Ethics Isn t Optional: Understanding and Applying the Code of Ethics

Transcription

1 Webinar Title: Description: Ethics Isn t Optional: Understanding and Applying the Code of Ethics Are you encountering ethical dilemmas on the job? In your volunteer work? Dietitians in all areas of practice face difficult situations every day. But unlike some people we observe or interact with, we are bound to honor our professional code of ethics. There may even be times when we are unaware that an action is ethically questionable. This practical educational program will provide an introduction to our professional code of ethics along with valuable resources to help interpret and apply our ethical principles. Together we will explore some ethical landmines in dietetics practice such as issues with nonconventional therapies, electronic health records, privacy, end-of-life care, licensure, and social media. Course Objectives: After completing this continuing education course, nutrition professionals should be able to: 1. Explain why ethics matter in providing quality nutrition care. 2. Differentiate between ethical, legal, business, and personal issues. 3. Utilize ethical principles as guidelines for decision making in practice. 4. Identify and use a systematic process to address ethically challenging situations that practitioners may face. Audience: Registered Dietitians (RD), Registered Dietitian Nutritionists (RDN), Dietetic Technicians Registered (DTR), Nutrition and Dietetic Technicians Registered (NDTR) and members of the interdisciplinary team Course Continuing Professional Education (CPE) Hours: 1.5 CDR Level: 2 Suggested Learning Needs Codes: 1020: Computer, Electronic Technology 1050: Ethics 1090: Media Skills 7110: Legal Issues, Malpractice Performance Quality Indicators Accepts own responsibility and accountability for actions and decisions related to customers Practices with honesty, integrity, transparency and fairness Recognizes and manages situations with ethical implications Reports unsafe, unethical or incompetent practice or behaviors Presented to you by Becky Dorner & Associates and Today s Dietitian

2 Instructions for Obtaining Continuing Professional Education (CPE): Becky Dorner & Associates is a Continuing Professional Education (CPE) Accredited Provider (NU004) with the Commission on Dietetic Registration (CDR). CDR Credentialed Practitioners will receive 1.5 Continuing Professional Education units (CPEUs) for completion of this activity/material. To obtain the CPE Certificate, each participant must complete a simple evaluation and pass a short test (a grade of 70% is required). You can re-take the test as many times as needed. If you are interrupted and cannot finish the test, simply save the test and come back later to finish it. If you wish, you may also submit evaluations of the quality of activities/materials on the CDR Website at A quick way to access the test is through your original order confirmation that you received after placing your order. Scroll towards the bottom and you find the area that says, To take a TEST, click on the link(s) below. There should be a link after the text (see highlight on sample to the right of this text). Click on the link, fill in your name to take the test, and receive the CPE certificate. If you are part of a group that purchased additional certificates, the confirmation will have the same number of links as certificates ordered. The person who received the confirmation can simply the links to the people who need to take the test. If you are a member on the Becky Dorner & Associates website, you can also access the test by logging into the website at Once you are logged in, click on the left tool bar on the category Members Only, then click on Purchased Tests. This page has all of the tests that you have purchased from Becky Dorner & Associates. Upon successfully completing the test, you will automatically be directed to the evaluation. Simply enter your address and complete the evaluation. When finished, click Submit Survey. Click on either print or download your certificate to generate the CPE Certificate with all of the course information including your name. Speaker: Janet Skates MS, RD, LDN, FADA Registered Dietitian, Speaker and Author Janet Skates MS, RD, LDN is a Registered Dietitian Nutritionist and nutrition consultant with over 35 years of experience. Currently the owner of Nutrition Consulting Services, she provides services primarily to business and industry. She has previous experience as an advanced level nutrition support clinician and directed a clinical department in a large medical center. Throughout her career, she has focused on promoting and improving quality nutrition practice in a variety of settings. Long active in the Academy of Nutrition and Dietetics, she is a past chair of the Academy s Ethics Committee. She has presented nationally on ethics and other topics and has been published in peer-reviewed dietetics and nursing journals. Presented to you by Becky Dorner & Associates and Today s Dietitian

