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[Dysphagia] Ethical Issues
kudos
> From: Brad Harvey <rd4u@sympatico.ca>
> Date: Tue, 13 Dec 2005 10:59:45 -0500
> To: <neurosp@aol.com>
> Cc: <dysphagia@b9.com>, <LiWalsh@serha.ca>, <wabeach@hsc.vcu.edu>
> Subject: Re: [Dysphagia] Ethical Issues
>
> Last year around this time I had a resident in my LTC home that was
> an enteral feed
> who rediscovered the pleasure of food. He was fully capable and
> wished to
> try pureed food after no oral intake for 10 years with a history of
> recurrent pneumonia and
> a VFSS that showed aspiration.
>
> He began eating and told me that he never thought pureed could taste
> so good.
> He and his wife were incredibly happy and he passed away within one
> month of starting to eat from pneumonia. I later saw his wife as she
> kept coming to the
> home to volunteer and she thanked me for providing excellent care and
> said she was
> glad that he got to pass on to the next world with a full tummy.
>
> Quality of life always wins over Quantity.
>
> Brad Harvey, Registered Dietitian
>
> Dietetics in Motion
> 654 Concession 3, RR#1
> Wilsonville, ON
> N0E 1Z0
> pager (519) 750-6566
> fax (519) 443-0334
> www.dieteticsinmotion.ca
>
> This information is directed in confidence solely to the person named
> above and may not otherwise be distributed, copied or disclosed.
> Therefore, this information should be considered strictly
> confidential. If you have received this email in error, please notify
> the sender immediately via a return email for further direction.
> Thank you for your assistance.
>
> On 13-Dec-05, at 8:31 AM, neurosp@aol.com wrote:
>
>> I believe you've summed it up. Well said!
>>
>> John
>>
>> -----Original Message-----
>> From: wabeach@hsc.vcu.edu
>> To: Walsh, Linda (R1SE) <LiWalsh@serha.ca>
>> Cc: dysphagia@b9.com
>> Sent: Tue, 13 Dec 2005 07:21:10 -0500
>> Subject: Re: [Dysphagia] Ethical Issues
>>
>>
>> Hello all,
>>
>> Bear in mind that nonmaleficence, "Do no harm", can mean in this case,
>> don't feed someone who will get pneumonia; it also may mean don't
>> prevent someone from eating, denying them pleasure, dignity, and a
>> quality of life which they set. Similarly, Benificence, "Do good", can
>> mean prevent chest infections, or it might mean, honor the competent
>> patient's wishes regardless of outcome.
>>
>> Ultimately self-autonomy supercedes other ethical precepts, when the
>> patient has made an informed consent or an informed denial.
>>
>> Caregivers troubled by feeding since it may worsen medical condition
>> should remember that not feeding will worsen psychic condition,
>> feelings of helplessness, and perhaps stoke rage (which may result in
>> the patient demanding even less care). Only the patient (or a
>> substitute decision maker who is actually exercising substitute
>> judgment) can determine quality of life. What the caregiver views as a
>> good quality of life may be what the patient views as a good quality
>> of life.
>>
>>
>> Woodford A. Beach, Ph.D., CCC/SP
>> Senior Speech Pathologist
>> Adjunct Asst. Professor of Neurology and PM&R
>> VCU Medical Center
>> Richmond. VA
>>
>> -------------------
>>
>>> Hi Paula,
>>> I have been interested to read the responses to your ethical case
>>> regarding C, the pt with a PEG who wishes to eat orally but every
>>>
>> time
>>
>>> he does he develops a chest infection. I agree that we should
>>>
>> respect a
>>
>>> pt's wishes if the pt is competent to make his own choices and has
>>>
>> been
>>
>>> given the information to make an informed choice. I have had pts
>>>
>> who
>>
>>> decide to take food/liquid orally against my advice and if they have
>>> made an informed choice, I respect their right to continue oral
>>>
>> intake
>>
>>> or to have family feed them orally.
>>> I think it gets a lot more complicated when pts cannot feed
>>>
>> themselves.
>>
>>> How do we respect a pt's rights and at the same time respond to
>>>
>> feeding
>>
>>> staff who wish to "above all, do no harm" to pts? Feeding staff
>>>
>> find it
>>
>>> very stressful when they are expected to feed a pt knowing that oral
>>> feeding will likely result in a worsening of the pt's medical
>>>
>> condition.
>>
>>> I would be interested to hear any comments on this dilemma.
>>> Linda
>>>
>>>
>>>
>> Woodford A. Beach, Ph.D., CCC/SP
>> Senior Speech Language Pathologist, VCUMC
>> Adjunct Asst. Professor, Neurology
>> Adjunct Asst. Professor, PM&R
>> Asst. Clinical Professor, Otolaryngology/Head & Neck Surgery
>> Virginia Commonwealth University
>> Richmond, VA 23298
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>
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