Ethical issues in dysphagia: when patients refuse assessment or treatment

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.