Ethical Challenges and Considerations in Dysphagia Management: A Scoping Review

Speech and language therapists (SLTs) working in dysphagia care regularly navigate complex ethical dilemmas involving clinical risk, patient autonomy and cultural considerations. While ethical principles are well-recognized in the field, consolidated evidence mapping how these principles and ethical reasoning components have been represented in the literature over time remains limited. This review offers a comprehensive synthesis of ethical challenges in dysphagia management across decades and contexts, uniquely structured using Rest's Four-Component Model of ethical behaviour.

This scoping review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. A systematic search of databases from 1990 to 2024 identified 22 peer-reviewed articles. Data were analysed using descriptive statistics and thematic content analysis, with ethical principles and components classified according to Beauchamp and Childress and Rest's Four-Component Model.

Analysis revealed evolving ethical priorities within interdisciplinary roles and responsibilities of SLTs. These ethical priorities suggest the importance of ethical decision- making and person-centred care in dysphagia management, specifically foregrounded by the focus on the principles of autonomy and informed consent and the components of moral judgement and sensitivity.

The findings underscore the dynamic and complex ethical landscape of dysphagia management, emphasizing the need for cultural awareness and respect, shared decision-making and evidence-based practice. To navigate these challenges, SLTs require continuous education, interdisciplinary collaboration and adaptable ethical frameworks. This review provides a comprehensive synthesis of ethical challenges and considerations through longitudinal, theory-informed analyses using Rest's Four Component model. This model is useful in breaking down complexity into understandable psychological steps, identifying gaps, guiding education and culture by fostering genuine ethical conduct beyond intellectual understanding across decades, geographic regions and professional roles in SLT.

What is already known on this subject The field of dysphagia often places SLTs at the intersection of clinical care, patient preferences and ethical decision-making, making the consideration of ethical principles an integral part of their practice. What this paper adds to existing knowledge A comprehensive synthesis of ethical challenges and considerations in dysphagia spanning multiple decades, geographic regions and methodological approaches using Rest's Four-Component Model to classify ethical components. What are the potential or actual clinical implications of this work? Cultural awareness and shared decision making are vital aspects in dysphagia management, with the use of telepractice raising ethical concerns related to equity, privacy and informed consent.