By Mary Gannon Kaufmann
There is a growing need and even hope that Registered Dietitians will be recognized as fully functioning and respected professionals, similar to nurse practitioners but focused on lifestyle and nutrition. There is also an increasing emphasis on becoming advanced practitioners who are trustworthy. Consequently, dietitians are encouraged to apply biochemistry and a comprehensive understanding of body systems- from anatomy and physiology to nutrition and dietetics. This author believes these positive developments enhance our understanding of the importance of dietetics and the need for competent, ethical fulfillment of our professional responsibilities.
However, compared to other healthcare disciplines like nursing or medicine, dietitians seem to lack a broader awareness of their professional identity, the need for affective and moral development, and how to function in ethical dilemmas. Like our peers, dietitians are science focused on providing care grounded in evidence-based, peer-reviewed research. What is lacking is a marked emphasis on personal affective and moral development for student dietitians and current practitioners alike.
Contrast this over-emphasis on objectivity and scientific savvy for dietitians to what Jordon Cohen MD, the former President of the AAMC emphasized to physicians in his president’s address in 2005, “The physician professional is defined not only by what he or she must know and do, but most importantly by a profound sense of what the physician must be.” This was girded on an emphasis in medical education on developing the physician vocation “through critical professional development”[i] to be altruistic, compassionate, empathetic in caring for patients, trustworthy, and truthful in all their professional behaviors.
Likewise, Kevin Murrell, MD[ii], states that physicians and all healthcare professionals have a “fiduciary responsibility” to advocate for the best interests of their patients and to practice “humility, especially in their hearts, habitually thinking of their patients with esteem”, which he describes as an “attitude of faith in the grace given to each person.” According to Murrell, physicians should concretely embody this by making “a strong effort to see the personality and good qualities of each person” they care for. He also emphasizes that when conflicts arise, practitioners must “attempt to understand rather than to judge” in order to become professionals who welcome the confidences that patients entrust to them. This implies that clinicians must develop virtues or good behavior patterns to become respected professionals. Clinicians get acquainted with their patients and weigh their dilemmas objectively and subjectively grounded in their own moral principles.
What does this have to do with applying ethical principles? While more will be shared about this in the next article, where we delve concisely into the four-part Code of Ethics for the Nutrition and Dietetics Profession, to decipher a just path as a trusted professional, practitioners need to process the issue through their subjectivity as well as their intellectual understanding.
In a simplistic statement, Approaches to Ethical Decision Making, Ethics in Practice 2023, M Nelkin, a medical ethicist speaking for the Academy of Nutrition and Dietetics, describes that morals are not part of ethical decision-making and “the process of clinical bioethics.” She emphasizes that “the framework that is used in ethical decision-making [for dietitians] is intended to aid in an objective, unbiased conclusion.”[iii] She outlines a 6-step rational process of defining the dilemma, applying the four parts of the COE, and selecting the best alternative. There is no discussion of applying wisdom and any subjective knowledge of the patient’s situation or one’s own moral principles or compass to advocate for another human person.
What is missing in the position of the Academy of Nutrition is any mention of being practitioners who altruistically work for vulnerable person’s best interests to build a “community of love and truth…[that] is fertile ground for good spiritual, emotional and physical health-the goal of the medical profession.[iv]” While some may say that Murrell’s work is in a manuscript, Catholic Health Care Ethics, his statements are based on Natural Law that guides all human persons, and not just Catholics. More to come in this in the next article.
[i] Puchalski c, Guenther M, Restoration and re-creation: spirituality in the lives of healthcare professionals, Curr Opin Support Palliat Care, 2012, 6:254-258
[ii] Murrell K, Confidentility in Catholic Health Care Ethics, A Manual for Practitioners Third Edition, Edited by Edward Furton, The National Catholic Bioethics Center, Philadelphia, 2020, p 3.10,3.11, 3.17
[iii] Nelkin M, Fornari A, Approaches to Ethical Decision-Making: Ethics in Practice 2023 Update, JAND, May 2023, vol, 123, 5, 824-830.
[iv] Murrell 2020