Ethics. Derived from the Greek word ethos which means customs, habitual usage, conduct and character.

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2 Ethics Derived from the Greek word ethos which means customs, habitual usage, conduct and character. Moral principles that govern a person s behavior or the conducting of an activity Branch of knowledge that deals with moral principles

3 Hippocratic Oath, late 5th century BC Ὄμνυμι Ἀπόλλωνα ἰητρὸν, καὶ Ἀσκληπιὸν, καὶ Ὑγείαν, καὶ Πανάκειαν, καὶ θεοὺς πάντας τε καὶ πάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶ ξυγγραφὴν τήνδε. Ἡγήσασθαι μὲν τὸν διδάξαντά με τὴν τέχνην ταύτην ἴσα γενέτῃσιν ἐμοῖσι, καὶ βίου κοινώσασθαι, καὶ χρεῶν χρηίζοντι μετάδοσιν ποιήσασθαι, καὶ γένος τὸ ἐξ ωὐτέου ἀδελφοῖς ἴσον ἐπικρινέειν ἄῤῥεσι, καὶ διδάξειν τὴν τέχνην ταύτην, ἢν χρηίζωσι μανθάνειν, ἄνευ μισθοῦ καὶ ξυγγραφῆς, παραγγελίης τε καὶ ἀκροήσιος καὶ τῆς λοιπῆς ἁπάσης μαθήσιος μετάδοσιν ποιήσασθαι υἱοῖσί τε ἐμοῖσι, καὶ τοῖσι τοῦ ἐμὲ διδάξαντος, καὶ μαθηταῖσι συγγεγραμμένοισί τε καὶ ὡρκισμένοις νόμῳ ἰητρικῷ, ἄλλῳ δὲ οὐδενί. Διαιτήμασί τε χρήσομαι ἐπ' ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμὴν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν. Οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι ξυμβουλίην τοιήνδε. Ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω. Ἁγνῶς δὲ καὶ ὁσίως διατηρήσω βίον τὸν ἐμὸν καὶ τέχνην τὴν ἐμήν. Οὐ τεμέω δὲ οὐδὲ μὴν λιθιῶντας, ἐκχωρήσω δὲ ἐργάτῃσιν ἀνδράσι πρήξιος τῆσδε. Ἐς οἰκίας δὲ ὁκόσας ἂν ἐσίω, ἐσελεύσομαι ἐπ' ὠφελείῃ καμνόντων, ἐκτὸς ἐὼν πάσης ἀδικίης ἑκουσίης καὶ φθορίης, τῆς τε ἄλλης καὶ ἀφροδισίων ἔργων ἐπί τε γυναικείων σωμάτων καὶ ἀνδρῴων, ἐλευθέρων τε καὶ δούλων. Ἃ δ' ἂν ἐν θεραπείῃ ἢ ἴδω, ἢ ἀκούσω, ἢ καὶ ἄνευ θεραπηίης κατὰ βίον ἀνθρώπων, ἃ μὴ χρή ποτε ἐκλαλέεσθαι ἔξω, σιγήσομαι, ἄῤῥητα ἡγεύμενος εἶναι τὰ τοιαῦτα. Ὅρκον μὲν οὖν μοι τόνδε ἐπιτελέα ποιέοντι, καὶ μὴ ξυγχέοντι, εἴη ἐπαύρασθαι καὶ βίου καὶ τέχνης δοξαζομένῳ παρὰ πᾶσιν ἀνθρώποις ἐς τὸν αἰεὶ χρόνον. Παραβαίνοντι δὲ καὶ ἐπιορκοῦντι, τἀναντία τουτέων.

4 Code of Ethics To help professionals conduct their actions in accordance with primary values, principles and ethical standards To assure the public that members of regulated professions are acting in a socially and professional aceptable manner To help individuals to govern their decision making in choosing between right and wrong To help professionals practise honestly and with integrity To guard against malicious or self-serving practices and actions

5 International Code of Ethics International Code of Ethics and Code of Good Practice (EFAD 2008) Dietitians practice in a just and equitable manner to improve the nutrition of the world by: 1.Being competent, objective and honest in our actions 2.Respecting all people and their needs 3.Collaborating with others 4.Striving for positive nutrition outcomes for people 5.Doing no harm 6.Adhering to the standards of good practice in nutrition and dietetics

6 International Code of Good Practice -Provision of Service and application of knowledge -Developing practice and application of research -Communication -Quality in practice -Continued competence and professional accountability

7 Responsibilities To the public To the clients To the profession To colleagues and other professionals

8 Ethical principles Universal standards that provide a guide to making decisions 4 basic Principles of Medical Ethics Autonomy Beneficence Non-maleficence Justice More principles Consent and capasity Substituted decision-making Truth telling and integrity Futile treatment Confidentiality and privacy

