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in this area need the mentoring, support, and guidance from experienced speech pathologists to help them navigate the complex interplay between clinical safety and quality-of-life issues to ensure the best care for our most vulnerable elderly and unwell patients. Acknowledgements Emma Tyler-Boltrek (senior speech pathologist), Alistair Bonnin (palliative care consultant) and Kevin Webb (clinical services co-ordinator, Neurology) from The Queen Elizabeth Hospital greatly assisted Helen Smith in considering issues about feeding tube placement from a whole hospital perspective. References Anonymous. (2010). Use of feeding tubes in patients with advanced dementia: Are we doing harm? Journal of Psychosocial Nursing and Mental Health Services , 48 (5), 15–19. DiBartolo, M. C. (2006). Careful hand feeding: An alternative to PEG tube placement in individuals with dementia. Journal of Gerontological Nursing , 32 (5), 25–33. Enck, R. E. (2010). Antibiotic use in end-of-life care: A soft line? American Journal of Hospice and Palliative Medicine , 27 (4) 237–238. Kellehear, A. (2009). On dying and human suffering. Palliative Medicine , 23 , 388–397. Mahtani-Chugani, V., Ganzalez-Castro, I., Saenz de Ormijana-Hernandez, A., Martin-Fernandez, R., & Fernandez de la Vega, E. (2010). How to provide care for patients suffering from terminal non-oncological diseases: barriers to a palliative care approach. Palliative Medicine , 24 (8), 787–795. Mino, J. C. & Frattini, M.O. (2009). Chronic palliative care: Specific practices for Alzheimer’s disease sufferers. Journal of Palliative Care , 25 (4), 257–264. Payne, S., Burton, C., Addington-Hall, J., & Jones, A. (2009). End–of–life issues in acute stroke care: A qualitative study of the experiences and preferences of patients and families. Palliative Medicine , 24 (2), 146–153. Shah, S.H. (2006). A patient with dementia and cancer: To feed via percutaneous endoscopic gastrostomy tube or not? Palliative Medicine , 20 , 711–714. Speech Pathology Australia. (2010). Code of ethics . Melbourne: The Australian Speech Pathology Limited. Retrieved from http://www.speechpathologyaustralia.org. au/library/Ethics/CodeofEthics.pdf

Tyler-Boltrek, E., Bonin, I.A., & Webb, K. (2009). Personal worksheet for feeding tube placement . Adelaide: The Queen Elizabeth Hospital & Health Service. 1 Names have been changed to protect the privacy of the client. 2 Cachexia = generally unwell with emaciation, usually occurring with cancer or a chronic infectious disease or illness. Helen Smith is elected by members to the Speech Pathology Australia Ethics Board. Helen has over 23 years of clinical, education, and management experience in speech pathology. She has practised professionally in the UK, Canada, Zimbabwe, and in metropolitan, rural, and remote Australia. She has a research interest in ethical practice and student education, and a clinical interest in palliative care. She is currently employed as the manager of speech pathology at The Queen Elizabeth Hospital in Adelaide and regularly presents to undergraduate and postgraduate students. Noel Muller is a consumer representative on the Speech Pathology Australia Ethics Board. Noel has been an active executive member of a consumer advisory group for a number of years and has represented consumer rights/issues in numerous areas including housing, disability, respite, aged care, suicide prevention, and forensic mental health. Noel is the president of Queensland Voice for Mental Health – the state-wide peak body for consumers and carers that provides the Queensland government with policy advice regarding mental health initiatives from a consumer and carer perspective. Trish Bradd is a senior council appointed member of the Ethics Board and a fellow of Speech Pathology Australia. She has extensive experience in the health sector, including many years as a speech pathologist working with an adult client population. Trish is currently the director of allied health for the Southern Clinical Support Transition Office, NSW Health.

Correspondence to: Helen Smith Manager, Speech Pathology Department The Queen Elizabeth Hospital, South Australia email: helen.smith4@health.sa.gov.au or Christina Wilson Senior Advisor – Professional Issues Speech Pathology Australia email: sapi@speechpathologyaustralia.org.au

This article was originally published as: Smith, H., Muller, N., & Bradd, T. (2011). Dysphagia assessment and management at the end of life: Some ethical considerations. ACQuiring Knowledge in Speech, Language, and Hearing , 13 (2), 88–91.

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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology

www.speechpathologyaustralia.org.au