In addition to being a PhD candidate, I am first and foremost a Registered Dietitian. As such, I have agreed to abide by the Code of Ethics for the Profession of Dietetics set forth by the Academy of Nutrition and Dietetics. This code consists of 19 principles, grouped in to 5 categories: Fundamental Principles; Responsibilities to the Public; Responsibilities to Clients; Responsibilities to the Profession; and Responsibilities to Colleagues and Other Professionals.
Like most documents guiding ethical conduct I have come across, upon reading the Code Of Ethics for my profession, it is easy to endorse and agree that they should be followed. However, in practice, there is a lot of gray area between “right” and “wrong”. This can lead to confusion and disagreement regarding the course of action which should be taken. For example, consider this case study (obtained from the Academy of Nutrition and Dietetics Ethics Resource page) specific to the dietetics field:
A skilled long-term facility patient with severe dementia tells a registered dietitian nutritionist (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 to be fed. What is the RDN’s role in this situation and what should be done?
Even without being in my field, I am certain most of you will realize the potential issues (both ethical and legal) involved and the challenges with applying the principles of the Code of Ethics in this situation.
Principle #12 states “The dietetics practitioner practices dietetics based on evidence-based principles and current information”. I’ll assume the RD followed this principle while making the initial feeding tube placement and infusion recommendations. However, Principle #9 states, “The dietetics practitioner treats clients and patients with respect and consideration”. Specifically, this principle is clarified by the following:
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.
Thus, while continuing with the feeding tube is likely the most evidence-based decision for the client’s nutritional and health status, the RD must also take the patient’s wish and quality of life/comfort in to consideration. Further complicating the issue, the resident has severe dementia, so may not be viewed as capable of making this decision for herself, and no advance directives are available.
In this case we see a potential clashing of the principles listed in the Code of Ethics, where there is not a clear answer about how the RD, the rest of the medical team, and the patient’s family should proceed.
I bring this situation up not to ask you to evaluate it and determine what you would do, but rather to provide one of many real-world examples in which applying professional Codes of Ethics gets fuzzy.
I’d love to hear about similar shades of gray in your fields as they relate to your ethical obligations.