1. Ethics—Walk the Talk Kathleen C. Niedert, PhD, RD, CSG, LD
Iowa Dietetics in Health Care Communities
April 25, 2014

2. Lying Cheating Stealing Ethical Lines Do Exist
There are some clear ethical lines that everyone knows should not be crossed—lying cheating, stealing. BUT what happens when the line becomes a bit blurry? When I was growing up my Dad always told me to use my use gut but unfortunately, some peoples guts just don’t seem to be functioning like they should.

3. Why Bend the Rules?
“I do it so that I get a good outcome. It doesn’t hurt to bend a (policy) (regulation) (law) (rule) if you get a good outcome”
Bending the rules for a good outcomes is often cited as the defense for not adhering to a policy, regulation, law or rule. As an expert witness, I can tell you that bending the rules, even with your best intentions is risky. It goes without saying that if you continue to bend the rules, sooner or later you forget what the proper procedures really is.
Nonadherence to approved policies could result in ethical violations as well as regulatory and legal liability for you, the practitioner, or your institution or both. There doesn’t have to be actual harm to place you in jeopardy

4. Every day we have those “gray” areas
Client-related decisions
Practicing beyond a person’s qualifications, capabilities, education, or experience
Providing both sides of an issue
Appropriate business practices
Clinical
Billing and proper use of health care resources
Appropriate advertising services
In today’s litigious world, with expanding and changing practices in both institutional and private practice or consulting settings many professionals are experiencing an increase in ethical conflicts and greater exposure to legal actions than ever before. And, unfortunately, sometimes making wrong decisions can have long-lasting and significant negative consequences for our lives and careers.
Even honest billing mistakes can have legal implications, but more alarming is that some dietetics practitioners overcharge because they believe that they are not being reimbursed at adequate funding levels. Charging for services not performed or time not spent with the client is unethical behavior.
Dietetic professionals who choose to advertise their services must be honest in all of their claims and should specifically list their areas of preferred or limited practice if they are working only in a specialty area. For example, if an RDN specializes and only works in geriatric nutrition, he or she should clearly state that in all advertising and billing materials, In addition, he or she should ensure all third-oparty payers are also aware of this limited specialty and clearly indicate this restricted area of practice in their patient literature.

5. “Gray” Areas where ethics comes into play
Appropriate business practices (cont.)
Food Service
Rebates
Human resource decisions
Relationships with professionals, customers and employees
When a conflict of personal interest may be involved if self-disclosure of a relationship is not revealed
Covering up a substance abuse problem
Rebates offered for buying products given either directly to th institutions or sometimes directly to the buyer can tempt the foodservice manager to buy products that do not best serve the needs of the customers or clients served. Conflicts of interest may cause foodservice management professionals to select equipment or systems that do not best fir the application.
Human resource decisions can be biased by personal traits, cultural bias or religious affiliations. Confidential information can be disclosed to the detriment of employees or clients.
Outcomes and decisions that are made in ethics dilemmas may be difficult and may not be popular but must meet the overall goal of competent and ethical professional practice and conduct by the foodservice management dietetics practitioner.
A foodservice director’s spouse is employed by a software company that develops and sells foodservice management software that is being considered for purchase by the director’s facility. A conflict of personal interest may be involved if the director does not self-disclose this relationship, A conflict of interest may be involved because the director may personally profit fro the sale of the software that the director’s spouse represents. It is important to have full disclosure of the potential conflict so that the institution can make decisions in their own best interest.
The dietetics management professional assumes the responsibility and accountability for personal competence of all those supervised in practice and is a steward for all the areas under management and responsibility. The dietetics practioner recognizes and exercises professional judgment within the limits of his/her qualifications and collaborates with others, seeks counsel, or makes referrals as appropriate.

6. Ethics is the Struggle Between…
“Right & Wrong” “Moral & Immoral” “Just & Unjust”
A layperson’s definition of “ethics” may include these three versions. We all have a different idea of what the word “ethics” means because dietetics is a diverse profession, with individuals from various generations, backgrounds, experiences, education, areas of practice, etc. Despite our diversity, our definition of “Professional Ethics” will likely include many similarities.

7. Ethics: (eth/iks)
1. The study of standards of conduct and moral judgment. 2. The study of the general nature of morals and of the specific moral choices to be made by a person. 3. The rules or standards governing the conduct of a person or the members of a profession.
Here are three formal definitions of ethics. The definition that best applies to our discussion of “professional ethics” is number three.

