[Dysphagia] Ethical Issues

[lobsterpam at aol.com (lobsterpam@aol.com)]

Brad,

Your scenario reminded me of a terminal CA resident  from many years 
ago; NPO... all she wanted was a vanilla milk shake.  Clinically, 
bedside, this woman was no candidate to eat.  But from a human and 
caregiving perspective, she was the best candidate to try whatever she 
wanted. As I recall, she died a few days after admission, but like your 
resident, she died happy.  (There was a Burger King down the road from 
our nursing home.)

Thanks for the reminder of the great good we can do, even when by many 
standards of measurement, things don't look good.

Pam Smith

-----Original Message-----
From: Brad Harvey <rd4u@sympatico.ca>
To: neurosp@aol.com
Cc: dysphagia@b9.com; LiWalsh@serha.ca; wabeach@hsc.vcu.edu
Sent: Tue, 13 Dec 2005 10:59:45 -0500
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?
?
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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 
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?
 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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