Ethical and Legal Implications of the Frazier Free Water Protocol Mrs. J is a 57-year-old woman who experienced a pontine stroke with relatively mild disability. After an acute-care hospitalization, she continued to have minimal-moderate right hemiparesis and poor balance, requiring assistance with ambulation and activities of daily living. She experienced a mild hypophonia and minimal flaccid dysarthria and a ... Article
Article  |   March 01, 2005
Ethical and Legal Implications of the Frazier Free Water Protocol
Author Affiliations & Notes
  • Lynne C. Brady Wagner
    Spaulding Rehabilitation Hospital, Boston, MA
Article Information
Swallowing, Dysphagia & Feeding Disorders / Professional Issues & Training / Articles
Article   |   March 01, 2005
Ethical and Legal Implications of the Frazier Free Water Protocol
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), March 2005, Vol. 14, 21-24. doi:10.1044/sasd14.1.21
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), March 2005, Vol. 14, 21-24. doi:10.1044/sasd14.1.21
Mrs. J is a 57-year-old woman who experienced a pontine stroke with relatively mild disability. After an acute-care hospitalization, she continued to have minimal-moderate right hemiparesis and poor balance, requiring assistance with ambulation and activities of daily living. She experienced a mild hypophonia and minimal flaccid dysarthria and a minimal-moderate dysphagia with consistent trace aspiration of thin liquids demonstrated on a videofluoroscopic evaluation of swallowing. Attempts at using indicated strategies did not eliminate aspiration during the evaluation.
Mrs. J underwent rehabilitation in a post-acute-care hospital that has a Free Water Protocol that was established with the input of the Speech-Language Pathology Department, the hospital pulmonologist, the Department of Dietetics and the hospital’s Risk Management Department. When Mrs. J was re-evaluated by the speech-language pathologist (SLP) in the rehabilitation hospital, she continued to demonstrate aspiration of thin liquids. The SLP discussed the evaluation with the patient’s physician. Because she had not demonstrated discomfort when drinking thin liquids, the SLP gave Mrs. J recommendations for a diet of soft, chopped solid foods and thick liquids during meals. Additionally, the SLP recommended that Mrs. J could drink water between meals, according to the “hospital protocol.”
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