3 Today s Webinar Audio and Webinar Please refer to handout for instructions. Ethics Isn t Optional: Understanding and Applying the Code of Ethics Handouts ed to the person who registered for the program. Questions Use GoToMeeting to ask questions. The program will last approximately 90 min. Janet Skates MS, RD, LDN, FADA Credit Hours: Please refer to your handouts for detailed information on about credit hours. May 4, 2017 Objectives: Janet Skates, MS, RD, LDN, FADA Disclosures: No conflicts of interest for this presentation Over 35 years of experience as an advanced level nutrition support clinician, department director, and consultant. Focus on promoting and improving quality nutrition practice in a variety of settings Owner of Nutrition Consulting Services provides services primarily to business and industry Long active in the Academy of Nutrition and Dietetics, she is the immediate past chair of the Academy s Ethics Committee She has presented nationally on ethics and other topics and has been published in peerreviewed dietetics and nursing journals What is Ethics? Why is Ethics Important? The study of what is right or what should be done in the face of uncertainty or conflict about values. Explain why ethics matters when providing quality nutrition care. Differentiate between ethical, legal, business, personal, and employment issues Identify a systematic approach to address ethical challenges that practitioners face. Utilize ethical principles as guidelines to resolve ethical dilemmas. Enhance quality of care Foster professionalism Meet patient (client) expectations Enhance regulatory compliance Enhance organization's culture Address community's health needs Improve staff morale & performance Enhance marketing & public relations Decrease impact of ethics conflicts William Nelson, Rural Ethics Program, Dartmouth Medical School 1

4 Ethics Impacts... Ethics Matters in Dietetics Practice Ethical Duties Owed to Patients Autonomy Honor the patients right to make their own decision Beneficence Do only that which benefits the patient Nonmaleficence Do no harm Justice Be fair and treat like cases alike Beauchamp & Childress. Principles of Biomedical Ethics. 4th ed Quality of care Cost of care Resource utilization Evolving practice Consider Most ethical decisions have... extended consequences. multiple alternatives. mixed outcomes. uncertain consequences. personal implications. Anstead SM, University of Maryland, Graduate School of Management & Technology Ethics and Professionalism Academy / CDR Code of Ethics Characteristics of profession Specialized body of knowledge of ethics Privilege of self-regulation Code JAND, Aug 2009, pp Snyder L (Ed). American College of Physicians Ethics Manual, 6th edition. Ann Intern Med. 2012; 156:

5 Code of Ethics Certifying Board for Dietary Managers (CBDM ) Code of Ethics Fundamental principles Responsibilities to Public Responsibilities to Clients Responsibilities to Profession Responsibilities to Colleagues and Other Professionals Functions of the Code of Ethics The Code of Ethics applies to All members of the Academy All credentialed members of CDR Comprised of 19 Principles Protect the profession and the credential Influence public and private policy Improve professional practice Educate practitioners about ethical decision making Meet the guidelines of the accrediting agency Academy Ethics Education Toolkit Purpose of the Code of Ethics Education Remediation Self-regulation Code of Ethics violations Handling complaints Anyone can file a complaint. All complaints are confidential. Complaints must be signed. Individual cited is given opportunity to respond. Ethics Committee attempts to reach fair resolution of any dispute. Academy Ethics Education Toolkit Academy Ethics Education Toolkit 3

6 Questions Systematic Approach for Making Ethical Decisions Fornari A. Approaches to ethical decision making. JAND 2015;115: Framework for Responding to Ethical Issues Framework for Responding to Ethical Issues Step 1. Define the ethical dilemma. Make sure you have the facts straight. What is the issue? Who are the key stakeholders? What further information is needed? Step 2. Connect ethical theory to dilemma in practice Fornari A. JAND 2015;115: Become familiar with & review the Code of Ethics. Which principles apply to the situation? Fornari A. JAND 2015;115: Step 4. Select best alternative and justify your decision Fornari A. JAND 2015;115: Consider cultural perspective and social context Framework for Responding to Ethical Issues Step 3. Apply Code of Ethics to the issue Ask questions to determine the interrelationships and consequences of all factors and decisions 1. Framework for Responding to Ethical Issues Does issue relate to autonomy, the intent to do no harm, taking steps to help others, or being fair and just? What are the possible alternatives? Does this decision reflect organizational, professional, and social values? Do the likely benefits of the decision outweigh any potential harms? Will this decision keep the problem from recurring and/or establish a good precedent? How would this decision look to someone outside the organization? Fornari A. JAND 2015;115:

