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[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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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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