Sharp Helen M, Bryant Karen N
Department of Speech Pathology and Audiology, and the Program in Biomedical Ethics and Medical Humanities, The University of Iowa, Iowa City, Iowa 52241, USA.
Semin Speech Lang. 2003 Nov;24(4):285-99. doi: 10.1055/s-2004-815578.
The primary goal of intervention for patients with dysphagia is to restore oral feeding. When patients are unable to achieve adequate nutrition, hydration, or safety with oral feeding, then nonoral approaches are often recommended. Although patients' rights to accept or refuse clinical recommendations are widely recognized, when a patient refuses tube feeding or other recommendations, dysphagia specialists are left with a host of practical questions about their role in caring for the patient. We review the criteria for assessing patients' capacity to make informed choices, approaches to decision making when patients lack capacity, and the roles and responsibilities of clinicians when patients choose high-risk treatment options.
吞咽困难患者干预的主要目标是恢复经口进食。当患者经口进食无法获得足够营养、水分或安全保障时，通常会推荐非经口途径。尽管患者接受或拒绝临床建议的权利已得到广泛认可，但当患者拒绝鼻饲或其他建议时，吞咽困难专家会面临一系列关于自身在患者护理中角色的实际问题。我们回顾了评估患者做出知情选择能力的标准、患者缺乏能力时的决策方法，以及患者选择高风险治疗方案时临床医生的角色和职责。
