Ethical Challenges and Considerations in Dysphagia Management: A Scoping Review.

The review included only English-language articles, potentially missing relevant perspectives from non-English speaking countries. No formal quality appraisal or risk-of-bias assessment was conducted, which is standard for scoping reviews but limits the certainty of the included studies' findings. The literature is heavily skewed towards high-income countries, so the ethical frameworks discussed may not apply directly to low- and middle-income contexts with different resource constraints and cultural norms. The small number of studies (22) makes it difficult to draw strong conclusions about temporal changes in ethical practice over the last four decades. Both reviewers were also authors of the included studies, which introduces potential bias in the selection and interpretation of the literature.

The authors declare no conflicts of interest.

Do not interpret the dominance of autonomy and informed consent in the literature as evidence that these principles are routinely enacted in clinical practice. The review explicitly notes a lack of studies addressing moral action, suggesting that while clinicians know what to do, they often lack the support to actually do it.