Sponsor Disclosure: Support for this presentation was provided by the Foodservice Express division of Med-Diet, Inc. The material herein is for educational purposes only. Reproduction or distribution of these materials is prohibited except as expressly provided by Med-Diet, Inc. or the presenter. Copyright 2018 Med-Diet, Inc. All rights reserved. Nutrition Professionals and Ethical Expectations 1 Ask Yourself; Is it illegal? Is it immoral? Is it unethical? And if you can say yes, pick another option. Objectives State the function and purpose of the Code of Ethics. Identify the distinction between ethical issues and legal, business or personal issues. Identify principles within Code of Ethics that may apply to a specific situation in practice. Ethics: (eth/iks) The study of standards of conduct and moral judgment. The study of the general nature of morals and of the specific moral choices to be made by a person. The rules of standards governing conduct of a person or the members of a profession. 1
Code of Ethics General principles that affect decision-making. Based on treat others as you like to be treated Guides decision when faced with ethical dilemmas or debatable situations. Code of Conduct General principles that governs actions Required HIPPA, disclosure of conflicts of interest Prohibited Discrimination/harassment, product endorsement Types of Codes Aspirational statements of ideals or broadly worded principles Hippocratic Oath First, do no harm Hippocrates: Let food be thy medicine and thy medicine food Educational aspirational principles combined with guidelines to help make informed choices in ambiguous situations Regulatory details rules that govern professional conduct and set forth sanctions/consequences Purpose for our Code of Ethics A part of the expectations of those involved in a profession /organization. People within the group don't want to condone bad, dishonest or irresponsible behavior. By setting out expected behaviors in the form of professional ethics, individuals work together to try to uphold a good reputation. Set forth consequences for not abiding by the code. Binding Affiliation If you are a member and/or certified as a RD, DTR, CDM, CFPP you have agreed to abide by your organization s Code of Ethics. Discipline of Certificants Evaluation completed by an Ethics Committee Due process Gather facts (all sides) Complaint dismissed or; Education / intervention as needed Probation Membership / Credential suspended or revoked 2
Law vs. Ethics Laws: codify societal norms Ethics: guidelines for behavior Legal decisions may not universally be considered ethical Many ethical principles are not codified into law LET S PRACTICE A Didactic Program in Dietetics (DPD) student, who is a student member of the Academy, is in a computer lab at the university taking an online exam for one of his courses. The course syllabus clearly states that the exam is to be taken without the use of the textbook or class notes. One of the student s classmates observes the student referring to the text and notes while completing the exam. What should be done in this situation? A Didactic Program in Dietetics (DPD) student, who is a student member of the Academy, is in a computer lab at the university taking an online exam for one of his courses. The course syllabus clearly state that the exam is to be taken without the use of the textbook or class notes. One of the student s classmates observes the student referring to the text and notes while completing the exam. What should be done in this situation? D. Personal Issue? E. No Issue A Didactic Program in Dietetics (DPD) student, who is a student member of the Academy, is in a computer lab at the university taking an online exam for one of his courses. The course syllabus clearly state that the exam is to be taken without the use of the textbook or class notes. One of the student s classmates observes the student referring to the text and notes while completing the exam. What should be done in this situation? Both the Academy/CDR and CDM/CFPP Code says: The [Dietetic Practitioner] conducts himself/herself with honesty, integrity and fairness. Key to Consider: - Student members have the same expectation as all other members - Students needs to recognize s/he is dishonest / cheating - Student may not relate this behavior to violating any ethical principle - Did faculty review acceptable ethical behaviors and discuss consequences - Is the University s honesty policy available and discussed? Including consequences of cheating on exams. - Discipline would be based on university / class policy - A student who cheats their way through classes may not do well on credentialing exams and could be a harm to public/clients 3
A Didactic Program in Dietetics (DPD) student, who is a student member of the Academy, is in a computer lab at the university taking an online exam for one of his courses. The course syllabus clearly state that the exam is to be taken without the use of the textbook or class notes. One of the student s classmates observes the student referring to the text and notes while completing the exam. What should be done in this situation? How might you handle this situation? A. Pretend you did not see anything B. Confront the student C. Bad mouth the student with others D. Tell the instructor / test preceptor E. B and D A CDM/CFPP/RD/DTR who works for a supermarket chain is invited to attend a 2- day CE-approved seminar, From Farm to Table, offered by a not-for-profit industry support group that represents and is funded by growers and producers of dairy products, fruits, vegetables, meat