Ethics for All: Applying ethics principles across the dietetics profession July 10, 2014

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1 NUTRI-BITES Webinar Series Ethics for All: Applying ethics principles across the dietetics profession July 10, 2014 Presenters: Esther F. Myers, PhD, RD, FADA and Dianne K. Polly, JD, RDN, LDN Moderator: James M. Rippe, MD Leading cardiologist, Founder and Director, Rippe Lifestyle Institute Approved for 1 CPE (Level 2) by the Commission on Dietetic Registration, credentialing agency for the Academy of Nutrition and Dietetics.

2 Webinar logistics CEUs a link to obtain your personalized Continuing Education Credit certificate will be ed within 2 days. A recording of today s webinar, slides, and summary PowerPoint will be available to download as a PDF within 2 days at: The presenter will answer questions at the end of this webinar. Please submit questions by using the Chat dialogue box on your computer screen.

3 ConAgra Foods Science Institute With a mission of: Promoting dietary and related choices affecting wellness by linking evidence-based understanding with practice

4 Today s Faculty Esther F. Myers, PhD, RD, FADA CEO, EF Myers Consulting Retired, Chief Science Officer, Academy of Nutrition and Dietetics Dianne K. Polly, JD, RDN, LDN Legal and Nutrition Consultant Moderator: James M. Rippe, MD Leading cardiologist, Founder and Director, Rippe Lifestyle Institute

5 Learning Objectives NUTRI-BITES Webinar Series After the webinar the participant will be able to: Identify guiding principles (fundamentals) used to resolve ethical dilemmas in dietetics Identify common situations across the full spectrum of dietetics profession that have ethical implications Apply Academy professional resources in considering ethical implications of traditional practice issues as well as new frontiers such as genetics and social media

6 Ethics is for Everyone: Applying ethics principles across the dietetics profession DIANNE K. POLLY, JD, RDN, LDN ESTHER MYERS, PHD, RD FADA, FAND JULY 10, :00-3:00 EASTERN DAYLIGHT TIME

Objectives As a result of this webinar the participants will be able to Identify guiding principles (fundamentals) used to resolve ethical dilemmas in dietetics Identify common situations across the

7 Objectives As a result of this webinar the participants will be able to Identify guiding principles (fundamentals) used to resolve ethical dilemmas in dietetics Identify common situations across the full spectrum of dietetics profession that have ethical implications e.g. food service management decisions, vendor relationships, educators and students situations, clinical practice decisions, billing practices, and research funding. Apply Academy professional resources in considering ethical implications of traditional practice issues as well as new frontiers such as genetics and social media

Definition of Ethics Ethics are standards of behavior you ought to live by Integrity is how consistent you are following your ethical standards Ethics are influenced by: Your

8 Definition of Ethics Ethics are standards of behavior you ought to live by Integrity is how consistent you are following your ethical standards Ethics are influenced by: Your values, your understanding of the roles you play; and your understanding of the obligations and dilemmas of those roles Integrity is influenced by your skills, knowledge and your character

9 Ethics is NOT... Ethics vs. Morals Ethics and morals are NOT always the same Morals = personal views of values Beliefs related to moral issues such as drinking, sex, gambling Can reflect influence of religion, culture, family and friends Ethics transcends cultural, religious and ethnic differences The Law = Something can be legal and not ethical and vice versa

happens to you, but by your thoughts and actions Ethics is not about placing

10 Ethics is NOT continued Ethics is not about getting caught Even if you get away with something, it may still be unethical Ethics is not defined by what happens to you, but by your thoughts and actions Ethics is not about placing blame It is important not to judge other people based on their personal beliefs

11 General Guidelines for Ethics When trying to decide if something is ethical, try the gut test - if gut is working Could you do it in front of your mother or your children? Would you want someone to act the same way to you? Personal ethics can sometimes be different than acceptable professional ethics

12 Academy s Code of Ethics Fundamental Principles Dietetics Practitioners 1-Conduct themselves with honesty, integrity and fairness 2-Supports and promotes high standards of professional practice Code lists responsibilities to: The public To your clients To the profession To your colleagues and other professionals

Duties to the Public (3-7) 3-Considers health, safety and welfare of public at all times 4-Complies with all laws and regulations 5-No false or misleading practices or

