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Julia is a 40-year-old female patient who experienced a stroke one month ago. For the last 10 years she had been living independently, in her own home. Since the stroke Julia needs help with all of her daily activities, and a recent assessment by a speech pathologist concludes that Julia cannot swallow safely, suggesting that she now requires an aphasic (soft food) diet. When the meal arrives and the nurse brings the food to Julia's mouth, she purses her lips and tells her to stop-she is angry and states she will not eat the soft foods. Julia tells the healthcare team that food, coffee, and the occasional glass of wine are among the few pleasures she has left in life and that to her taste, the soft diet and thickened fluids are unpalatable. Furthermore, she feels that the soft diet reduces her to feeling like a baby. Julia makes it clear that she wants the team to reorder a "normal" diet.
Some of the nurses on the unit do not feel comfortable feeding Julia something that she could potentially choke on. They fear that if Julia aspirates when they are helping her with a regular diet, they will be held responsible for her death; however, they know that if they only offer to feed her soft foods Julia will go on a hunger strike. Julia's partner Mark is very concerned about her safety and insists that the risk for choking is too high, and the healthcare team needs to take steps to maintain her nutritional status by inserting a feeding tube.
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