Clearly there is a substantial body of bio-medical knowledge which underpins dysphagia care and had today’s conference focussed on that I would have been at sea. But instead it looked at other aspects including the symbolic nature of eating (nourishment rather than mere nutrition), values-based decision making, capacity and best interests, different patient reactions to severe illness, the balance of risk and wellbeing, rational reasons for rejecting gastrostomy and experience-based co-design of services.
Conferences are not neutral selections of clinicians. They tend to be self selecting depending on the nature of the content to be presented. But I was struck by the audience’s acceptance of the importance of values based practice, the central role of capacity decisions, the value of an acceptance of risk rather than the clinically safer idea of liquidising all food (to over simplify grossly) and all sorts of other non-narrowly-medical-scientific judgements. Why would that be?
In mental health care, one reason for an interest in such aspects is as a reaction to the ever present possibility of the uber-paternalism reflected in coercive treatment under the Mental Health Act. But that doesn’t apply to dysphagia care. But it was suggested to me over lunch that the reason might be this: no other area of medicine presents to non-medical-doctors the frequent interplay of both a lack of capacity in its patients with the need for invasive medical procedures. So speech and language therapists are forced to think of the broader aims of healthcare and the key issue of a balance of quality of life versus its mere preservation. If so, we should expect them to be at the forefront of the philosophy of healthcare. I must keep an eye open.