13 Duties to the Public (3-7) 3-Considers health, safety and welfare of public at all times 4-Complies with all laws and regulations 5-No false or misleading practices or communications 6-Must withdraw when unable to fulfill his professional duties to clients and others 7-These duties/responsibilities are inclusive for all areas of practice

and patients with respect and consideration 10-Protects confidential information

14 Responsibilities to Clients (8-11) 8-Recognizes and exercises professional judgment within limits of his qualifications; makes referrals if necessary 9-Treats clients and patients with respect and consideration 10-Protects confidential information and makes full disclosure of any limitations 11- Comply with all public principles (3-7)

Responsibilities to our Profession (12-18) 12-Practices with evidence based principles and current information 13-Presents reliable information without personal bias, recognizing legitimate

15 Responsibilities to our Profession (12-18) 12-Practices with evidence based principles and current information 13-Presents reliable information without personal bias, recognizing legitimate differences of opinion exists 14-Lifelong duty to keep competent in practice 15-Avoids conflicts of interest or discloses as needed 16- Permits use of name with products/services only if rendered by him or supervised by him 17- Accurately represents credentials & qualifications 18- Not invite, accept, or offer gifts, monetary incentives or other considerations

16 Responsibilities to Colleagues and Other Professionals (19) 19-Demonstrates respect for the values, rights, knowledge, and skills of colleagues and other professionals.

org/codeofethics Ethics in Action Articles Ethics Opinions

17 Using Academy resources Code of Ethics (Handout Page #12) Published articles (See handout) Website Ethics in Action Articles Ethics Opinions Instructions for Compiling Ethics Complaints and Violations

Discussion cases 1. Review scenario 19 2. Polling Slides (Slides 20-22) 1. Ask for your vote Is this an ethics issue 2.

18 Discussion cases 1. Review scenario Polling Slides (Slides 20-22) 1. Ask for your vote Is this an ethics issue 2. Ask for your vote Who does it involve 3. Ask for your vote which of the code of ethics principles apply (Refer to handout for full description of each principle) 3. Review key application points

19 First Is it truly an ethical issue? A. Legal Issue B. Employer Policy C. Personal Issue D. Business Dispute E. Ethics only F. Ethics plus one or more of the other issues Remember it could also be a combination issue

20 A. Public Next --- Who does it involve?? 21 B. Client C. Profession D. Colleagues and Other Professionals

21 Select Principle(s) that apply (Code of Ethics) Fundamental Principles 1. Honesty, integrity and fairness 2. Standard of professional practice and Code of Ethics Responsibilities to the public 3- Health Safety and welfare of public 4-Laws, regulations and Code of ethics 5-Objective and respect for needs and values 6-Not false or misleading 7-Withdraw when unable to fulfill duties/responsitilities Responsibilities to Clients 8-Professional judgement within their limits 9-Client/patient respect and consideration 10-Protect confidential information 11 -Comply with all principles related to public (#3-7) 22 Responsibilities to the Profession 12. Evidence-based principles 13. Reliable/substantiated information & interprets w/o bias 14. Life-long learning 15. Real or porential conflict of interest 16. Use of name only for services rendered 17. Uses accurate professional qualifications & credentials 18. Gifts, monetary incentives or other considerations Responsibilities to Colleagues and Other Professionals 19. Respect for other professionals

22 Scenarios End of Life Management Purchasing Social Media Conducting Research Business Private Practice

23 End of Life Case Scenario You work in a nursing home and have become friends with a young mother who has end stage cancer. She has shared with you that she did not want any extraordinary care once she could no longer eat solid food. She had been consuming very few calories for the last several weeks. She is heavily medicated and is now refusing to eat. The physician and her family believe she could live for several months with a tube feeding. Do you see this as an ethical issue?