7 Framework for Responding to Ethical Issues Framework for Responding to Ethical Issues Step 5. Develop plan to implement the resolution Use the Standards of Professional Performance and Standards of Practice as a guide. Step 6. Evaluate outcomes and how to prevent a similar occurrence. Seek additional knowledge if needed. Monitor outcome to ensure expected outcome is achieved Determine strategies to prevent similar issue in future Fornari A. JAND 2015;115: Fornari A. JAND 2015;115: Is it an ethical issue? Distinguishing Ethical vs. Other Issues Legal issue Laws codify social norms Enforced through criminal or civil justice system Laws set only a minimally acceptable standard of conduct Laws may not universally be considered ethical Relationship Between Law and Ethics Employment issue Law Must be specific to one of the 19 principles of the Code Is it an ethical issue or... Is it an ethical issue or... Must be a violation of established rules or standards governing the conduct of a person or members of a profession Ethics Law and Ethics Is the issue addressed (or should it be addressed) in employer s policy? Can issue be resolved in workplace with appropriate structure to provide business oversight?. 5

8 Is it an ethical issue or... Business issue Failure to deliver quality service or product that meets standards Is it an ethical issue or... Personal issue Billing or contract disputes Scheduling problems Dissatisfaction with services Religion Relates to the individual s morals or own principles regarding right or wrong May differ from the Academy s code of ethics Examples - religious or cultural issues Culture Grandgenett, Ethics in Business Practice JAND 2010;110: Questions Responding to Ethical Challenges End-of-life care Applicable Code of Ethics Principles A resident in a skilled longterm care facility has dementia and is gastrostomy tube feedings. The resident tells the RDN that she no longer wants to be fed via her gastrostomy feeding tube. She has no advanced directive. The resident s daughter wants her mother fed. What is the RDN s role in this situation and what should be done?... provides professional services with objectivity and with respect for the unique needs and values of individuals. COE Principle 5... recognizes and exercises professional judgment within limits of his/her qualifications.. Makes referrals as appropriate COE Principle 8... treats clients and patients with respect and consideration. COE Principle 9 6

9 Key Points to Consider Competency Issues Respect patient s self-determination Right to consent to, modify, or refuse care Provide sufficient information Forced feedings do not prolong survival in advanced dementia and may contribute to discomfort and complications. Enable client and others to make their own informed decisions Refer to another RDN if unable to support client s wishes. A dietitian whose prior experience was in acute care leaves the workforce for 10 years. Upon deciding to return to work, she interviews for a position with a dialysis center and is offered the job. During her 10 years away from practice, she participated in continuing professional education activities related to medical nutrition therapy. However, she does not have current focused knowledge, skills, or experience in renal nutrition. D. Schwartz, JAND 2015;115: Key Points to Consider Applicable Code of Ethics Principles... promotes high standards of professional practice. COE, Principle 2... complies with all laws and regulation applicable.. to the profession... COE, Principle 4... assumes a life-long responsibility and accountability for personal competence in practice... COE, Principle 14 Licensure A RDN, who had been licensed in a state with a voluntary licensure law (title act) with no scope of practice, subsequently failed to renew her license, but continued to use the LDN credential. The state licensure board launched an investigation and determined that the RDN had filed a renewal but had never followed up on a request for missing information. The RDN reported she had moved during the period of the licensure renewal. Recognize steep learning curve due to complexity of kidney disease According to SOP/SOPP for Renal Nutrition, the RDN would be considered a competent practitioner. Additional training suggested Implications for organization if not meeting CMS Conditions for Coverage Applicable Code of Ethics Principles... complies with all laws and regulations applicable or related to the profession or to the practitioner s ethical obligations as described in this Code. COE Principle #4 Adapted from the Academy s Ethic Education Case Studies pro%20files/practice/ethics_case_studies_2009 _code.ashx. Accessed 3/16/ accurately presents professional qualifications and credentials COE Principle #17 Adapted from the Academy s Ethic Education Case Studies pro%20files/practice/ethics_case_studies_2009 _code.ashx. Accessed 3/16/2017 7

