The Rights Lens focuses on protecting the dignity, autonomy, and freedoms of individuals. According to the Markkula Center for Applied Ethics, ethical decisions should respect the fundamental rights of all people involved, especially the right to make informed decisions about one’s own life and body. In healthcare, this means patients have the right to receive accurate information, understand their options, and make voluntary choices about medical treatment, even when providers disagree with those decisions.

The Rights Lens emphasizes:

• Autonomy

• Dignity

• Liberty

• Informed consent

• Self-determination

From this perspective, ethically appropriate healthcare requires respecting a person’s right to make decisions regarding their own body and life.

Using the Rights Lens, the primary ethical responsibility is respecting the resident’s autonomy and right to self-determination.

This lens asks:

• Does the patient have the right to make decisions about their own body?

• Has the patient received enough information to make an informed choice?

• Are decisions being made voluntarily, without coercion or pressure?

• Are institutional policies respecting or limiting individual freedoms?

Under this framework, a cognitively intact resident maintains the right to accept or refuse dysphagia recommendations after receiving education regarding:

• aspiration risk,

• pneumonia risk,

• dehydration and malnutrition concerns,

• quality-of-life implications,

• and available alternatives.

Even if clinicians believe the resident’s choice is unsafe, the Rights Lens argues that competent adults still retain the right to make decisions others may consider unwise.

Administrators and clinicians are often motivated by:

• Beneficence (wanting to protect the patient),

• Nonmaleficence (do no harm)

• Fear of legal liability.

However, the Rights Lens warns that these motivations can become paternalistic when institutions prioritize risk reduction over patient autonomy.

Examples of ethically concerning practices may include:

• Forcing compliance with thickened liquids,

• Threatening discharge for refusal,

• Withholding preferred foods or drinks,

• Or requiring residents to sign coercive “diet waivers.”

These approaches may protect the institution, but they risk violating the resident’s right to informed refusal and bodily autonomy.

Clinical ethics literature reinforces that autonomy is a foundational principle of ethical healthcare practice. Per the Patient Self-Determination Act of 1990 (Teoli & Ghassemzadeh, 2023), competent adults have the right to:

• Consent to treatment,

• Refuse treatment,

• And participate in shared decision-making.

In healthcare associated infection management “[o]ne important challenge…is that the definitions are complex and may be subject to interpretation by healthcare providers.” (Agency for Healthcare Research and Quality, 2019).

In dysphagia management, research regarding the ability to determine risk for dysphagia-associated complications is still emerging (Palmer & Padilla, 2024), but SLPs and other medical professionals cannot currently fully quantify aspiration or choking risk.

Because of the uncertaintly surrounding dysphagia risk prediction, healthcare professionals are ethically responsible for:

1. Providing accurate information (including uncertainties)

2. Explaining risks and benefits honestly

3. Assessing decision-making capacity

4. Supporting communication needs to participate in shared decision-making

5. Respecting the final informed decision

The ethical responsibility of the healthcare team is not to eliminate all risk. Instead, it is to support informed, patient-centered decisions while continuing to provide compassionate care.

1. What documentation or processes need to be in place to support the use of dysphagia informed consent while maintaining compliance with CFR regulations?

2. Should safety ever outweigh a competent patient’s autonomy?

3. At what point does “protecting” a patient become paternalism?

4. How can healthcare leaders balance liability concerns with resident rights?

5. Does requiring a resident to sign a waiver support autonomy or undermine it?