8. Ethics
The code of moral principles and values that govern the behaviors of a person or group with respect to what is right or wrong.
A Code of Ethics:
Is a set of rules for practitioners behavior
Is a statement of behavioral norms for a profession or a community of shared values
Can help practitioners work through an ethical practice dilemma or issue
Can help build a public trust in the activities of a profession

9. Influence on Personal Ethics
People
Your family played a large part in shaping your personal ethics.
Your family member and friends exert strong influence on your ethics.
Teachers, especially when you were younger, may have laid the foundation for ethical decisions.

10. Influence on Personal Ethics
Culture
Culture is an integral part of every society.
It is a learned pattern of behavior and ways in which a person lives his or her life.
Culture is essential for the existence of a society, because it binds people together. In the explicit sense of the term, culture constitutes the music, food, arts and literature of a society. Culture is way of life.
A culture is a way of life that is based on beliefs and values, such as art, food, dance, rituals, religion, etc

11. Influence on Personal Ethics
Culture
Culture is an integral part of every society.
It is a learned pattern of behavior and ways in which a person lives his or her life.
Culture is essential for the existence of a society, because it binds people together. In the explicit sense of the term, culture constitutes the music, food, arts and literature of a society. Culture is way of life.
A culture is a way of life that is based on beliefs and values, such as art, food, dance, rituals, religion, etc

12. Influence on Personal Ethics
Law
Laws, some argue, represent the minimum standard of behavior.
Law is a set of rules in society set by the government in order to maintain control.
Law of state has much and more influence one personal ethics.
Acting ethically mean following the law.

13. Influence on Personal Ethics
Law
Laws, some argue, represent the minimum standard of behavior.
Law is a set of rules in society set by the government in order to maintain control.
Law of state has much and more influence one personal ethics.
Acting ethically mean following the law.

14. Influence on Personal Ethics
Religion
Religion is belief in super natural and divine power or powers and how we relate to them. It comprises belief and practice.
Religious traditions give instructions to followers about what’s right and wrong. That is, belief systems define what is or isn’t ethical.
In some religions, unethical behavior is punished and ethical behavior is rewarded. In other religions, teachings provide guidelines for ethics, but leave latitude for the believer to interpret what is ethical and what isn’t

15. Criteria for Ethical Decision Making
Most ethical dilemmas involve
A conflict between needs of the part & whole.
The individual versus the organization.
The organization versus society as a whole.

16. Background to Ethical Context
An Ethical dilemma is a complex situation that often involves an apparent mental conflict between moral imperatives, in which to obey one would result in transgressing another. This is also called an ethical paradox.
Making ethical decisions is relatively easy when all the facts of a situation are known.
If necessary I can be ethical. Fortunately it hasn’t come to that

17. Background in Ethical Context
Ethics As a Communication Issue
We communicate our values and beliefs t others via verbal and nonverbal behavior
We are defined in the eyes of others according to the way we behave
We also need to communicate to others the importance and necessity of good ethics
It follows that we have a responsibility to act in ways that promote honest and fairness to maximize the personal worth of each person in the organization

18. Background to Ethical Context
Ethics in Corporations – A Historical View
Companies have long fought the battle of corporate corruption. Because corporations are run by people and no human being is morally perfect, ethical issues are bound to arise. How these issues are handled is the best indicator of a corporation’s ethical commitment. Establish ethically moral behavior in your corporation by taking the task seriously.
When company executives behave unethically, that behavior often ends up in the news. While most companies have ethics policies, they don't necessarily enforce or even follow them. By incorporating ethics into the very heart of the business and reinforcing the idea of ethical behavior, businesses can run efficiently, legally and ethically.

19. Communication and Ethical Issues
Key Areas for Ethical Communication
Key areas for ethical communication
Ethical treatment of a subject takes time, thought, and preparation. As a professional, it is important for you to focus on ethical communication in three key areas:
Personal Written and Spoken Messages
Cross-Cultural Messages
Advertising Messages
Let’s take a look at each one of these

20. Communication and Ethical Issues
Personal Written and Spoken Messages
Your messages, both written and spoken, demonstrate not only the message, you intended but also a message regarding your values and integrity.
Use these guidelines to evaluate your purpose and motives in each situations.
The guidelines are:
Message purpose
Research methods
Selection of material
Development of ideas
Use of language
Ethical context
Self-analysis

