Applied Ethics Case Study

Imagine being told you can never drink water again.

Not because you are unconscious.
Not because you are unable to make decisions.
But because someone else believes the risk is too high.

Every day in skilled nursing facilities (SNFs), patients with dysphagia are placed on thickened liquids or texture-modified diets because of aspiration risk. In many facilities, these recommendations are presented as mandatory rather than optional. Patients are often told they “have to” comply with restrictive diet recommendations, even when they are cognitively intact and able to demonstrate understanding of the risks, benefits, and alternatives.

This case study explores one of the most common ethical dilemmas in dysphagia management:

When safety and autonomy conflict, who gets to decide?

As you move through this interactive case study, you will examine the perspectives of two individuals operating from very different ethical lenses:

• A SNF Administrator focused on safety and organizational responsibility

• A SNF Assistant Administrator focused on legal protections for patient autonomy, supporting patient dignity, and maintaining patient quality of life

You will then be asked to consider what ethical leadership looks like when no option fully eliminates risk.