[Dysphagia] Ethical Issues

[pressmah at sjhmc.org (pressmah@sjhmc.org)]

However, the patient and/or family must decide how aggressively they plan to
treat pneumonia  

-----Original Message-----
From: neurosp@aol.com [mailto:neurosp@aol.com]
Sent: Tuesday, December 13, 2005 8:32 AM
To: wabeach@hsc.vcu.edu; LiWalsh@serha.ca
Cc: dysphagia@b9.com
Subject: Re: [Dysphagia] Ethical Issues


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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