Shades of Gray: Professional Codes of Ethics in Action

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 appreciate the challenge of applying 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 recommendation for feeding tube placement and use. However, Principle #9 states, “The dietetics practitioner treats clients and patients with respect and consideration”. This principle is further clarified by:

  • 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 status and overall health, 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 clashing of the principles listed in the Code of Ethics. There is not a clear answer about how the RD, along with 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 is not straightforward.

I’d love to hear about similar shades of gray in your fields as they relate to your ethical obligations.

-Tanya


About tanyamh

A PhD Student at Virginia Tech. This blog was created as a class requirement for Contemporary Pedagogy - Spring 2013.

5 comments:

  1. I am sure individuals in most fields face dilemmas of similar gravity that make it hard to do “what’s right,” even if they have the best of intentions. I was looking at the Code of Conduct and Rules for Professional Conduct for the American Institute of Hydrology (I study hydrology), and I found some guidelines that are pretty vague and almost contradictory. On the one hand, a big priority of the AIH is promoting public awareness and trust, yet several of the rules insist that hydrologists should present their work “modestly” and “in a dignified, unostentatious manner”–which I agree with, but also resonate with your comment concerning the grey area in ethics.

  2. I am right there with you regarding ethics not being straightforward. I am a professional counselor and run into this a lot. I think that when we work with humans and being human comes with having various dilemmas, some that can’t be solved merely by adhering to a certain code. Thanks for the post!

  3. Great post! I think that ethical dilemmas do pose a challenge to our professional roles a lot of times. The reason why I find this post particularly interesting is because my girlfriend is a pursuing her PhD in philosophy and she teaches ethics. I have had many discussions with her about how there seem to be grey areas in ethics. However, I think that there should be some way to resolve this dilemma without succumbing to ethical relativism, which is the theory that morality is relative. So subscribing to this theory would allow for someone to justify their actions by appealing to different norms such as cultural or religious.

    1. I certainly agree this dilemma can be resolved, and I like your suggestion for ideologies to lean on in doing so. Thanks so much for stopping by and commenting!

  4. I can definitely see some areas that don’t have simple black and white decisions or answers. The feeding tube example clearly illustrates the complexity and grey-ness of some situations. Do you honor the patients wishes or keep them healthy? Given the fact that the patient has dementia should play a significant role in the decision as well as the primary care giver and doctors and professionals.

Leave a Reply to Siddharth Bhela Cancel reply

Your email address will not be published. Required fields are marked *