How Do I Know Whether It Is an Ethical Issue? Helping Registered Dietitian Nutritionists Identify Ethical Issues in Practice

Abstract

Continuing Professional Education (CPE) Information The Continuing Professional Education (CPE) quiz for this article is available for free to Academy members through the MyCDRGo app (available for iOS and Android devices) and through www.jandonline.org (click on “CPE” in the menu and then “Academy Journal CPE Articles”). Log in with your Academy of Nutrition and Dietetics or Commission on Dietetic Registration username and password, click “Journal Article Quiz” on the next page, then click the “Additional Journal CPE quizzes” button to view a list of available quizzes. Non-members may take CPE quizzes by sending a request to [email protected] There is a fee of $45 per quiz (includes quiz and copy of article) for non-member Journal CPE. CPE quizzes are valid for 1 year after the issue date in which the articles are published. Ethical dilemmas arise when one’s values are in conflict with the regulations and procedures that one is obligated to comply with as a professional or an employee. The registered dietitian nutritionist (RDN) and nutrition and dietetic technician, registered (NDTR) are practitioners and have an obligation to patients, colleagues, and the community, as well as to their profession. They participate in the clinical, research, management, public health, and industry arenas and must be able to discern the differences in ethical issues that include organizational and legal components (Figure 1). For instance, a contract dispute may require a legal response. Issues about employee performance may be resolved organizationally through human resources management. However, in some instances the difference between an ethical dilemma, a legal issue, a business issue, or an employment issue needs clarification. Hospital or workplace policies can affect the decision-making process. Ethics committees, as part of the division of medical ethics, participate in patients’ goals of care, provide and use appropriate ethical language, collaborate with all health services within the institution, lead in ethics education, and provide a point place in defining capacity and health literacy, as well as creating an atmosphere of transparency. Ethics committees review presented cases in which members analyze the values, ethical principles, philosophical approaches, and health care statutes related to the conflict or uncertainty that prompted the ethics consultation. Presenting a case includes stating the dilemma, providing the medical information, and communicating how the case progressed. Nutrition and dietetics practitioners can be important members of ethics committees. The RDN and NDTR are important members of the interdisciplinary team and are equipped with specialized knowledge, unique skills, and approaches for information gathering. This article presents a framework to help the nutrition and dietetics practitioner identify and distinguish ethical challenges encountered in clinical practice. Using case studies as examples and providing resources and tools to guide them, ethical issues faced by three nutrition and dietetics practitioners are analyzed. Figure 1Identifying issues in practice with the ethical dilemma, relevant principle, and the Academy of Nutrition and Dietetics/Commission on Dietetic Registration’s Code of Ethics. Definition Principles Issues/topics Code of Ethics Clinical ethics Standards for decision making in the medical environment Autonomy, beneficence, nonmaleficence, justice Informed consent, refusal of treatment, confidentiality, medically beneficial treatment Communication, bias, vulnerable patient, conflict of interest, moral distress, research #5, #9, #10, #12, #15 Legal Issues Pertaining to state and federal law Informed consent, refusal of treatment, surrogate decision maker, confidentiality, abuse of power, research #1, #2, #9, #19 Policy issues/organizational ethics Standards and structure by which a business or institution operate Interaction with vendors, gift giving and receiving, abuse of power, conflict of interest, confidentiality, research #1, #2, #8, #18, #19 Open table in a new tab The Continuing Professional Education (CPE) quiz for this article is available for free to Academy members through the MyCDRGo app (available for iOS and Android devices) and through www.jandonline.org (click on “CPE” in the menu and then “Academy Journal CPE Articles”). Log in with your Academy of Nutrition and Dietetics or Commission on Dietetic Registration username and password, click “Journal Article Quiz” on the next page, then click the “Additional Journal CPE quizzes” button to view a list of available quizzes. Non-members may take CPE quizzes by sending a request to [email protected] There is a fee of $45 per quiz (includes quiz and copy of article) for non-member Journal CPE. CPE quizzes are valid for 1 year after the issue date in which the articles are published. M. B. Nelkin is vice president, MCH Group, LLC, New York, NY; clinical assistant professor of science education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; and member, Division of Medical Ethics, Department of Medicine, Northwell Health-Long Island Jewish Hospital, New Hyde Park, NY.