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In an exploratory, open-ended, and non-random study, 60 health care workers in nine long-term care institutions in Israel were questioned regarding their experiences, thoughts and feelings related to force feeding senile demented patients. The main findings were analysed according to an ethical decision-making model. Israeli care workers tended to ground their explanations in traditional Jewish sanctity of life ethics. Their actions as well as their emotional reactions seemed the logical outcome of this world view: patients were force fed and caregivers did not feel guilt for using force or accepting suffering, since they felt obliged to preserve life and thus their actions were right. They did feel ugly and upset about the situation. While most caregivers felt that force feeding was the only acceptable route in an institution, some suggested family home care where discretionary case by case ethics was seen as a viable alternative. This paper compares the Israeli interview results with those of the Swedish studies.

A theoretical model for the assessment of the interaction between the patient with Parkinson's disease and his caregiver during assisted feeding is suggested. It is based on literature about impairments in Parkinson's disease and about interaction. The main concepts of the model are clarity of cues, sensitivity, interpretation, responsiveness and synchrony. It is suggested that the patient should be allowed to focus on the socio-emotional content versus the task content of communication during different phases of interaction during the meal.