9 Examples on Ethic reflection Diversity End of life Social media Genetics

10 Snapshot Diversity End of life Social media Genetics

11 Social media Blogs Microblogs Social networking sites Photo/video/file sharing sites

12 Social media Dr. AT, 48, was fired from the hospital last year and reprimanded by the state medical board last week. The hospital took away her privileges to work in the emergency room for posting information online about a trauma patient. AT s posting did not include the patient s name, but she wrote enough that others in the community could identify the patient. A Wisconsin hospital and several in California have made headlines in recent years as nurses and other staff members were fired for talking about patients on Facebook or posting photographs of them online. What are the ethics related issue in these cases? Confidentiality and privacy

13 Snapshot Diversity End of life Social media Genetics

14 End of life - terminology Terminal phase Palliative phase Incurable disease The dying phase.. How do we predict survival?

15 Case Male, age 65, ca. coli, chemotherapy was ended Referred to dietitian for plan of intravenous feeding Nil per os, Q; Fistula to intestine? The oncologist wanted to give nutrition while waiting for the surgeons decision. BMI 17, Weight loss 34 kg/6 mo What are the ethics related issue in this case? Beneficence

16 Case 2 weeks earlier the patient had told the dietitian that he didn t want i.v. feeding. What are the ethics related issue in this case? Autonomy, consent and capasity, truth telling and integrity, futile treatment and beneficence Do we face a dilemma? Beneficence vs autonomy? How do we resolve such situation?

17 Snapshot Diversity End of life Social media Genetics

18 Diversity Issues and Ethics Diversity/cultural diversity/ culturally diverse : ethnic groups, racial affiliation, religion and religious values, social affiliation, gender, language, sexual orientation. Within group diversity: diverse levels of, i.e. comprehension, level of hearing, dementia, developmental challenged, language proficiency, chronic disease level progression.

19 Diversity Issues and Ethics Trans-border and trans-culture increase diversity of populations. Increased multicultural population pose ethical and practical challenges.

20 Diversity Issues and Ethics Case example - The spirit catches you and you fall down A middle aged Hmong woman Was referred to the dietitian with the medical diagnosis of Hyperlipidemia. Patient s resisted to share health history and nutrition information. The nutrition prescription provided by the dietitian was met with resistance. Collaboration with a Shaman would allow the dietetic consult to be accepted. What are the ethics related issues in the case?

21 Diversity Issues and Ethics Ethical behavior : honoring autonomy, promoting justice and serve beneficence. autonomy requires that patients differences be considered in the health care encounter, justice requires developing the interpersonal insights needed to treat patients fairly, beneficence assures doing the best for the patients

22 Diversity Issues and Ethics One of the unanswered research question still is whether concordant relationships produce measurable improved health outcomes among groups of diverse backgrounds. So, ethically.

23 Snapshot Diversity End of life Social media Genetics

24 Genetic Issues and Ethics Nutrigenetics is the study of the relationships among genes, diet and health outcomes. Nutrigenomics (a related but distinct field) It is the study of how genes and nutrients interact at the molecular level.

25 Genetic Issues and Ethics Human Genome Project and genomic technologies diseases\conditions with gene-related backgrounds (known and yet unknown) individualize dietetic counseling based on genetic premises

26 Genetic Issues and Ethics Case 1 Two men of the same age Eat a diet low in fruits and vegetables and high in sodium and saturated fat One develops hypertension, hypercholesterolemia and eventually atherosclerosis, While the other one lives without such chronic diseases.

27 Genetic Issues and Ethics Case 2 Two post-menopausal women Consume similar diets low in choline Estrogen levels are low in both One develops liver dysfunction due to the choline deficiency The other does not

28 Genetic Issues and Ethics Two male teenagers Case 3 Consumed similarly a relatively healthy selection of foods, including a variety of fruits and vegetables One of them developed acute signs of vitamin C deficiency, Scurvy. Clinical and nutritional evaluations did not explain the symptoms. The intake of vitamin C was marginal by both subjects.

29 Case 1 consider Genetic Issues and Ethics Critical thinking Familial hypercholesterolemia; specific monogenic disorder Case 2 consider PEMT ( Phosphatidylethanolamine n-methyltransferase) choline synthesis, 1 or 2 SNPs, Estrogen Case 3 consider GTST (glutathion s-transferase), 2 SNPs, RDI for vitamin C Ethical principles: Truth telling and Integrity Futile treatment

30 Genetic Issues and Ethics Ethical principles relevant in issues of nutragenetics related cases: Avoiding harm Truth telling and integrity Futile treatment Confidentiality and privacy

31 Genetic Issues and Ethics Ethically and professionally the results of genetic testing for disease risk should never supersede clinical decision based on phenotypical traits and family history, but should be complementary.

32 Thank you, stay tuned

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