24 First Is it truly an ethical issue? A. Legal Issue B. Employer Policy C. Personal Issue D. Business Dispute E. Ethics only F. Ethics plus another issue

25 A. Public Next --- Who does it involve?? 26 B. Client C. Profession D. Colleagues and Other Professionals

26 Select Principle(s) that apply (Code of Ethics) Fundamental Principles 1. Honesty, integrity and fairness 2. Standard of professional practice and Code of Ethics Responsibilities to the public 3- Health Safety and welfare of public 4-Laws, regulations and Code of ethics 5-Objective and respect for needs and values 6-Not false or misleading 7-Withdraw when unable to fulfill duties/responsitilities Responsibilities to Clients 8-Professional judgement within their limits 9-Client/patient respect and consideration 10-Protect confidential information 11 -Comply with all principles related to public (#3-7) 27 Responsibilities to the Profession 12. Evidence-based principles 13. Reliable/substantiated information & interprets w/o bias 14. Life-long learning 15. Real or porential conflict of interest 16. Use of name only for services rendered 17. Uses accurate professional qualifications & credentials 18. Gifts, monetary incentives or other considerations Responsibilities to Colleagues and Other Professionals 19. Respect for other professionals

27 Key Application Points It is an ethical issue and could be a legal issue It involves your responsibilities to a patient/client & to professional colleague (MD) Primary principles of the code: Number 1 and 2 of fundamental principles Number 8 Number 9 Number 19 Legal Issue: If she has prepared advanced directives, they should be honored

Common situations Management As the manager of a large dietetics department you have final approving authority on purchasing contracts for foods, medical foods, and dietary supplements.

28 Common situations Management As the manager of a large dietetics department you have final approving authority on purchasing contracts for foods, medical foods, and dietary supplements. Recently at the FNCE exhibit hall, one of the company representatives for a medical food company identified one of the benefits of using their product was the additional software programs provided to track patient outcomes. Is it ethical for you to choose this medical food supplement and use the software.

29 First Is it truly an ethical issue? A. Legal Issue B. Employer Policy C. Personal Issue D. Business Dispute E. Ethics only F. Ethics plus another issue

30 A. Public Next --- Who does it involve?? 31 B. Client C. Profession D. Colleagues and Other Professionals

31 Select Principle(s) that apply (Code of Ethics) Fundamental Principles 1. Honesty, integrity and fairness 2. Standard of professional practice and Code of Ethics Responsibilities to the public 3- Health Safety and welfare of public 4-Laws, regulations and Code of ethics 5-Objective and respect for needs and values 6-Not false or misleading 7-Withdraw when unable to fulfill duties/responsitilities Responsibilities to Clients 8-Professional judgement within their limits 9-Client/patient respect and consideration 10-Protect confidential information 11 -Comply with all principles related to public (#3-7) 32 Responsibilities to the Profession 12. Evidence-based principles 13. Reliable/substantiated information & interprets w/o bias 14. Life-long learning 15. Real or porential conflict of interest 16. Use of name only for services rendered 17. Uses accurate professional qualifications & credentials 18. Gifts, monetary incentives or other considerations Responsibilities to Colleagues and Other Professionals 19. Respect for other professionals

32 Key Application Points Primarily an ethical issue with employer policy Primary Principles of the Code of Ethics Fundamental Number 1 Profession Number 18 Consideration is the value of the comparable or similar software

Recently you decided to enhance your blog by actually writing about a particular patient s medical nutrition therapy.

33 Common Situations Social media You have a private practice in addition to working at an acute care hospital. In your private practice, you have a blog and frequently comment on general nutrition practices. Recently you decided to enhance your blog by actually writing about a particular patient s medical nutrition therapy. You think this might help others with similar conditions. You recommend specific nutritional supplements. You do not actually disclose the name of the patient you are writing about. Are there any ethical violations with doing this?

34 First Is it truly an ethical issue? A. Legal Issue B. Employer Policy C. Personal Issue D. Business Dispute E. Ethics only F. Ethics plus another issue

35 A. Public Next --- Who does it involve?? 36 B. Client C. Profession D. Colleagues and Other Professionals

36 Select Principle(s) that apply (Code of Ethics) Fundamental Principles 1. Honesty, integrity and fairness 2. Standard of professional practice and Code of Ethics Responsibilities to the public 3- Health Safety and welfare of public 4-Laws, regulations and Code of ethics 5-Objective and respect for needs and values 6-Not false or misleading 7-Withdraw when unable to fulfill duties/responsitilities Responsibilities to Clients 8-Professional judgement within their limits 9-Client/patient respect and consideration 10-Protect confidential information 11 -Comply with all principles related to public (#3-7) 37 Responsibilities to the Profession 12. Evidence-based principles 13. Reliable/substantiated information & interprets w/o bias 14. Life-long learning 15. Real or porential conflict of interest 16. Use of name only for services rendered 17. Uses accurate professional qualifications & credentials 18. Gifts, monetary incentives or other considerations Responsibilities to Colleagues and Other Professionals 19. Respect for other professionals

