Clinical Dietitians’ Perceptions of Ethical Decisions

Abstract

A study was conducted to identify ethical dilemmas dietitians face in the use of nutrition support, describe the factors that enter into ethical decision making, and determine what resources dietitians use when making ethical decisions. The authors developed a four-part questionnaire based on ethical dilemmas described in the literature and corresponding to the purposes of the study. The questionnaire was mailed to 348 clinical dietitians; 135 (39%) returned the questionnaire and of these 97 were usable for data analysis. A majority (67% and 75.3%) of dietitians took an active role in decisions regarding initiating and discontinuing invasive and noninvasive nutritional support respectively. The clinical dietitians in this study ranked (l=low;5=high) advance directives as the most influential factor in making nutrition support decisions (mean 3.78±1.11). The most frequently occurring ethical conflicts were related to justification for initiating nutrition support (mean 2.95±1.06) and responsibility for seeing that patients receive appropriate nutrition support (mean 2.86+1.43). The ethical issue that was perceived as having greatest intensity was use of invasive nutritional support for terminally ill patients (mean 2.79±1.6). The most useful resources in ethical decision making were input from other members of the health care team (77%), personal experience (61%), and professional code of ethics (57.7%). Dietitians are actively involved in ethical decision making, many regularly encounter ethical problems in practice, and they use a variety of resources to assist in resolving ethical dilemmas.