10 Food Safety Key Points to Consider Obligation to protect the public and do no harm. Licensure s purpose is the protect the public. Implications for putting facility at increased risk with noncompliance. Consequences/responsibilities of voluntary compliance when licensure is optional A NDTR becomes aware that staff are dry logging food temperatures instead of checking actual food temperatures. He suspects staff do not understand the risk posed by not checking food temperatures, but he lacks time to provide additional training. Adapted from the Academy s Ethic Education Case Studies %20files/practice/ethics_case_studies_2009_code.a shx. Accessed 3/16/2017 Key Points to Consider Applicable Code of Ethics Principles... considers the health, safety, and welfare of the public at all... CDR/AND COE Principle 3... complies with all laws and regulations applicable or related to the profession... CDR/AND COE Principle 4 Protection of public is a key function of the Code of Ethics. Role of leader to design and implement processes to protect the public. Berthelsen et al. J Acad Nutr Diet. 2014;114:1104 EHR and privacy issues A consultant RDN who has several clients and facilities tells one client about the advantages of another s client s electronic health record (EHR) system in documenting nutrition care. To demonstrate the differences in the two systems capabilities, the RDN accesses the EHRs from residents at both facilities and allows her current client to compare the differences. Applicable Code of Ethics Principles... protects confidential information and makes full disclosure about any limitation.. to guarantee full confidentiality. CDR/AND COE Principle complies with all applicable laws and regulations concerning the profession. CDR/AND COE Principle 4 8

11 Key Points to Consider Ethical vs. legal vs. employment issue Access was unauthorized and not related to resident s care Web-based Services Violation of HIPAA and organizational privacy compliance program Fornari. Approaches to Ethical Decision-Making JAND 2015;115: Castle et al. The Electronic Health Record, Genetic Information, and Patient Privacy. JAND 2008;108: Applicable Code of Ethics Principles Key Points to Consider... supports and promotes high standards of professional practice. CDR/AND COE Principle 2 CDR/AND COE Principle 9 Actions should be consistent with the Academy s SOPP and SOP guidelines related to counseling Determine appropriate guidelines for web-base practice that incorporate evidence based principles. Specify guidelines for practice with company prior to accepting the position... practices dietetics based on evidence-based principles and current information CDR/AND COE Principle 12 JAND 2015;115: Applicable Code of Ethics Principles Social media... treats clients and patients with respect and consideration. A nutrition-based internet company has asked RDNs to provide consultation to clients with diabetes and other nutrition-related diseases using web-based counseling and meal-planning principles. No personal information about the clients (eg. Past medical history, vital signs, social history) would be available for review by the RDN before providing any information to the online client. The NDRT is interviewing several qualified candidates for an position in the department. A colleague mentions she is a Facebook friend of one of the applicants. Is it okay for the NDRT to ask the colleague to view the applicant s personal Facebook page?... conducts himself/herself with honesty, integrity, and fairness in practice. CDR/AND COE Principle 1... demonstrates respect for the values, rights, knowledge, and skills of colleagues and other professionals. CDR/AND COE Principle 19 9

12 Key Points to Consider Non-conventional therapies Publicly available vs. password-protected information Use caution with protected information Accessing private Facebook account without permission may violate laws protecting digital communications Do not ask for Facebook passwords Hacking another person s is illegal. Ayers E. JAND 2013;113: Fox M. JAND 2012;112: Helm J. JAND 2016;116: Key Points to Consider Applicable Code of Ethics Principles... assumes responsibility and accountability for personal and professional competence in practice. CDR/AND COE Principle presents reliable and substantiated information and interprets controversial information without personal bias, recognizing that legitimate differences of opinion exist. CDR/AND COE Principle is alert to the occurrence of a real or potential conflict of interest and takes appropriate action whenever a conflict arises. Emerging science stretches our thinking about ethical practice Evolving evidence changes practice Need for disclosure when emerging science & financial benefit merge Greater accountability for examining evidence CDR/AND COE Principle 15 Vendor Relations / Gifts A pediatric RDN splits her time between the hospital and a pediatric gastroenterologist s office. The physician wants the RDN to complete training to become a certified L.E.A.P. therapist and work with her food sensitive patients to improve their health through identifying and eliminating reaction foods from their diet. What concerns, if any, does this situation raise? Resources Academy s EAL, Position or Research Committees Ethics Matter: Emerging Science and Its Implications for Ethical Dietetics Practice FNCE, Oct 20, 2014 Applicable Code of Ethics Principles... does not invite, accept, or offer gifts, monetary incentives, or other consideration that affect or reasonably give an appearance of affecting his/her professional judgement CDR/AND COE Principle 18 A staff dietitian arranged to have a sales rep demonstrate a product to the RD's and SLP's during a lunch that the sales rep provided. The sales rep was careful to say the meeting was educational. 10