37 Key Application Points This is an ethical issue and also possibly a legal issue Jurisdictional issues with discussing MNT across state lines without licensure; possible HIPAA violations. This involves patients/clients. Primary principles of code: Number 2 Number 3 and 4 Number 10

Common Situations-Conducting Research You applied for and received research funding from an industry associated foundation based on a sound research proposal that you submitted.

38 Common Situations-Conducting Research You applied for and received research funding from an industry associated foundation based on a sound research proposal that you submitted. The research is completed and a dietitian who is employed by the industry has contacted you outside the normal communication channels and asked to be shown the research findings in advance of submission of the manuscript with primary results.

39 First Is it truly an ethical issue? A. Legal Issue B. Employer Policy C. Personal Issue D. Business Dispute E. Ethics only F. Ethics plus another issue

40 A. Public Next --- Who does it involve?? 41 B. Client C. Profession D. Colleagues and Other Professionals

41 Select Principle(s) that apply (Code of Ethics) Fundamental Principles 1. Honesty, integrity and fairness 2. Standard of professional practice and Code of Ethics Responsibilities to the public 3- Health Safety and welfare of public 4-Laws, regulations and Code of ethics 5-Objective and respect for needs and values 6-Not false or misleading 7-Withdraw when unable to fulfill duties/responsitilities Responsibilities to Clients 8-Professional judgement within their limits 9-Client/patient respect and consideration 10-Protect confidential information 11 -Comply with all principles related to public (#3-7) 42 Responsibilities to the Profession 12. Evidence-based principles 13. Reliable/substantiated information & interprets w/o bias 14. Life-long learning 15. Real or porential conflict of interest 16. Use of name only for services rendered 17. Uses accurate professional qualifications & credentials 18. Gifts, monetary incentives or other considerations Responsibilities to Colleagues and Other Professionals 19. Respect for other professionals

42 Key Application Points Could be an issue for either or both dietitians involved What is the intent of the request? What is perception? Could be a legal issue depending on how contract/agreement with funder was constructed References include thoughts on how to effectively and ethically work with research funders Codes of Ethics to consider Fundamental Principal #1 Professional Principal #15 Colleagues Principal #19

Common Situation Using Genetics and Emerging Research You are on an advisory group member for an company that is marketing genetic testing whose results are then used to produce and market tailored

43 Common Situation Using Genetics and Emerging Research You are on an advisory group member for an company that is marketing genetic testing whose results are then used to produce and market tailored dietary supplements of common vitamins, minerals and bioactive substances to the recipients of the test. Once you review the published research you are concerned that they are over-interpreting the published research that is cited as the basis of their business model to tailor the products for the clients.

44 First Is it truly an ethical issue? A. Legal Issue B. Employer Policy C. Personal Issue D. Business Dispute E. Ethics only F. Ethics plus another issue

45 A. Public Next --- Who does it involve?? 46 B. Client C. Profession D. Colleagues and Other Professionals

46 Select Principle(s) that apply (Code of Ethics) Fundamental Principles 1. Honesty, integrity and fairness 2. Standard of professional practice and Code of Ethics Responsibilities to the public 3- Health Safety and welfare of public 4-Laws, regulations and Code of ethics 5-Objective and respect for needs and values 6-Not false or misleading 7-Withdraw when unable to fulfill duties/responsitilities Responsibilities to Clients 8-Professional judgement within their limits 9-Client/patient respect and consideration 10-Protect confidential information 11 -Comply with all principles related to public (#3-7) 47 Responsibilities to the Profession 12. Evidence-based principles 13. Reliable/substantiated information & interprets w/o bias 14. Life-long learning 15. Real or porential conflict of interest 16. Use of name only for services rendered 17. Uses accurate professional qualifications & credentials 18. Gifts, monetary incentives or other considerations Responsibilities to Colleagues and Other Professionals 19. Respect for other professionals

47 Key Application Points Could be combination of ethical and legal Legal would be related to compliance with advertising claims Principles to consider Fundamental #1 Public #3, #6c Profession #12, #13 Colleagues and Other Professionals #19

Common situations Private Practice You are a recent graduate of an accredited dietetics internship. You want to start your own practice with a fellow student.