and grains. The location is a resort in a part of the country that is known for growing/producing the commodities featured. The seminar agenda includes visits to farms, producers and a food processing plant; presentations by researchers and marketing staff; and a culinary demonstration. The processing plant is the headquarters of a company that produces nationally known and also store brands. The transportation, lodging, meals, and registration fee are paid by the support group. A CDM/CFPP/RD/DTR who works for a supermarket chain is invited to attend a 2- day CE-approved seminar, From Farm to Table, offered by a not-for-profit industry support group that represents and is funded by growers and producers of dairy products, fruits, vegetables, meat and grains. The location is a resort in a part of the country that is known for growing/producing the commodities featured. The seminar agenda includes visits to farms, producers and a food processing plant; presentations by researchers and marketing staff; and a culinary demonstration. The processing plant is the headquarters of a company that produces nationally known and also store brands. The transportation, lodging, meals, and registration fee are paid by the support group. D. Personal issue? E. No Issue A CDM/CFPP/RD/DTR who works for a supermarket chain is invited to attend a 2- day CE-approved seminar, From Farm to Table, offered by a not-for-profit industry support group that represents and is funded by growers and producers of dairy products, fruits, vegetables, meat and grains. The location is a resort in a part of the country that is known for growing/producing the commodities featured. The seminar agenda includes visits to farms, producers and a food processing plant; presentations by researchers and marketing staff; and a culinary demonstration. The processing plant is the headquarters of a company that produces nationally known and also store brands. The transportation, lodging, meals, and registration fee are paid by the support group. The Academy/CDR and CDM/CFPP Code says: The [dietetic practitioner] conducts himself/herself with honesty, integrity and fairness. 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. Key to Consider: The individual should discuss the invitation with his employer and achieve clarity about conflict of interest and ethics/compliance policies. If the program meets the individual s development goals/performance objectives, he might attend if either he or his employer completely funds his attendance. The individual should investigate the commodity group including their mission and funding. If the rationale for the program, mission statements of the funders, or funding disclosures are unclear, he should not attend. A CDM/CFPP/RD/DTR who works for a supermarket chain is invited to attend a 2- day CE-approved seminar, From Farm to Table, offered by a not-for-profit industry support group that represents and is funded by growers and producers of dairy products, fruits, vegetables, meat and grains. The location is a resort in a part of the country that is known for growing/producing the commodities featured. The seminar agenda includes visits to farms, producers and a food processing plant; presentations by researchers and marketing staff; and a culinary demonstration. The processing plant is the headquarters of a company that produces nationally known and also store brands. The transportation, lodging, meals, and registration fee are paid by the support group. How might you handle this situation? A. Just go on the trip; no one has to know B. Discuss company policy and possibility of going with employer C. Outright decline and move on D. Other? 4
Case Study #3 A 45-year old man was referred to the Lipid Disorders Clinic because of a plasma triglyceride level of 16,000 mg/dl.,his physician had prescribed medical nutrition therapy (MNT) consisting of a diet with 10% of the calories from fat. When the RDN asked the patient about his motivation for making changes in his eating or exercise habits, he replied, Exactly zero! The RDN responded, Then we have nothing to talk about. He replied, What do you mean? The patient and the RDN then had a 30-minute conversation. The patient set a goal to order Big Macs (29 grams fat) instead of the Bacon Ultimate Cheeseburgers (77 grams fat). This goal was not in keeping with a 10% fat diet. At the end of the session, the RDN gave the patient an analysis of his eating habits, his goal sheet, practical information about the 10% fat diet, and a return appointment. Case Study #3 A 45-year old man was referred to the Lipid Disorders Clinic because of a plasma triglyceride level of 16,000 mg/dl.,his physician had prescribed medical nutrition therapy (MNT) consisting of a diet with 10% of the calories from fat. When the RDN asked the patient about his motivation for making changes in his eating or exercise habits, he replied, Exactly zero! The RDN responded, Then we have nothing to talk about. He replied, What do you mean? The patient and the RDN then had a 30-minute conversation. The patient set a goal to order Big Macs (29 grams fat) instead of the Bacon Ultimate Cheeseburgers (77 grams fat). This goal was not in keeping with a 10% fat diet. At the end of the session, the RDN gave the patient an analysis of his eating habits, his goal sheet, practical information about the 10% fat diet, and a return appointment. D. Personal issue? E. Other? Case Study #3 A 45-year old man was referred to the Lipid Disorders Clinic because of a plasma triglyceride level of 16,000 mg/dl.,his physician had prescribed medical nutrition