21. Communication and Ethical Issues
Key Areas for Ethical Communication
Cross-Cultural Messages
Never before have so many people from different cultures lived and worked together.
The world has become a global village, and the work force reflects that diversity. Because we have such different customs and ways of communicating, it is natural that misunderstandings occur in the workplace.
The cross-cultural ethical outline will help you assess your ethicality in multicultural situations.
Cross-Cultural Ethical Guidelines:
Cultural context
Misunderstandings
Language
Accountability

22. Communication and Ethical Issues
Key Areas for Ethical Communication
Advertising Messages
It is ethically wrong to advertise products in ways that confuse. Whether promoting a college jazz event, a gateway weekend, or a line of products for a multimillion dollar company, the rule for ethical advertising is consistent:
Tell the truth, don’t misrepresent , and don’t manipulate language to create a false impression.
Ethical Guidelines for Advertising:
Language
Graphics/print
Omission
Truth
Accountability

23. Communication and Ethical Issues
Ethics and Organizational Responsibility
Business corporations exists for one reason: to make money . Today, however, corporations are mindful of their corporate social responsibility, or CSR (Corporate Social Responsibility), also known as their "triple bottom line," which includes a concern for profits, but also an ethical treatment of people and the world in which we live. Proponents of CSR models say that businesses are actually more profitable when they employ high CSR standards, but that idea is still disputed by some corporate and financial analysts.
Environment
Human Rights
Community Development
Employee Welfare

24. Three Pillars of an Ethical Organization
SOURCE: Adapted from Linda Klebe Trevino, Laura Pincus Hartman, and Michael Brown, “Moral Person and Moral Manager,” California Management Review 42, No. 4 (Summer 2000),

25. The Academy’s/CDRs Code of Ethics
A compass for ethical conduct
Use of the Academy’s and CDRs Code of Ethics for the Profession of Dietetics gives dietetic professionals a compass for ethical conduct. The Code of Ethics administered with crucial thinking skills provides a framework for making ethical decisions. All of us must remember that the using good ethical judgment affects the integrity of the profession as a whole and sets a high standard of conduct and professionalism that is recognized by the industries, businesses, and clients served.

26. Types of Codes Aspirational Educational Regulatory
Generally speaking there are three types of codes:
Aspirational codes: These are statements of ideals or broadly worded principles towards which a practitioner should strive—the Hippocratic Oath.
Educational Codes: These combine aspirational principles with guidelines to help individual professionals make informed choices in ethically ambiguous situations—student honor code
Regulatory codes: These codes include a detailed set of rules to govern professional conduct. They serve as a basis for settling grievances either between members and/or nonmembers. They are enforced by monitoring and applying sanctions. These types of codes require the largest commitment of resources (time, energy and people) to receive process and enforce complaints.
Our Code of Ethics has aspects of all three types of codes with an increased emphasis on educational and remedial interventions.

27. The Code consists of Five Categories
Fundamental Principles
Responsibilities to the Public
Responsibilities to Clients
Responsibilities to the Profession
Responsibilities to Colleagues and Other Professionals
Nineteen Principles
The Code of Ethics for our profession is defined by 5 general categories with 19 principles. The 5 categories were created to demonstrate the application for the 19 principles. The first category stresses the importance of the first 2 principles which are fundamental to all practitioners regardless of the area of practice and status. The four remaining categories stress the impact of the principles to the various audiences we serve.
You might think of the principles as the common “values” we share in our individual definitions of “professional ethics.”

28. Functions of the Code of Ethics
The code is intended to:
Protect the profession and the credential
Influence public and private policy
Improve professional practice
Educate dietetics practitioners about ethical decision making
Meet the guidelines of the accrediting agency for the Commission on Dietetic Registration
As a working document, our Code has a number of very specific functions.
Misuse of credentials is prohibited by the Code
Aid dietetics professionals in lobbying efforts or organizational policy development
Following the Code promotes better decision making when professional ethics are challenged
This is done through presentations like this one or at FNCE or through Ethics in Action columns and Ethics Opinions published in the Journal
The National Commission for Certifyinbg Angencies mandates the need for a Code of Ethics

29. Misconceptions about the Code of Ethics
The Code is not intended to:
Identify and reprimand all unqualified dietitians and dietetic technicians
Be a punitive force to take away credentials
There are several misconceptions about the Code of Ethics. The focus of the Code is EDUCATION, REMEDIATION, and SELF REGULATION. The purpose of the Code is not to “Police” practitioners