48 Common situations Private Practice You are a recent graduate of an accredited dietetics internship. You want to start your own practice with a fellow student. You practice in Tennesee and he lives and practices in Mississippi, but only three miles apart. Each of you are licensed in your respective states. You want to specialize in eating disorders and nursing home contractors. You now want to do telemedicine medical nutrition therapy and work with an herbalist but your friend does not. You decide you will see these patients on the side and not let him know. Would this be an ethical violation?

49 First Is it truly an ethical issue? A. Legal Issue B. Employer Policy C. Personal Issue D. Business Dispute E. Ethics only F. Ethics plus another issue

50 A. Public Next --- Who does it involve?? 51 B. Client C. Profession D. Colleagues and Other Professionals

51 Select Principle(s) that apply (Code of Ethics) Fundamental Principles 1. Honesty, integrity and fairness 2. Standard of professional practice and Code of Ethics Responsibilities to the public 3- Health Safety and welfare of public 4-Laws, regulations and Code of ethics 5-Objective and respect for needs and values 6-Not false or misleading 7-Withdraw when unable to fulfill duties/responsitilities Responsibilities to Clients 8-Professional judgement within their limits 9-Client/patient respect and consideration 10-Protect confidential information 11 -Comply with all principles related to public (#3-7) 52 Responsibilities to the Profession 12. Evidence-based principles 13. Reliable/substantiated information & interprets w/o bias 14. Life-long learning 15. Real or porential conflict of interest 16. Use of name only for services rendered 17. Uses accurate professional qualifications & credentials 18. Gifts, monetary incentives or other considerations Responsibilities to Colleagues and Other Professionals 19. Respect for other professionals

52 Key Application Points This could be both an ethical and a legal issue Legal & Business issues: What was the business agreement and organizational structure? This involves clients and colleagues and other professionals Principles of Code involved Number 1 and 2 Number 8 and 12 Number 19

Profession Colleagues and other professionals Situations with ethical

53 Summary Ethical issues are rarely black or white Code of Ethics provide guiding principles Organized by who we have responsibilities to: Fundamental Public Client Profession Colleagues and other professionals Situations with ethical considerations can span all practice settings and all areas of practice Many resources are available

54 Questions

55 Ethics for All: Applying ethics principles across the dietetics profession NUTRI-BITES Webinar Series Based on this webinar, learners should be able to: Identify guiding principles (fundamentals) used to resolve ethical dilemmas in dietetics Identify common situations across the full spectrum of dietetics profession that have ethical implications Apply Academy professional resources in considering ethical implications of traditional practice issues as well as new frontiers such as genetics and social media

56 ConAgra Foods Science Institute Nutri-Bites Webinar details A link to obtain your Continuing Education Credit certificate will be ed within 2 days Today s webinar will be available to download within 2 days at: For CPE information: acontinelli@rippelifestyle.com Recent CEU webinars archived at the ConAgra Foods Science Institute website: Sports Nutrition: The Power to Influence Exercise Performance Culinary Competency to Enhance Dietetic Practice Nutrition and Oral Health: What Dietitians Should Know Lifestyle Approaches to the Prevention and Treatment of Diabetes Food Safety at Home, Work, and Play

57 Next ConAgra Foods Science Institute Nutri-Bites Webinar A Decade of Nutrigenomics: What does it mean for dietetic practice? Judith A. Gilbride, PhD, RD, CDN, FADA Date: September11, pm EDT/1-2 pm CDT

58 How are we doing? Stay on the line for a brief survey about today s ConAgra Foods Science Institute Nutri-Bites webinar: Ethics for All: Applying ethics principles across the dietetics profession Thank you!

Ethical Dilemmas for Nutrition and Dietetic Practitioners

Ethical Dilemmas for Nutrition and Dietetic Practitioners Kathryn K Hamilton MA RDN CSO CDN FAND Catherine Gruenfelder MS RDN Patricia Gibbons, BS NDTR Disclosures Kathryn Hamilton MA RDN CSO CDN FAND