Eating at Risk within Long-Term Care: A Case for the Relational Ethics Lens

Publication: Canadian Journal of Dietetic Practice and Research
15 March 2024

Abstract

Within long-term care homes (LTCHs), conflicts occur between residents’ desires, LTCH constraints, and healthcare providers’ concerns about risks of harm. Due to the high prevalence of dysphagia and malnutrition in these settings, decisions regarding food choices are a common source of such tensions. Existing biomedical ethical models fail to capture the complexity of the interprofessional chronic care environment. This article proposes an alternative ethical lens, the relational ethics model. We describe a case illustrating the application of a decision-making framework with a relational ethics lens for a resident with severe dysphagia and malnutrition. We highlight how the bioethics model excludes important actors from ethical decision making. We encourage registered dietitians working in LTCH to incorporate a relational ethics model into their practice to help identify resident’s values and bring attention to the interconnectedness of caring relationships and contextual factors. This approach can inform difficult decisions regarding the food and nutrition choices of residents and may facilitate meaningful outcomes for both individuals and the long-term care community.

Résumé

Dans les centres d'hébergement et de soins de longue durée (CHSLD), des conflits surviennent entre les souhaits des résidents, les contraintes des CHSLD et les préoccupations des professionnels de santé concernant les risques de préjudice. Les décisions concernant les choix alimentaires sont une source fréquente de telles tensions, en raison de la prévalence élevée de la dysphagie et de la malnutrition dans ces contextes. Les modèles éthiques biomédicaux existants ne reflètent pas la complexité de l’environnement interprofessionnel des soins aux malades chroniques. Cet article propose une perspective éthique alternative, le modèle d’éthique relationnelle. Nous décrivons un cas illustrant l’application d’un cadre décisionnel sous l’angle de l’éthique relationnelle pour un résident souffrant de dysphagie sévère et de malnutrition.

Get full access to this article

View all available purchase options and get full access to this article.

Conflicts of Interests: The authors declare that they have no competing interests.

REFERENCES

1
Namasivayam AM and Steele CM. Malnutrition and dysphagia in long-term care: a systematic review. J Nutr Gerontol Geriatr, 2015. 34(1):1–21.
2
Preshaw DH, Brazil K, McLaughlin D, and Frolic A. Ethical issues experienced by healthcare workers in nursing homes. Nurs Ethics, 2016. 23(5):490–506.
3
Bollig G, Gjengedal E, and Rosland JH. Nothing to complain about? Residents’ and relatives’ views on a “good life” and ethical challenges in nursing homes. Nurs Ethics, 2014. 23(2):142–153.
4
Beauchamp T, Childress J. Principles of biomedical ethics: marking its fortieth anniversary. 2019, Taylor & Francis. pp. 9–12.
5
Beauchamp TL, Childress J. Principles of biomedical ethics. 1994: Edicoes Loyola.
6
Metz T and Miller SC. Relational ethics. Inter Encyclopedia Ethics, 2016:1–10.
7
Holstein MB, Waymack M, Parks JA. Ethics, aging, and society: The critical turn. 2010: Springer publishing company.
8
Corey G, Corey MS, Callanan P. Issues and ethics in the helping professions. 9th ed. 2014, Belmont, CA; Australia: Brooks/Cole/Thomson Learning.
9
Hemsley B, Steel J, Sheppard JJ, Malandraki GA, Bryant L, and Balandin S. Dying for a meal: an integrative review of characteristics of choking incidents and recommendations to prevent fatal and nonfatal choking across populations. Am J Speech Lang Pathol, 2019. 28(3):1283–1297.
10
Munoz N and Posthauer ME. Nutrition strategies for pressure injury management: Implementing the 2019 international clinical practice guideline. Nutr Clin Pract, 2022. 37(3):567–582.
11
Ojo O. Managing malnutrition in older people living in residential care. Nursing and Residential Care, 2022. 24(4):1–7.
12
Horner J, Modayil M, Chapman LR, and Dinh A. Consent, refusal, and waivers in patient-centered dysphagia care: Using law, ethics, and evidence to guide clinical practice. Am J Speech Lang Pathol, 2016. 25(4):453+.
13
Kenny B. Food culture, preferences, and ethics in dysphagia management. Bioethics, 2015. 29(9):646–652.
14
Cichero J. Age-related changes to eating and swallowing impact frailty: aspiration, choking risk, modified food texture and autonomy of choice. Geriatrics, 2018. 3(4): pp. 69.
15
Jameton A. Nursing practice, the ethical issues. 1984, Englewood Cliffs, N.J: Prentice-Hall.
16
Webster G, Baylis F. Moral residue, in Margin of error: The ethics of mistakes in the practice of medicine, S.B. Rubin and L. Zoloth, Editors. 2000, University Pub. Group: Hagerstown, Md. pp. 217–230.
17
Heilman MKD and Trothen TJ. Conscientious objection and moral distress: A relational ethics case study of MAiD in Canada. J Med Ethics, 2020. 46(2):123.
18
Epstein EG and Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics, 2009. 20(4):330–342.
19
Booi L, Sixsmith J, Chaudhury H, O’Connor D, Young M, and Sixsmith A. ‘I wouldn’t choose this work again’: Perspectives and experiences of care aides in long-term residential care. J Adv Nurs, 2021. 77(9):3842–3852.
20
Whitehead PB, Herbertson RK, Hamric AB, Epstein EG, and Fisher JM. Moral distress among healthcare professionals: Report of an institution-wide survey. J Nurs Scholarsh, 2015. 47(2):117–125.
21
Braedley S, Owusu P, Przednowek A, and Armstrong P. We’re told, ‘suck it up’: long-term care workers’ psychological health and safety. Ageing International, 2018. 43(1):91–109.

Information & Authors

Information

Published In

cover image Canadian Journal of Dietetic Practice and Research
Canadian Journal of Dietetic Practice and Research
Volume 85Number 2June 2024
Pages: 91 - 94
Editor: Naomi Cahill

History

Version of record online: 15 March 2024

Key Words

  1. ethics
  2. dysphagia
  3. malnutrition
  4. long-term care

Mots-clés

  1. éthique
  2. dysphagie
  3. malnutrition
  4. soins de longue durée

Authors

Affiliations

Rebekah Sandhu MAN, RD
Queen’s University, Kingston, ON
Meara Brown MSc, RSLP
Vancouver Island Health Authority, Victoria, BC
Jodi Webber MSW PhD
Algoma University, Sault St. Marie, ON

Metrics & Citations

Metrics

Other Metrics

Citations

Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

Cited by

1. Nutrition for Older Adults: Nourishing Body AND Soul

View Options

Get Access

Login options

Check if you access through your login credentials or your institution to get full access on this article.

Subscribe

Click on the button below to subscribe to Canadian Journal of Dietetic Practice and Research

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF

View PDF

Full Text

View Full Text

Media

Media

Other

Tables

Share Options

Share

Share the article link

Share on social media