13 Key Points to Consider Use of Copyright Materials Accepting gifts & perception of impropriety Educational sessions vs. product demonstrations Employer policies may be more stringent than state or federal sunshine laws Boyce B. JAND 2017;117 Feb 24. pii: S (17) Coyle, Ann Intern Med. 2002;136: Killebrew. Accepting Gifts: Let ADA's Professional Code of Ethics Be Your Guide. JAND 2010;110: ) Applicable Code of Ethics Principles A hospital nutrition committee is considering implementing a presurgical nutrition protocol to reduce the risk of post-surgical infections. The RDN obtains copies of several studies of clinical trials from the hospital s medical library. Is it ethical for the RDN to copy the articles for distribution to the committee members for review prior to the committee meeting? Key Points to Consider... conducts himself/herself with honesty, integrity, and fairness. CDR/AND COE Principle 1... does not engage in dishonest, misleading, or inappropriate business practices that demonstrate a disregard for the rights or interests of others. CDR/AND COE Principle 19a Compliance with copyright Fair Use guidelines would not apply Rights depend on contracts negotiated between vendor & institution When in doubt, ask librarian Ritter-Goodner, et al. Obtaining and Using Copyrighted Research Journal Content - Convenience vs. Ethics. JAND 2011;111: Ethics Resources Making It Relevant Academy of Nutrition and Dietetics Commission on Dietetic Registration Ethics Committee & HQ Support Team Ethics For Further Reading List Ethics in Action columns Ethics in Opinions Ethics Toolkit Case Studies Ethics Resources Making It Relevant ANFP Values Statement CBDM, CFPP Code of Ethics Select CDM RESOURCES Select Code of Ethics and Download 11

14 Take Home Messages Questions Ethical practice improves the quality of nutrition care. Ethical dilemmas are not always obvious and may not have easy answers. A systematic framework, along with your Code of Ethics, helps clarify and resolve issues. Use your professional Code of Ethics and related resources to inform and guide your ethical practice. Thank you! Janet Skates MS, RD, LDN, FADA Office (423) Mobile (423) Please complete your evaluation Attendance certificates are available for downloading by following the instructions in your handouts Watch our e-zines for upcoming programs janetskates@yahoo.com 12

15 Selected Ethics References Ayers E. Ethics Opinion: The Impact of Social Media on Business and Ethical Practices in Dietetics. J Acad Nutr Diet. 2013; 113(11): Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 4 th ed. New York, NY: Basic Books; Coyle SL; Ethics and Human Rights Committee, American College of Physicians- American Society of Internal Medicine. Physician Industry Relations. Part 1. Individual Physicians. Ann Intern Med. 2002;136: Fornari A. Approaches to ethical decision-making. J Acad Nutr Diet 2015;115: Fox M. Legal Risks of Social Media: What Dietetics Practitioners Need to Know J Acad Nutr Diet 2012;112: Gallagher-Allred CR. Communication and Education for Families Dealing with End-of- Life Decisions. J Acad Nutr Diet 2012;112: Gates GE, Amaya L. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, are ethically obligated to maintain personal competence in practice. J Acad Nutr Diet. 2015;115: Grandgenett R, Derelian D. Ethics in business practice. J Acad Nutr Diet. 2010;110: Integrated Ethics: Ethics in Healthcare. Integrated on-line module. National Center for Ethics in Health Care. Veterans Health Administration. Accessed March 15, Helm J, Miller Jones R. Practice Paper of the Academy of Nutrition and Dietetics: Social Media and the Dietetics Practitioner: Opportunities, Challenges, and Best Practices. J Acad Nutr Diet 2016;116: Killebrew D. Accepting Gifts: Let ADA s Professional Code of Ethics Be Your Guide. J Acad Nutr Diet 2010;110: Larsen J. Ethics in Action: Ownership of Copyrighted Materials. J Acad Nutr Diet. 2010; 110: Lo B. Resolving Ethical Dilemmas. 5 th edition. Philadelphia: Kippincott Williams & Wilkins; 2013.