therapy (MNT) consisting of a diet with 10% of the calories from fat. When the RDN asked the patient about his motivation for making changes in his eating or exercise habits, he replied, Exactly zero! The RDN responded, Then we have nothing to talk about. He replied, What do you mean? The patient and the RDN then had a 30-minute conversation. The patient set a goal to order Big Macs (29 grams fat) instead of the Bacon Ultimate Cheeseburgers (77 grams fat). This goal was not in keeping with a 10% fat diet. At the end of the session, the RDN gave the patient an analysis of his eating habits, his goal sheet, practical information about the 10% fat diet, and a return appointment. The Academy/CDR and CDM/CFPP Code says: The [dietetics practitioner] treats clients and patients with respect and consideration. objectivity and respect for the unique needs and values Respects the client s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal. enables clients to make their own informed decisions Case Study #3 Key to Consider: This could be an ethical issue because the RDN accepted a patient goal not consistent with the physician s MNT prescription for a 10% fat diet. Regardless of the need for the patient to eat as little fat as possible in order to reduce his plasma triglycerides to a safer level, it was essential for the dietitian to meet the patient where he was. The fact that she respected and accepted the client s goal, admittedly not in keeping with his diet prescription, may have encouraged him to consider future goals consistent with a 10% fat diet.. The RDN should document the approach taken and communicate with the physician about the specifics of the interaction. Case Study #4 A skilled long-term facility patient with severe dementia tells the RD/DTR/CDM 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 to be fed. What is the nutrition professional s role in this situation and what should be done? Case Study #4 A skilled long-term facility patient with severe dementia tells the RD/DTR/CDM 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 to be fed. What is the nutrition professional s role in this situation and what should be done? D. Personal issue? E. Combination? 5
Case Study #4 A skilled long-term facility patient with severe dementia tells the RD/DTR/CDM 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 to be fed. What is the nutrition professional s role in this situation and what should be done? The Academy/CDR and CDM/CFPP Code says: The [dietetics practitioner] recognizes and exercises professional judgment within the limits of his/her qualifications and collaborates with others, seeks counsel, or makes referrals as appropriate. treats clients and patients with respect and consideration / respect for the unique needs and values of individuals. practices dietetics based on evidence-based principles and current information / assumes responsibility & accountability for personal/professional competence. Case Study #4 Key to Consider: Decisions about end-of-life care should consider the concepts of autonomy, beneficence, capacity and competency, quality of life, substituted judgment, and social responsibility. Those who provide care for persons in longterm care or those facing end-of-life nutrition issues should be knowledgeable about these concepts. Although the resident has diminished capacity, it is important to be respectful of her values and maintain her dignity. The nutrition professional should inform the healthcare team about the resident s comments as well as any previous discussions she may have had with the resident about feeding. Case Study #4 Key to Consider: The resident s sense of quality of life, not the caregivers, is the central issue. With comfort and emotional well-being being the long term goal, rather than prolonging life, staff should promote care that increases the resident s sense of quality of life; conversely, interventions that diminish comfort should be discouraged, if there were no discussions and no advance directives, the daughter may be the person designated to make decisions. State laws vary widely and should direct end-of- life decisions when applicable. Consider referral to an ethics committee. Discussion with the daughter about the probable futility or lack of benefit of the tube feeding needs to be addressed. Along with the healthcare team, the RD should encourage family members to make decisions that best incorporate the resident's values, recognizing that the decision to be made may not be the one they would make for themselves or for the patient using their own values. If the decision is made to continue feeding the patient and the RDN does not agree, she has a duty to transfer care to another RDN. Summary Is the situation described an ethical issue? OR Is it 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. Is it an employer policy? 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 (for example, Human Resources) or through federal and state laws that protect employees. Summary Is it a personal issue? An issue too specific to be reflected in the Academy/CDR Code. Is it a business dispute? An issue rising from a business dispute or poor business practices. 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. Content for this Program was Developed from Organization Resources Academy/CDR Code of Ethics for the Nutrition and Dietetics Profession June 2018 CDM /CFPP Code of Ethics June 2016 Eatrightpro.org Ethics Education Resources: Case Studies & Facilitators Guide CBDMonline.org 6
Your Special Diet Partner Thank you for participating in today s session! 37 7