Ethical and Legal Issues Impacting Dietetics Practice Joanna Fitzmorris, MPH Dietetic Intern, Queens CollegeOverview 01 Position of the 02 Key Terms 03 Case Presentation Academy 04 Ethical Topics 05 Conclusion 06 Case SummaryPosition of the Academy It is the position of the Academy of Nutrition and Dietetics that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians should work collaboratively as part of the interprofessional team to make recommendations on providing, withdrawing, or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees. Academy Position Paper: J Acad Nutr DieDNR DO NOT perform CPR on this patient prevents unnecessary and unwanted invasive treatment at the end of life CPR may include: + chest compressions & rescue breathing + defibrillation y eo + breathing tubes to open airway + medicationClinical Capacity The ability to: P * Understand the potential benefits & harms of health care + Understand possible alternatives , * Make AND communicate health care decision Can be affected by medical, functional, and environmental factorsClinical Capacity Qualified health care professionals are legally empowered to make these determinations in almost every state under state advance directive laws. The courts become involved only when the determination itself or another aspect of the process is challenged by the patient or someone else.Advanced Directive Legal documents that extend a person’s control over health care decisions in case of incapacity Usually involving end-of-life care or planning for psychiatric emergenciesAdvanced Directive Types of Advanced Directives Living will: Expresses preferences for medical treatment and end-of-life care Designates a surrogate decision-maker as a health care agent or proxy These two types of advance directives are typically combined into a single advance directive documentHealth Care Proxy A person named by the patient to make decisions regarding only health care Makes decisions on behalf of patient if/when they lose capacityRight to Self- Determination Patients have the right to autonomy Ensures patients have the capacity and ability to make decisions The individual's right to self-determination generally takes precedence over the beliefs of health care providersEthical Issue family would like to proceed with TF placement. MOLST as follows: DNRVDNI Resident is 94 years old with progressing AMS Main ethical factors: Competence and BeneficenceCase Presentation: 94 y/o Female with PMHx lung cancer s/p lobectomy, PE, AFIB on Xarelto, COPD no home O2 HTN, presented AMS. 1 week prior pt began to have audio and visual hallucinations, worsening AMS. CT (- ) for acute pathology. Suspected HSV encephalitis/meningitis. Brpapon respiratory acidosis but did not tolerate. Seen y palliative in’setting of deteriorating status. RD will communicate with MD, NP and SW to discuss possible TF (if candidate)Diet Orders Diet: No Added Salt Diet Consistency: Puree Liquid Consistency: Nectar thick Intake: Poor (<25%) Receiving Substantial/maximal stance at meals Boost Pudding 119 ml / 5 oz (280. kcal, 7 g protein) PO 3 x day LPS-SF 45mL PO 2xday (mixed in applesauce or pudding) Hi Cal Cereal (475 kcal, 12 gm. pro/serving per 6 oz.) Provide / gnc ourage 6-8 une of water (per ordered consistenc' 4x/day with medication seen)Anthropometrics & Relevant Findings CBW 82.2# Dx of Failure to Thrive UBW: 100# Sacrum and B/L buttocks MASD. *UBW: 82% recent wt loss of unknown amount BMI15.5 IBW: 95#-105# %IBW:87%Test ‘wae Mev '$0.0-100.0 a 20-540 cnc 320-360 lRDW sam 40 Potassivn [42 mmorl {102 mmol. [25 mmoU [Anion Gap. 13 mov 70-09 7 mera 723 (0.68 mal (050-120 [s maval Isa-t0s Total Protein [59 [0-83 [a0 a [Total Bilirubin (0.6 meal 0212 Lab Values Low Alb & TP: impaired skin integrity -supp provided Low Glu & Ca: decreased ap etite -no s/s hypoglycemia, no DM Dx Low HGB MCV & HCT: decreased appetite -on ferrous sulfate, folic acid1. Competence and professional development in practice (Non-maleficence) le. Make evidence-based practice decisions, taking into account the unique values and circumstances of the patient/client and community, in combination with the practitioner's expertise and judgment. If. Recognize and exercise professional judgment within the limits of individual qualifications and collaborate with others, seek counsel, and make referrals as appropriate. 1g. Act in.a caring and respectful manner, mindful of individual differences, cultural, and ethnic diversity. Ih. Practice within the limits of their scope and collaborate with the inter- professional team.2. Integrity in personal and organizational behaviors and practices (Autonomy) 2a. Disclose any conflicts of interest, including any financial interests in products or services that are recommended. 2e. Provide accurate and truthful information in all communications. 2h. Respect patient/client's autonomy. Safeguard patient/client confidentiality according to current regulations and laws.Conclusion + Family requested palliative care & no further hospitalization * Updated Advanced Directives.Advanced Directives Careplanning/End of Life Careplanning DNI DNR DO NOT HOSPITALIZE MOLST NO TUBE FEEDING Provide education and counseling to clarify advanced directives, care, and treatmentSummary Patient's family had Medical team Family requested wishes that raised ethical collaboratively explained _ palliative care based on concerns regardingend the risks and benefits of _ information and of life care tube feeding to family in support provided to an unbiased manner themThank YouRi 1. Raymond JL, Morrow K. Ki ise and Mahi even; 2025, Food and the Nutrition Care Process. Nutrition Care. Academy Publishing. Accessed April 29, 2024, 2. 4 standardized terminology to ensure Opt ttps: wew.nepracory 8, Width M, Reinhard T, The Essential Pocket Guide for Clinical Nutrition, Wolters Kluwe 4, Consent 1 Professio itp 5. Posit American boon 1390. 7. Code of Ethics for the Ni ry 2018. Accessed April 29, 2024. ttps:/avww.eatrigh