlism to guide shared decision-making. |
End-of-life decision, especially in cases of patients unable to obtain nutrition by mouth (to place a tube or not?). It is necessary to weigh risks and benefits, consider the patient’s preferences and beliefs and make autonomy feasible. |
| 2012 |
Kaizer F, Spiridigliozzi AM, Hunt MH 21
|
“Promoting shared decision-making in rehabilitation: development of a framework for situations when patients with dysphagia refuse diet modification recommended by the treating team” |
Examine the clinical context of diet modifications for dysphagic patients undergoing rehabilitation in hospitals; explore ethical aspects of the clinical algorithm; discuss the authors’ experience with the development and use of the tool. |
Dysphagia; shared decision-making; diet modification; ethics; rehabilitation; adherence; deglutition; deglutition disorders. |
Clinical decision-making process for modifying diets for dysphagia; management of dysphagia; refusal to modify the diet and non-adherence to the team’s recommendations regarding oral feeding. |
Safeguard autonomy through shared decision-making. Patient-centered care; creation of an algorithm to help resolve conflicts (refusal or non-adherence to the consistency modification). The algorithm improves the communication between components. |
| 2015 |
Kenny B 22
|
“Food culture, preferences and ethics in dysphagia management” |
Reflect on ethical issues identified in speech therapy practice with the aim of showing some of the concerns in the management of dysphagia; examine the role of the speech therapist in supporting the patient’s autonomy when they disagree with the caregivers in relation to objectives and values. |
Clinical; dysphagia; food culture and preferences; shared decision-making; speech pathology. |
Ethical issues involving enteral diet and diet modification; devaluation, by the care team, of the food and liquids offered; conflict between physical, sociocultural and health objectives due to the dysphagic patient’s food preferences. |
Assess the risks and benefits of oral feeding in dysphagic patients; maintain individual choice safely and effectively. The dysphagia algorithm is a tool to promote partnerships and shared decision-making. |
| 2019 |
Askren A, Leslie P 23
|
“Complexity of clinical decision making: consent, capacity, and ethics” |
Discuss the bases of clinical decision-making with the intention of minimizing clinical discomfort; accept the patient’s right to refuse thickened liquids; eliminate the practice of defensive medicine (paternalism). |
Ethics; consent; capacity; decision-making. |
Patient’s right to refuse diet modifications (texture and thickening of liquids); non-adherence to the recommendations of the care team on oral feeding or indication of alternative route of short or long term. |
Promote the patients’ well-being and ensure their autonomy. The professional code of ethics says that the speech therapist must use informed consent to guarantee autonomous choices. |
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Source: Moher and collaborators; 2009 13.
