Speak Out June 2018

Casuistry approach worksheet

What are the most important issues in this case? What is the client’s diagnosis and prognosis? Diagnosis of progressive neurological disease. A recent deterioration in physical function has worsened his dysphagia and dysarthria. Are there quality-of-life issues to consider? Yes, Mr Study is aware that his medical conditions are limiting his life expectancy, and has indicated clearly he does not want to have modified texture foods or fluids. Kasey has not had the chance to discuss with him what that means regarding a plan for managing his swallowing as safely as possible. Has the client expressed a strong preference for or against an intervention? Yes, Mr Study has indicated that he does not want to have texture modified food and fluids. Kasey is unsure why and has not been able to have a conversation with Mr Study about alternatives. He may be agreeable to other types of intervention to minimise risk of aspiration. What is the nature of the ethical dilemma (with reference to the Code of Ethics)? Kasey is mindful of the values: Professionalism To act in an objective manner to help individuals … irrespective of our own personal opinions. Respect and care We respect the rights and dignity of our clients. Quality standards and continuing competence We maintain our currency of professional knowledge and practice and acknowledge the limits of these. Kasey does not have much experience working with clients with this progressive neurological disease and is unsure of the usual course of the disease and the most appropriate interventions to offer. And the principles of: Autonomy She will respect Mr Study’s wishes regarding modification of food and fluids but is considering how she can discuss his decision and provide information in another way that may better inform his decision. Beneficence and non-maleficence She considers that her role is to offer intervention that will assist him to eat and drink as safely as possible. Kasey is aware she will need to introduce AAC in order to discuss Mr Study’s decision and options for intervention and is aware of the urgency. Kasey has not worked with many clients who have completely refused to modify the texture of any foods and drinks. Previously she has been able to have a discussion with clients regarding their options for intervention and agree on a plan. Kasey has supported clients to use AAC in other cases, but not with this progressive neurological disease. She has some knowledge regarding the choice and introduction of AAC but considers that she needs further support in that area. Kasey has previously used many avenues to find and understand the evidence to support choice of interventions for clients. She feels confident in her ability to do seek out the evidence for a particular clinical scenario. She reflects that when she did spend the time to find and consider the evidence for other cases, she became more confident that she could provide clients with sufficient information to make a fully informed choice and deliver appropriate interventions. Is there empirical evidence to inform case management? Yes, Kasey is aware of the evidence to support the use of modified texture food and fluids in the management of dysphagia as well as other interventions such as compensatory techniques and environmental modifications. She has not previously investigated the evidence regarding swallowing interventions and strategies that are particularly effective for clients with this progressive neurological disease. Have I managed (or read about) a case like this before? How did I approach previous cases?

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June 2018 www.speechpathologyaustralia.org.au

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