Attempts of Clinical Ethical Evaluation in the Medical Management of Aged Inpatients with Dysphagia

Abstract

Background: The author thinks that almost all doctors consider clinical ethical aspects, during the doctors'diagnosing disease, offering advise and providing treatment. But there are not a form nor the custom of descripting the clinical ethical aspects. Therefore no doctors mention it. The medical care is a set of versatile procedures to aim at the improvement of the patient through various considerations for medical diagnosis and treatment, evaluation and care of psychological and social aspects. It is my opinion that we had better mention not only the medical aspects but also the clinical ethical aspects, in future medical care. The purpose of this article is to extract the clinical ethical problems concerning the nutritional channel selection through two cases of aged patients with dysphagia, using the case examination sheet made by Albert R Jonsen. Subjects & Methods: The subjects were two aged patients with disphagia. We explained the course and treatment of the disease to the surrogates. Then we asked what kind of treatment the surrogates wished to be given by paying respect to their autonomy. Simultaneously, we evaluated the cases, using the case examination sheet made by Albert R Jonsen. We report the clinical ethical aspects of these two cases. Results: The ethical problem of the two cases is that the patients could not indicate their intensions in the case examination sheets. Their son and daughter became their surrogates. The surrogate of the first case wanted to use possible means including tube feeding. The surrogate of the second case thought it important that the patient wanted to eat. The tube feeding was chosen in first case, and oral intake was chosen in the second case. Several months later, they died of pneumonia and bronchitis. Conclusion: The patients' relatives became their surrogates because the patients could not indicate their intensions. They felt they were held responsible for their surrogate decision making of treatment.