title: Ethical issues in dysphagia: when patients refuse assessment or treatment.
abstract: The primary goal of intervention for patients with dysphagia is to restore oral feeding. When patients are unable to achieve adequate nutrition, hydration, or safety with oral feeding, then nonoral approaches are often recommended. Although patients' rights to accept or refuse clinical recommendations are widely recognized, when a patient refuses tube feeding or other recommendations, dysphagia specialists are left with a host of practical questions about their role in caring for the patient. We review the criteria for assessing patients' capacity to make informed choices, approaches to decision making when patients lack capacity, and the roles and responsibilities of clinicians when patients choose high-risk treatment options.
authors.affiliation: Department of Speech Pathology and Audiology, and the Program in Biomedical Ethics and Medical Humanities, The University of Iowa, Iowa City, Iowa 52241, USA. helen-sharp@uiowa.edu
authors.forename: Helen M
authors.initials: HM
authors.lastname: Sharp
authors.forename: Karen N
authors.initials: KN
authors.lastname: Bryant
mesh_terms: D016223:Advance Directives / Q000941:ethics / Q000331:legislation & jurisprudence; D000368:Aged; D003657:Decision Making; D003680:Deglutition Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D026690:Ethics, Clinical; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000941:ethics* / Q000331:legislation & jurisprudence; D016743:Mental Competency; D018529:Nutritional Support / Q000941:ethics* / Q000523:psychology / Q000592:standards; D028701:Patient Rights / Q000941:ethics / Q000331:legislation & jurisprudence; D016312:Treatment Refusal / Q000941:ethics* / Q000331:legislation & jurisprudence; D014481:United States