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 considerQuestions to considerQuestions 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?
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Ethics
Roundtable Home
Responses
Annotated Bibliography
|
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 AM Guilford, PA Sullivan, A Hodges (eds). The
Swallowing Management of Cancer Patients. San Diego: Singular.
for more information see
http://www.singpub.com
To submit cases or to be added to the list of respondents
please contact: Helen Sharp Department of Speech Pathology and
Audiology, 307 WJSHC University of Iowa, Iowa City, IA 52242.
Phone: 319-335-6596, fax 319-335-8851, e-mail:
helen-sharp@uiowa.edu