American Speech-Language-Hearing Association

Rehabilitation and End-of-Life Care

Ethics Roundtable: Case Study

Mrs. J. is 68 years old. She has widely metastasized (end-stage) laryngeal cancer that was treated with radiation and chemotherapy two years ago. She has repeatedly told her doctor, her daughter, and a close family friend that she does not want her life prolonged with a feeding tube.

Mrs. J. is currently in the hospital for pain management and is recovering from pneumonia. She and the team have discussed and are setting up hospice services to follow her at home. She is ready to resume oral feeding now that she is feeling better. A member of the care team on the acute care floor suggests that a swallowing evaluation be done to rule out aspiration as the cause of her pneumonia. Mrs. J. agrees to the evaluation, but repeats her desire not to have a feeding tube placed.

The case manager for her insurance company questions the need for evaluation or intervention, based on documentation that she is terminally ill.

Questions to Consider

  • Do you think that speech-language pathology (dysphagia) services are appropriate? Why?
  • How would you respond to the case manager's question about the appropriateness of a rehabilitation service for this terminally ill patient?

Related Readings

  • Groher, M. E. (1990). Ethical dilemmas in providing nutrition. Dysphagia. 5: 102–109.
  • Segel, H. A. & Smith, M. L. (1995). To feed or not to feed. AJSLP. 4(1): 11–14.
  • Sharp, H. M. & Genesen, L. B. (1996). Ethical decision-making in dysphagia management. AJSLP. 5(1): 15–22.
  • Sharp, H. M. & Payne, S. K. (1998). Care at the end of life. In A. M. Guilford, P. A. Sullivan, A. Hodges (eds). The Swallowing Management of Cancer Patients. San Diego: Singular. For more information visit Delmar Health Care.

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