Ethical selection of enteral and infant formula: demonstrating evidence-based practice and a responsible vendor relationship.

R EGISTERED DIETITIAN NUTRItionists (RDNs) are regularly involved with activities requiring decision making with ethical implications. Typical and significant ethical decision-making activities are related to selecting medical food supplements and enteral and infant formula, and choosing the durable medical equipment (DME) vendor that will be providing the formulas in the home. At times and in varying clinical situations, choosing a DME company to provide formula and related supplies and choosing the brand and types of medical food supplements or enteral and infant formulas are decisions delegated to the RDN for recommendation or action. At other times, the RDN may also be involved in an organization’s procurement processes for these products and services. Recently, an Academy of Nutrition and Dietetics’ active member approached the Academy ’s Ethics Committee raising the concern that these formula selection and related decisions are made following recommendations from vendor representatives or from RDNs “gut” feelings rather than using an evidence-based practice approach. This clinical decision situation offers a useful example from which to consider evidencedbased practice in ethical decision making and the role of vendor information in these decisions. ETHICAL PRINCIPLES The Academy of Nutrition and Dietetics Code of Ethics Principles 12 and 13 state that the RDN’s practice should be “based on evidenced-based principles” and respond to controversial topics “without personal bias,” respectively. Ethical decisions should consider available research evidence and patient’s needs as well as cost, safety, availability, efficacy, reliability, and convenience of various options to address the clinical situation. Ethical decisions should not be clouded by subjective determinants such as the 4 F’s of ethical failure: familiarity, friendship, favors, and finances. The Code of Ethics Fundamental Principle 1 calls for “honesty, integrity, and fairness,” and explicitly recommends RDNs in Principle 18 to not “invite, accept, or offer gifts, monetary incentives, or other considerations” that can affect their professional judgment.