Sometimes a difficult decision to swallow: Ethical dilemmas when patients with dysphagia who lack capacity want to eat

  • Meaghann S. Weaver
    Address correspondence to: Meaghann S Weaver, MD, PhD, MPH, FAAP, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
    VHA National Center for Ethics in Health Care (M.S.W., C.M.A.G.), Washington, District of Columbia, USA

    Department of Pediatrics (M.S.W.), University of Nebraska Medical Center, Omaha, Nebraska, USA
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  • Cynthia M.A. Geppert
    VHA National Center for Ethics in Health Care (M.S.W., C.M.A.G.), Washington, District of Columbia, USA

    Departments of Psychiatry and Internal Medicine (C.M.A.G.), Ethics Education, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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      Mr. J is an 82-year-old retired farmer with a preexisting diagnosis of moderate vascular dementia who recently suffered a stroke resulting in a new diagnosis of dysphagia and a loss of complex decision-making capacity. He is admitted to a hospital rehabilitation unit for a course of speech, physical and occupational therapy. His wife, Mrs. J, is his surrogate and has made clear that the couple's shared goals of care are for him to regain as much function as possible so he can return to his own home. Consonant with those goals, his medical record documents preference for full resuscitation. A swallowing study determined he is more likely to choke on thin liquids.
      • Steele CM
      • Alsanei WA
      • Ayanikalath S
      • et al.
      The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review.
      Based on this evaluation, speech therapy recommended Mr. J's diet be restricted to a soft pureed texture.
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