By Mary Gannon Kaufmann
When practitioners review the Code of Ethics for Nutrition and Dietitian Professionals from 2018[i], most struggle to apply it and understand what it is calling them to. Mostly, this is because the COE is not calling the provider to anything personal enough. It presents intellectual principles or objectives that are good in themselves and describes the process of intellectually weighing the parameters to determine the best course of action in a difficult medical situation to be unbiased and competent, but it misses the human and subjective elements. Practitioners must develop personal attributes and habits over time to have professional integrity. We must recognize that we need to allow space for good habits or professional virtues to grow as we practice.
We need to become reflective dietitians and regularly ask ourselves, What sort of dietitian do I want to become? This is so we can define “the virtues we should develop in ourselves to be known as a [dietitian] with good character.”[ii] Practitioners of good character can more easily recognize and navigate complex issues. Our assessment of the consequences of an action must overlap with our description of our duty (the 4 parts of the COE) and with our character for us to determine the best course of action. Ethics demand virtuous action undertaken by caring humans.
What is missing in the discussion on working with ethics in our profession is any reference to the need to develop practical wisdom and professional virtues in order to decipher conscientious action in patient care. Having rubrics to measure the situation against is one thing but having practical insight, charity, prudence, and patience to apply and live as ethical providers or ethical agents is another thing. Providers are human persons in human relationships with patients who care about doing what’s right for the people they care for. Some call this a conscience that comes from forming “a disposition or trait of character that enables the individual to reach the goal of a specific professional activity.”[iii]
Four virtues or patterns of good behavior and thought are important for ethical healthcare providers to understand, practice, develop, and mature as they care for patients. Professional practice virtues for dietitians include: charity, prudence, patience, and a sense of justice.
Charity, which also includes two related virtues, mercy, and beneficence, allows the dietitian to truly know the client and work for the best interests of the client, sometimes at a cost to themselves. Mercy is “grief for another’s distress, a type of compassion,” while beneficence is “doing good to someone.”[iv] Both should be guided by reason and modified by circumstances. Charity, along with a merciful and beneficent mindset, allows a patient to build trust and strong professional liaison with a dietitian, where the patient feels the practitioner’s personal warmth.
Prudence allows a practitioner to make sound practical judgements and chart the best possible course. According to Beauregard, prudence “involves being cautious, taking counsel, considering past and present experience and exercising foresight into what may come about as a consequence of the present action.”[v] While a practitioner considers the COE, they must be moved from the heart and illuminated with practical wisdom to be ethical and moral.
Furthermore, savvy dietitians need to exercise patience or have “a certain mental equilibrium and calm”[vi] in order to decipher best actions in difficult experiences. They must know how to maintain their focus, calmness, and warmth even when patients may be angry, silent, and untrustworthy to show up when they are scheduled. Having patience allows dietitians to have clear thinking, approachable demeanors, and equitable/just care for vulnerable people.
Once developed, these practical professional virtues allow the dietitian to truly support a patient’s self-determination, work for the patient’s best interests, and appropriately place her resources to reach the patient’s most appropriate care. This is quality care.
[i] Code of Ethics for the Nutrition and Dietetics Profession, Academy of Nutrition and Dietetics, Published 2018
[ii] Naeem, Noor-I-Kiran, Revisiting the Need for Intellectual and Moral Virtues in making Ethical Decisions in Healthcare, pak J Med Sci, December 2024, 40, 11 24552457.
[iii] Vizcarrondo F, The Return of Virtue to Ethical Medical Decision Making, Linacre Quarterly 79, 1, February 2012, 73-80
[iv] Beauregard D, Virtue in Bioethics, in Catholic Health Care Ethics, A Manual for Practitioners Third Edition, Edited by Edward Furton, The National Catholic Bioethics Center, Philadelphia, 2020, p 3.26
[v] Beauregard, 2020
[vi] Beauregard, 2020