16 Nicklas TA, et al. Nutrition Professionals Are Obligated to Follow Ethical Guidelines when Conducting Industry-Funded Research. J Acad Nutr Diet 2011;111: Ritter-Goodner PK, et al. Obtaining and Using Copyrighted Research Journal Content - Convenience vs. Ethics. J Acad Nutr Diet 2011;111: Schwartz DB. Ethical decisions for withholding/withdrawing medically assisted nutrition and hydration. J Acad Nutr Diet. 2015;115: Additional Resources The Academy of Nutrition and Dietetics Ethics Committee & HQ Support Team Ethics for Further Reading List Code of Ethics brochure New! Ethics in Action columns Ethics in Opinions Ethics Toolkit Case Studies Commission on Dietetics Registration CDR has over 25 external ethics-related CPE activities that can be found on the CPE Online Database. To access: Go to In Title or Description, type "ethics" Select Learning Needs Code: 1050

17 Code of Ethics for the Profession The Academy of Nutrition and Dietetics (Academy) and its credentialing agency, the Commission on Dietetic Registration (CDR), believe it is in the best interest of the profession and the public it serves to have a Code of Ethics in place that provides guidance to dietetics practitioners in their professional practice and conduct. Dietetics practitioners have voluntarily adopted this Code of Ethics to reflect the values and ethical principles guiding the dietetics profession and to set forth commitments and obligations of the dietetics practitioner to the public, clients, the profession, colleagues, and other professionals. The current Code of Ethics was approved on June 2, 2009, by the Academy Board of Directors, House of Delegates, and the Commission on Dietetic Registration. THE CODE OF ETHICS APPLIES TO THE FOLLOWING PRACTITIONERS: All members of the Academy who are credentialed (RDN or NDTR) All members of the Academy who are not credentialed All RDNs and NDTRs who are not members of the Academy. The Code is overseen by a 3 person Ethics Committee, with representation from the Board of Directors, Commission on Dietetic Registration and House of Delegates. The term of office is 3 years.

18 There are 19 principles of the code which are divided into 5 categories FUNDAMENTAL PRINCIPLES RESPONSIBILITIES TO THE PUBLIC RESPONSIBILITIES TO CLIENTS RESPONSIBILITIES TO THE PROFESSION RESPONSIBILITIES TO COLLEAGUES AND OTHER PROFESSIONALS FUNDAMENTAL PRINCIPLES 1. The dietetics practitioner conducts himself/herself with honesty, integrity, and fairness. 2. The dietetics practitioner supports and promotes high standards of professional practice. The dietetics practitioner accepts the obligation to protect clients, the public, and the profession by upholding the Code of Ethics for the Profession of Dietetics and by reporting perceived violations of the Code through the processes established by the Academy and its credentialing agency, the Commission on Dietetic Registration (CDR). RESPONSIBILITIES TO THE PUBLIC 3. The dietetics practitioner considers the health, safety, and welfare of the public at all times. The dietetics practitioner will report inappropriate behavior or treatment of a client by another dietetics practitioner or other professionals. 4. The dietetics practitioner complies with all laws and regulations applicable or related to the profession or to the practitioner s ethical obligations as described in this Code. a. The dietetics practitioner must not be convicted of a crime under the laws of the United States, whether a felony or a misdemeanor, an essential element of which is dishonesty. b. The dietetics practitioner must not be disciplined by a state for conduct that would violate one or more of these principles. c. The dietetics practitioner must not commit an act of misfeasance or malfeasance that is directly related to the practice of the profession as determined by a court of competent jurisdiction, a licensing board, or an agency of a governmental body. 5. The dietetics practitioner provides professional services with objectivity and with respect for the unique needs and values of individuals. a. The dietetics practitioner does not, in professional practice, discriminate against others on the basis of race, ethnicity, creed, religion, disability, gender, age, gender identity, sexual orientation, national origin, economic status, or any other legally protected category. b. The dietetics practitioner provides services in a manner that is sensitive to cultural differences. c. The dietetics practitioner does not engage in sexual harassment in connection with professional practice. 6. The dietetics practitioner does not engage in false or misleading practices or communications. a. The dietetics practitioner does not engage in false or deceptive advertising of his or her services. b. The dietetics practitioner promotes or endorses specific goods or products only in a manner that is not false and misleading. c. The dietetics practitioner provides accurate and truthful information in communicating with the public. 7. The dietetics practitioner withdraws from professional practice when unable to fulfill his or her professional duties and responsibilities to clients and others.

