Ethical issues and dysphagia

Abstract

People with many different medical problems will develop swallowing problems or dysphagia. The management of dysphagia cannot be done in isolation, particularly as the end of life approaches. Interventions to assist in the provision of nutrition are in most countries a medical treatment. Decisions will need to be made that will be influenced as much by social, cultural and religious expectations and norms as by clinical status and medical information. The best interests of the patient will always be the overriding aim, but negotiation between the patient, family and medical team may be required. Human life is sacred (including the ability to eat and drink socially) but only to the extent that it contributes to the joy and happiness of the one possessing it, and to those about him, and it ought to be the privilege of every human being to cross the river Styx in the boat of his own choosing, when further human agony cannot be justified by the hope of future health and happiness (Emanuel, Death and Dying, Rowan and Littlefield, 2004; Sánchez García et al. Nestle Nutr Inst Workshop Ser 72:101–108, 2012).