Ethical Decision-Making in Clinical Nutritional Practice

Ethics requires a critical evaluation of assumptions and arguments about norms and values; what should be done and what should not. Practitioners should practice ethically, and the professions should be at the forefront of applied ethics. There are four principles, patient autonomy, beneficence, non-maleficence and justice, which are guides to ethical dayto-day practice. Patient autonomy: autonomy means self-rule by persons of their thoughts and actions. Patient autonomy requires the practitioner to realise that patients have the right to be involved in decision-making on their own behalf. Beneficence refers to the duty of the practitioner to do the best for the patient. The benefits of breast-feeding are many, and the eventual outcome on health enormous. Nevertheless, health-care workers are diffident in promoting breast-feeding, and readily accept excuses for not breast-feeding, contrary to the principle of beneficence. Nonmaleficence refers to the duty of the practitioner not to do harm; it requires the practitioner to withhold harmful therapies; Vitamin E, for example, has been proven to be ineffective as an antioxidant in humans, and large doses have been proven to increase mortality. Yet these are the doses available in supermarkets and “Health shops”. Nutritionists should actively advise against harmful “dietary supplementation”. Distributive justice requires every patient to have an equal opportunity to obtain appropriate therapy. There are relatively few nutritionists and dieticians in South Africa, and indeed in the entire African continent, but proportionately even fewer in the areas of greatest need. A case illustrates the application of these ethical principles to show how they can be applied to our daily practice. Using these four principles is a practical approach to solving ethical dilemmas.