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 Diagnostic test of mental capacity
Understand information relevant to decision
Retain the information
Use or weigh up the information
Communicate the decision

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. Family experience & insight
Dysphagia
Oral Hygiene
Quality of life
Reflux
PEG
Sensory impairment
Chronic respiratory condition
Skeletal problems
Pressure sores
Trachestomy
Research Evidence
Family experience & insight
Practitioner wisdom
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