30. The Code of Ethics
How does the Code fit in with other Academy and Commission on Dietetic Registration Initiatives:
The categories and principles of the Code of Ethics helps guide a dietetic practitioner’s practice. They apply to all Academy members whether credentialed or non-credentialed plus CDR credentialed practitioners.
The Standards of Professional Practice describe a method or approach for monitoring and improving dietetics practice.
The CDR Professional Development Portfolio is a framework for RDs and DTRs to plan and develop continuing professional education.
All three are different initiatives, yet all three work toward improving dietetics practice and promoting the profession

31. Accessing the Code
Journal of the Academy of Nutrition and Dietetics, August 2009, pages
Academy Web site –
The Code is accessible via the following resources. The Journal provides the entire Code with an abbreviated Code of Ethics providing just the categories and principles on the web

32. Ethics Requirement
Current published Professional Development Portfolio Guide for Cycles Ending 2019 includes the requirement of a minimum of 1 CPEU in ethics, effective with the 5-year recertification cycle which ends May 31, 2017.
Must meet Learning Need Code 1050
A number of resources available to meet requirement

33. Tools & Resources www.eatright.org/codeofethics
Ethics Committee
Ethics Team at Headquarters
Ethics For Further Reading List
FNCE sessions*
Ethics Opinions*
Ethics in Action columns*
Ethics Case Studies*
Impact of Social Media on the RDN and DTR (NEW)
Case Studies and Discussion Question for Ethics Video Series*
Ethics Video Series*
In addition to the Code itself, a number of tools and resources are available.
Ethics Committee: The 3 person committee that oversees all activities related to the Code of Ethics with special emphasis on education of practitioners.
Ethics Team: Academy staff -- Representatives from various Academy Headquarters teams support the Ethics Committee and help members on ethical issues.
Ethics for Further Reading List: This list is a resource that can be used by educators to direct reading and learning objectives for students, both introductory and advanced, in the area of ethics and ethical behaviors as a professional in dietetics. The list will be useful for practitioners to keep current on ethics and the impact on practice. This list was prepared by the Academy Ethics Committee and will be updated twice per year (January and August). [Refer to Handout E]
Ethics Education Toolkit: Presentation materials available for educating members and facilitating discussions in affiliates/districts and DPG meetings. The presentation can be used in educational settings with students or as in-service for practitioners.
Academy’s Food and Nutrition Conference and Exhibition (FNCE): An ethics session is routinely offered. Recent examples include Open Space Discussion: Being Ethical in an Unethical World.
Ethics Opinions: Ethics opinions reflect the interpretation or application of the Academy/CDR Code of Ethics for the Profession of Dietetics by the Ethics Committee in response to a specific ethics issue or situation facing dietetics practitioners in practice. Opinions serve as an educational guide for conduct and are published in the Journal of the Academy of Nutrition and Dietetics. The most recently published was Ethics Opinion: Eliminating Dietetics Related Inequities. [Refer to Handout E]
Ethics in Action Columns: These columns provide education for members on ethical practice. The column is published in the Journal of the Academy of Nutrition and Dietetics. The articles can be found on Academy’s web site at
Case Studies: In order to assist practitioners and students to understand the application of the 2009 Code of Ethics, the Ethics Committee commissioned the development of case studies based on "real life situations" that RDs and DTRs face on a daily basis. A total of 24 case studies are provided. Each case study provides an overview of the situation, questions for discussion and key points to consider. These case studies should be used after reviewing the 2009 Code and would be useful for group discussions or classroom assignments. [Refer to Handout F]
Case Studies and Discussion Question for Ethics Video Series: These case studies, featured in the video series, can be used to encourage discussions of the cases described in each video. Be sure to have a copy of the 2009 Code of Ethics available for a reference.
Code of Ethics — Video Version: This 10 minute video provides the practitioner with an overview of the Code of Ethics and the value it provides in daily practice. The video contains the perspective of a variety of RDs and DTRs within the Academy of Nutrition and Dietetics. This video can be used to stimulate a discussion about the implications of the Academy/CDR Code of Ethics for the Profession of Dietetics.
Ethics Video Series: Ethical Dilemmas in Dietetics Practice: A series of five videos are provided which present a case study with a series of questions to be considered. This is followed by a roundtable discussion of the case study by members who have served on the Academy/CDR Ethics Committee and the Code of Ethics Task Force. Each video is 5-7 minutes in duration

