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Ethical dilemmas and considerations in dysphagia management

Ethical dilemmas and considerations in dysphagia management. Dr Hannah Crawford Consultant Speech & Language Therapist. Values and beliefs. Many influencing factors Subjective Right thing or least wrong thing Judgement free Compassion. Risk management clients & families objectively.

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Ethical dilemmas and considerations in dysphagia management

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  1. Ethical dilemmas and considerations in dysphagia management Dr Hannah Crawford Consultant Speech & Language Therapist

  2. Values and beliefs • Many influencing factors • Subjective • Right thing or least wrong thing • Judgement free • Compassion

  3. Risk management clients & families objectively • Inform • Reference all areas of ebp • Facilitate communication across the wider MD Teams • Support clients & families in their choice • No SLT ‘judgement’ about final decision

  4. Competent management uses good quality evidence to inform multidisciplinary discussion of risk & intervention options in order to meet professional & ethical standards. The competent SLT will support the client & their family to arrive at the most appropriate individualised intervention.

  5. Outcomes • Surrogate & clinical • Compliance? • Measure them! • Negotiation • Patient & family choice

  6. Capacity & consent

  7. Best Interests • Unwise decisions • Not based on age, appearance, condition or behaviour • Will capacity return? • Person must be encouraged to participate in decision • Past and present wishes, beliefs, values • Consult all important and/or involved parties • Consider all relevant circumstances • Least restrictive options • Special considerations for life sustaining decisions

  8. Dysphagia Oral Hygiene Quality of life Reflux PEG Sensory impairment Chronic respiratory condition Skeletal problems Pressure sores Trachestomy What has happened in similar cases? Why am I making the decisions I am? Whose risk is it? Supervision & support What would Dan want for himself? What do family say about what Dan would want? What is the right thing to do? Compromise? Least restrictive options - MCA Ref: Sackett et al, 1996

  9. “if you fill you mind with judgement……you have no capacity for curiosity and compassion” Jon Ronson, Radio 4 Loose Ends 3rd May 2019

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