19 a. The dietetics practitioner withdraws from practice when he/she has engaged in abuse of a substance such that it could affect his or her practice. b. The dietetics practitioner ceases practice when he or she has been adjudged by a court to be mentally incompetent. c. The dietetics practitioner will not engage in practice when he or she has a condition that substantially impairs his or her ability to provide effective service to others. RESPONSIBILITIES TO CLIENTS 8. The dietetics practitioner recognizes and exercises professional judgment within the limits of his or her qualifications and collaborates with others, seeks counsel, or makes referrals as appropriate. 9. The dietetics practitioner treats clients and patients with respect and consideration. a. The dietetics practitioner provides sufficient information to enable clients and others to make their own informed decisions. b. The dietetics practitioner respects the client s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal. 10. The dietetics practitioner protects confidential information and makes full disclosure about any limitations on his or her ability to guarantee full confidentiality. 11. The dietetics practitioner, in dealing with and providing services to clients and others, complies with the same principles set forth in Responsibilities to the Public (Principles #3-7). 14. The dietetics practitioner assumes a life-long responsibility and accountability for personal competence in practice, consistent with accepted professional standards, continually striving to increase professional knowledge and skills and to apply them in practice. 15. The dietetics practitioner is alert to the occurrence of a real or potential conflict of interest and takes appropriate action whenever a conflict arises. a. The dietetics practitioner makes full disclosure of any real or perceived conflict of interest. b. When a conflict of interest cannot be resolved by disclosure, the dietetics practitioner takes such other action as may be necessary to eliminate the conflict, including recusal from an office, position, or practice situation. 16. The dietetics practitioner permits the use of his or her name for the purpose of certifying that dietetics services have been rendered only if he or she has provided or supervised the provision of those services. 17. The dietetics practitioner accurately presents professional qualifications and credentials. a. The dietetics practitioner, in seeking, maintaining, and using credentials provided by CDR, provides accurate information and complies with all requirements imposed by CDR. The dietetics practitioner uses CDRawarded credentials ( RD or Registered Dietitian ; DTR or Dietetic Technician, Registered ; CS or Certified Speciaist ; and FAND or Fellow of the Academy of Nutrition and Dietetics ) only when the credential is current and authorized by CDR. b. The dietetics practitioner does not aid any other person in violating any CDR requirements, or in representing himself or herself as CDR-credentialed when he or she is not. RESPONSIBILITIES TO THE PROFESSION 12. The dietetics practitioner practices dietetics based on evidence-based principles and current information. 13. The dietetics practitioner presents reliable and substantiated information and interprets controversial information without personal bias, recognizing that legitimate differences of opinion exist. 18. The dietetics practitioner does not invite, accept, or offer gifts, monetary incentives, or other considerations that affect or reasonably give an appearance of affecting his/ her professional judgment. Clarification of Principle: a. Whether a gift, incentive, or other item of consideration shall be viewed to affect, or give the appearance