34. Access to the Ethics Committee
Any member or non-member can make a complaint.
Complaints are not anonymous but are confidential.
If a complaint is made, it is forwarded to the member for a response.
The Ethics Committee then reviews the complaint and discusses the response in executive session.
Any member or non-member can make a complaint to the Ethics Committee. They must submit their name when making the complaint. If the complaint is determined to be valid, it is then forwarded to the person against whom the complaint is made. Both the complaint and the response are then discussed by the Ethics Committee in Executive Session

35. Ethics Case Management Procedure
The enforcement procedures are intended to permit a fair resolution of disputes on ethical practices in a manner that protects the rights of individuals while promoting understanding of ethical practice.
The Ethics Committee has the authority and the flexibility to determine the best way to resolve a dispute, including educational means where appropriate.
These procedures are intended to permit a fair resolution of disputes on ethical practices in a manner that protects the rights of individuals while promoting understanding of ethical practice.
The Ethics Committee has the authority and the flexibility to determine the best way to resolve a dispute including educational means where appropriate.

36. What happens next… Case may be dismissed
Further information may be requested
Person may be contacted with specific actions for educational intervention
Then what happens?
Any of the following may be the case resolution.
 Case may be dismissed
 Further information may be requested
 Person may be contacted with specific actions for educational intervention
 Membership in the Academy of Nutrition and Dietetics may be censured, placed on probation, suspended, or revoked
 RD or DTR credential or board certified specialist credential may be suspended or revoked
 Ethics Committee uses a defined policy and procedure handbook to guide its decisions

37. What happens next…
Membership in the Academy of Nutrition and Dietetics may be censured, placed on probation, suspended, or revoked
RDN or DTR credential or specialist credential may be suspended or revoked
Ethics Committee uses a defined policy and procedure handbook to guide its decisions.
Then what happens?
Any of the following may be the case resolution.
 Case may be dismissed
 Further information may be requested
 Person may be contacted with specific actions for educational intervention
 Membership in the Academy of Nutrition and Dietetics may be censured, placed on probation, suspended, or revoked
 RD or DTR credential or board certified specialist credential may be suspended or revoked
 Ethics Committee uses a defined policy and procedure handbook to guide its decisions

38. Ethical Issue or Not ? Legal, regulatory, or ethical issue?
Employer policy issue?
Personal issue?
Business dispute?
Academy/CDR member issue?
If violation of the Code violation-cite principle violated
What are the first steps in working through an ethical issue? You can start with a series of simple questions:
1. Is the situation described an ethical issue? OR
2. Is it a legal issue? State and federal laws provide oversight for much of the work in our field. There is a difference between law and ethics.
Laws: codify societal norms. Enforcement is through the criminal justice system.
Ethics: guidelines for behavior. This may not involve formal enforcement.
Legal decisions may not universally be considered ethical.
Many ethical principles are not formalized into law.
3. Is it an employer policy? Example - disagreement with supervisor.
4. Is it a personal issue? An issue too specific to be reflected in the Academy/CDR Code. Example: religious or cultural beliefs supersede professional code of ethics.
5. Is it a business dispute? An issue rising from a business dispute or poor business practices.
6. Does the complaint relate to an Academy member or Commission on Dietetic Registration (CDR) credentialed practitioner? The Code only applies to these two groups. The lines between these issues are blurry. But, these simple questions help us identify “up-front” what may be involved in making a decision and how the Code may or may not be helpful.
When a violation of the Code has occurred, the complainant should be able to cite which principle has been violated.

39. Recent Complaints # Inquiries # Complaints Complaint Types 8 1
Personal dispute 15 5
Inappropriate advice (3); Practice without a license; Copyright violation 16 6
Inappropriate advice; Personal dispute; Poor business practice (4) 24 11
Poor business practice (5); Licensure violation (4); Lack of scientific support; Legal violation 18
Personal dispute; Lack of scientific support (2); Misuse of RDN, Poor business practice
This slide is a compilation of the types of ethics cases the Academy Ethics committee has faced. The complaints noted on the slide have occurred during the period of The number of complaints that the Ethics Committee addresses per year is usually If a complaint warrants investigation, it usually takes 4-6 months to gather the necessary information and for the Ethics Committee to determine a course of action (dismiss, censure a practitioner, place a practitioner on probation, suspense the credential for a period of time or revoke the credential).