There are various individual problems of clinical ethics in swallowing treatment, and so medical teams face difficulties in management. We report the use of a clinical ethics conference in our hospital with the four-box method to make a decision for a case with severe dysphagia. The patient was an 87-year-old man who had been suffering from repeated aspiration pneumonia. He was unable to eat each meal orally due to poor general condition and severe dysphagia. However, he refused any type of tube feeding. With swallowing therapy, he became able to eat orally once a day, and accept intermittent oro-esophageal tube feeding. Nevertheless, it was still difficult to provide him with meals three times a day due to lack of caregiving manpower with sufficient skills in meal assistance. Alternative tube feeding was indispensable to save him, but he complained that he wanted to eat without restriction. Therefore, we held a clinical ethics conference using the four-box method, which made our team staff realize many unnoticed ethics problems. Furthermore, he could eat orally once a day with respect and autonomy. As a result, his thinking gradually changed, and he received a CV port implantation. Finally, he was transferred to a long-term care hospital. We were able to proceed with decision-making with utmost respect for this patient’s will. Clinical ethics conferences may lead to better clinical decision-making and patients’ consensus.