Complexity of Clinical Decision Making: Consent, Capacity, and Ethics

Abstract

Speech–language pathologists (SLPs), and really their patients, are often faced with challenging clinical decisions to be made. Patients may decline interventions recommended by the SLP and are often inappropriately labeled “noncompliant.” The inappropriateness of this label extends beyond the negative charge; the patient's right to refuse is, in fact, protected by law. Anecdotal exchanges, social media platforms, and American Speech-Language-Hearing Association forums have recently revealed that many SLPs are struggling with the patient's right to decline. Many are not comfortable with the informed consent process and what entails patients' capacity to make their own medical decisions. Here, we discuss the basics of clinical decision-making ethics with intent to minimize the clinician's discomfort with the right to refuse those thickened liquids and eliminate the practice of defensive medicine.

Fonoaudiologia, conflitos decisórios e pacientes disfágicos: revisão integrativa

“…Dos nove artigos, sete são estudos de caso que analisam dilemas e conflitos éticos do ambiente terapêutico [15][16][17][18][19][20]22 . Outros dois artigos apresentaram modelos e algoritmos para tomada de decisão no cuidado do paciente disfágico 21,23 . Cinco artigos são assinados por pesquisadores dos Estados Unidos [16][17][18][19][20] , o país com mais publicações, seguido da Austrália, com duas publicações 22,15 , e Canadá 21 e Reino Unido 23 , com uma publicação cada.…”

Shifting Tides Toward a Proactive Patient-Centered Approach in Dysphagia Management of Neurodegenerative Disease

“…Reasonable alternatives to this do exist, and the factors that weigh into this decision may be different for an individual with a neurodegenerative condition than one who expects marked improvement in swallow function over time or with rehabilitation. Therefore, deliberation with the patient and family in this case may be beneficial to facilitate a plan to align with the patient's goals of care (Askren & Leslie, 2019).…”

Ethical Issues in Dysphagia Management

“…The concerns arise not from the physiologic events but rather when difficulties arise with eating, drinking, and/or swallowing. 1 Dysphagia refers not merely to the biomechanics of the oropharyngeal tract but more broadly to "all aspects of swallowing, including related feeding behaviors." 2 Ethical issues for speech-language pathologists (SLPs) relate to the planning and delivery of services in this area.…”

“…Reading the queries posted to online forums there is often more emotional language, more reports of sleepless nights, and more fear of losing one's license, with dysphagia than with communication issues even in similar conditions. 1 Possible reasons for this are that SLPs have a longer history and a more clearly defined role in the support of people with communication issues than they do with dysphagia. Other professions have been caring for people with eating, drinking, and swallowing problems as long as health care has existed and only relatively recently did the SLP move into that realm.…”

“…Disclosure is a prerequisite for informed consent and is what the courts will look for if we are ever challenged. 1,26 An important piece of federal legislation is the Patient Self-Determination Act of 1990 (PSDA), 24 and the corresponding requirements laid out by the CMS. 27 The PSDA requires most Medicare and Medicaid providers (hospitals, managed care/home health organizations, nursing homes, and hospice programs) to give people specific information about their entitlements under state laws, including the right to:…”