20 of affecting, a dietetics practitioner s professional judgment is dependent on all factors relating to the transaction, including the amount or value of the consideration, the likelihood that the practitioner s judgment will or is intended to be affected, the position held by the practitioner, and whether the consideration is offered or generally available to persons other than the practitioner. b. It shall not be a violation of this principle for a dietetics practitioner to accept compensation as a consultant or employee or as part of a research grant or corporate sponsorship program, provided the relationship is openly disclosed and the practitioner acts with integrity in performing the services or responsibilities. c. This principle shall not preclude a dietetics practitioner from accepting gifts of nominal value, attendance at educational programs, meals in connection with educational exchanges of information, free samples of products, or similar items, as long as such items are not offered in exchange for or with the expectation of, and do not result in, conduct or services that are contrary to the practitioner s professional judgment. d. The test for appearance of impropriety is whether the conduct would create in reasonable minds a perception that the dietetics practitioner s ability to carry out professional responsibilities with integrity, impartiality, and competence is impaired. RESPONSIBILITIES TO COLLEAGUES AND OTHER PROFESSIONALS 19. The dietetics practitioner demonstrates respect for the values, rights, knowledge, and skills of colleagues and other professionals. a. The dietetics practitioner does not engage in dishonest, misleading, or inappropriate business practices that demonstrate a disregard for the rights or interests of others. b. The dietetics practitioner provides objective evaluations of performance for employees and coworkers, candidates for employment, students, professional association memberships, awards, or scholarships, making all reasonable efforts to avoid bias in the professional evaluation of others. How Do I Know if it is Really an Ethics Issue? In the Ethics Committee s experience, many of the matters brought to them are not ethics matters. Instead, the matters presented are business disputes, employment disputes, or legal matters. What is... AN ETHICAL ISSUE? The violation of established rules or standards governing the conduct of a person or the members of a profession. An ethical issue is specific to one of the 19 principles of the Code. A LEGAL ISSUE? Many state and federal laws apply to our profession. If a state or federal law has been violated, the issue could result in action by the Ethics Committee. However, not every violation of the law is a breach of the Academy/CDR Code of Ethics for the Profession of Dietetics. A BUSINESS ISSUE? An issue may be a business issue, but not an ethical issue, if it arises from a business dispute or breach of a contractual obligation, or a failure to provide products or services of an expected quality. Examples include bill-ing or contract disputes, scheduling problems or other dissatisfaction with services provided. You should not attempt to use the Code to resolve business disputes between practition-ers, other health care providers or consumers. AN EMPLOYMENT ISSUE? Employment issues can be addressed by an employer s policy or policies or can be resolved in the workplace via the appropriate structure to provide oversight (i.e., Human Resources) or through federal and state laws that protect employees. An employment issue may not be an ethical issue, such as a disagreement with a supervisor or other employee about how to conduct business. Additional examples of an employment issue include: disagreement about time or hours worked; misleading statements to supervisors, coworkers, customers, or vendors; and misusing an employer s assets.

21 Approach to Ethical Decision-making * STEP 1 STEP 4 STATE AN ETHICAL DILEMMA Identify components of potential ethical dilemma Is it an ethical issue, OR a Communication problem, OR a Practitioner-patient issue, OR a Practitioner-supervisor/employer issue, OR a Legal matter What are the facts of the situation? Objectively identify the issue Who are key participants Identify your perceptions/values What further information is needed STEP 2 CONNECT ETHICAL THEORY TO THE DILEMMA IN PRACTICE Employ four key principles of ethical theory* Autonomy Nonmaleficence Beneficence Justice STEP 3 APPLY THE ACADEMY CODE OF ETHICS TO THE ISSUE AND YOUR ETHICAL DECISION-MAKING There are 19 principles of the current Academy Code of Ethics. Two are fundamental principles: Honesty, integrity, and fairness; and Behaviors that support and promote high professional standards. SELECT THE BEST ALTERNATIVE AND JUSTIFY YOUR DECISION Identify possible alternatives to resolve the dilemma, considering: Cultural influences affecting your decision making process How alternative solutions track with your values and your institution s values Your confidence in and ability to defend the ultimate decision? Whether the decision aligns with the Academy Code of Ethics and/or the SOPs/SOPPs How the decision might affect others and whether they will support it Make a final decision STEP 5 DEVELOP STRATEGIES TO SUCCESSFULLY IMPLEMENT THE CHOSEN DECISION Strategies to successfully implement the chosen resolution Seek additional knowledge to clarify or contextualize the situation as needed Implement chosen resolution STEP 6 EVALUATE THE OUTCOMES AND HOW TO PREVENT A SIMILAR OCCURRENCE Monitor outcomes, ensuring intended outcome(s) are achieved What are the strategies to prevent a similar issue in the future? *Adapted from Fornari A. Approaches to ethical decision-making. J Acad Nutri Diet. 2015; 115 (1):

22 INDIVIDUAL VS ORGANIZATIONAL ETHICS What if my ethics complaint concerns an organization or group, not an individual? The Code of Ethics for the Dietetics Profession pertains to individual practitioners, not organizations. The Academy is an individual professional membership organization. Thus, the Academy cannot accept ethics complaints that pertain to organizations. If you have an organizational ethics issue: If your concern involves a for-profit or non-profit organization, reach out to the governing body or Board of Directors If your concern relates to a hospital or healthcare system, consider contacting the American Hospital Association (AHA) If your complaint involves a health insurer, the America s Health Insurance Plans (AHIP) may be able to assist If your concern relates to a non-dietetics professional that is not an Academy member, consider contacting the professional organization that represents that profession The focus of the code is: EDUCATION REMEDIATION SELF-REGULATION The purpose of the code is not policing practitioners. Copyright 2016 by the Academy of Nutrition and Dietetics. All rights reserved.