ETHICAL AND LEGAL ISSUES

IMPACTING DIETETICS
PRACTICE
Clinical Rotation
Amal El-Rowmeim
§ Patients have a right to make decisions on their health care as well as appoint
someone to make these decisions if they are no longer able to.
§ Patient self-determination act (1991):
§ Health care facilities are required to inform patients on admission of their right to consent
or refuse treatments and form advance directives.
§ A legal document that lists a person’s decisions on their health care if they are no
longer able to verbalize their wishes.
§ Types:
§ DNR/DNI
§ Health care proxy
§ MOLST
§ A DNR order means that the patient is requesting not to receive
cardiopulmonary resuscitation/CPR in the event that their heartbeat or
breathing stops.
§ This does not exclude other treatments from being administered such as
mechanical ventilation.
§ A DNI order means that if breathing were to cease a breathing tube will not be
placed, but CPR and cardiac drugs may be used.
§ A person appointed to make decisions on your health care if your doctor
determines that you are no longer capable of making decisions for yourself.
§ The proxy must be at least 18 years old.
§ You may limit the proxy’s authority in making health care decisions, remove
them as your proxy, and change your mind about your treatment plans at any
time.
§ Medical Orders for Life Sustaining Treatment:
§ Signed document by a medical physician recording your wishes regarding heath
care treatments:
§ CPR
§ Feeding tubes
§ Mechanical ventilation
§ And other medical interventions.
§ Determine treatment goals
of patient
§ Discuss feeding options,
hydration, weight
monitoring etc.
§ Diagnoses:
§ Traumatic subdural hemorrhage
§ Parkinson’s disease
§ Dementia
§ Prostate cancer metastasized to butt (soft tissue sarcoma)
§ History of falls
§ Rheumatoid arthritis
§ Documented poor PO intake/refusal of meals in the hospital.
§ Underweight
§ Diet:
§ Was No Added Salt puree/thin liquids
§ Aspiration precautions
§ Poor intake (~25%)
§ Plan:
§ Speech therapist evaluation
§ Select menu filled out by resident’s daughter
§ Super cereal (360 kcals, 11 g pro) at breakfast
§ 4 oz health shake at meals (600 kcal, 18g pro)
§ Ensure Plus 4oz PO QID (700 kcal, 26 g pro)
§ Care plan meeting with family
§ Health Care Proxy (wife)
§ MOLST:
§ DNI
§ DNR
§ Do not hospitalize unless pain or severe symptoms cannot be otherwise controlled.
§ No feeding tube
§ No IV fluids
§ No weights
§ No labs
§ No further diagnostic testing
§ Position of the Academy of Nutrition and Dietetics: Ethical and Legal Issues in
Feeding and Hydration. (2013, June). Retrieved from
http://www.eatrightpro.org/~/media/eatrightpro%20files/practice/position%20an
d%20practice%20papers/position%20papers/ethical-position-paper.ashx
§ Advanced Directives: Making Your Wishes Known And Honored. (n.d.). Retrieved
from https://ag.ny.gov/sites/default/files/advancedirectives.pdf