Code of Ethics

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Code of Ethics

Approved by the CDO Board of Directors on March 22, 2024.

2024 Code of Ethics highlights 

PURPOSE

The College of Dietitians of Ontario Code of Ethics guides ethical dietetic practice for dietitians registered with the College of Dietitians of Ontario.
 
The Code of Ethics defines values, principles, and expectations applicable across all contexts and decision-making levels. It articulates the ethical standards for practitioners, including dietitians, dietetic practicum students, and applicants to the college, and is used to help clients, colleagues, and the public understand ethical commitments. 

USING THE CODE OF ETHICS

The Code of Ethics aligns with other College standards, legislation, policies, and guidelines. It forms an ethical framework for dietetic practice, supporting informed decisions, upholding care and professionalism and building trust in dietitians.

ETHICAL PRINCIPLES

The College has adopted a value-based Code of Ethics, which applies healthcare principles to guide evidence-informed and culturally safer dietetic practice.

The Code of Ethics principles align with professional values, including cultural humility, integrity, responsibility, excellence, and trustworthiness.

Key principles include:

• Respect for autonomy: Acknowledges the decision-making rights of individuals and ensures client-informed consent.
• Beneficence (doing good): Promote population/public health, equity, and accountability.
• Non-maleficence (not harming): Emphasizes harm reduction.
• Respect for Persons, Justice, and Dignity: Upholds every individual's inherent value and worth, advocating for fair treatment and the just and equitable distribution of resources and services to benefit society.

ETHICAL EXPECTATIONS

Ethical expectations apply to four key areas: responsibility to the client, the public, the individual practitioner (self), and the profession.
 
A practitioner demonstrates these expectations when making ethical choices by ensuring:

1.  RESPONSIBILITY TO CLIENTS

a.  Uphold the client's health care decisions, choices, and rights related to informed consent, research, and personal health information.
b.  Exercise knowledge, skills, judgement, and a professional attitude focused on client welfare to promote client-centred dietetic practices, treating clients with empathy, compassion and dignity. Foster respectful relationships.
c.  Commit to acknowledge and honour each client's inherent worth, value and cultural beliefs without discrimination, respecting their diverse ways of knowing.
d.  Provide equitable care to all clients regardless of personal attributes, including but not limited to race, ethnicity, gender identity and gender expression[1], sexual orientation, body size/weight, age, religion, or socioeconomic status.
e.  Treat each client interaction (question, comments, discussion, verbal and non-verbal communication) uniquely, avoiding assumptions about backgrounds or beliefs. Seek clarification and respond empathetically to create a safe and supportive environment.
f.  Practise using an evidence-informed approach to meet a client's needs and combine evidence with a client's preferences and traditions for client-centred dietetic services. i.  Optimize food and nutrition decisions by considering benefits and risks while prioritizing each client's unique needs and values.
ii. Acknowledge the limitations of evidence-informed practice, including that research evidence is only one source of knowledge and often reflects Western knowledge and methodologies. Consider all relevant contexts, traditions, and knowledge.
iii. Recognize that clients may approach their health and wellness, food and nutrition in diverse ways. Be aware of personal, social, economic and environmental factors influencing individual and population health. g.  Collaborate respectfully with colleagues, clients, caregivers, and relevant partners (including spiritual leaders and Elders) to provide care that meets specific client needs.
h.  Bill clients accurately and in a manner that reflects the services delivered. Maintain financial records whenever billing occurs in dietetic practice.
i.  Uphold professional boundaries and abstain from personal relationships with clients, including sexual relationships and conduct that could be perceived as sexual.
j.  Address trauma by acknowledging and understanding the impact of distressing experiences on an individual's mental, emotional, and physical well-being. Collaborate where possible to create an atmosphere that promotes healing, respects individual experiences, and avoids re-traumatization.
k.  In compliance with applicable legislation, implement measures that protect personal health information, ensuring these protections when utilizing artificial intelligence, social media, and virtual care tools.
l.  When using artificial intelligence (AI) tools such as Chatbots and virtual assistants, apply professional judgment to review AI output and ensure that the information generated when editing or creating content is consistent with equity, diversity, and inclusion principles. 

2.  RESPONSIBILITY TO THE PUBLIC

a.  Demonstrate professionalism, constructive dialogue, integrity, and civility in all communications.
b.  Act transparently and ethically in all professional and business dealings: 
i.  When advertising, transparently, publicly, and comprehensively disclose any financial or material relation with for-profit or not-for-profit third parties whose interests may be affected by the content of the advertising.  
ii. Uphold ethical integrity by avoiding conflicts of interest. Identify circumstances that could result in a conflict of interests, particularly those involving financial, contractual, or material relationships with commercial entities interested in the outcomes of dietetic practice. These relationships represent a high risk for influencing or undermining the dietitian’s primary obligation to exercise professional judgment on a patient’s or the public’s behalf. Conflicts of interest should be prevented wherever possible (i.e., by avoiding gifts or payments from interested third parties). If not possible, conflicts of interest should be decisively managed publicly and comprehensively disclosed[2].c.  Strive to act trustworthy by making choices and engaging in behaviours that demonstrate reliability, honesty and integrity.
d.  Be aware of potential harm when practising dietetics and identify risk characteristics, including the type, likelihood, frequency, impact, duration, and whether they are perceived by the practitioner (to themselves) as rational or irrational[3].  
i.  Determine the best way to mitigate harm in a given situation, take appropriate actions and apply protective factors.
ii. While taking no action can be a valid risk response, avoiding or ignoring risks can lead to harm.
e.  Provide optimal care to reduce health disparities, protect human rights, and promote fairness and equity. Strive to eliminate barriers for equity-deserving groups, contribute to improving access to dietetic care when possible, and address and prevent systemic racism[4] and discrimination in healthcare.
f.  Uphold human autonomy when using technology, including Artificial intelligence (AI) tools, ensuring individuals retain decision-making authority, especially regarding person-centred outcomes. When using AI in healthcare, integrate it responsibly and ethically, improving dietetic services with professionalism and compassion.
g.  Complete and organize record keeping in order to ensure easy access, promote collaboration with other healthcare providers, adhere to legal requirements, and safeguard client confidentiality.
h.  Comply with reporting duties by promptly reporting inappropriate behaviour or treatment, including self-reporting as required by law[5].
i.  Regularly evaluate the quality and effectiveness of dietetic services.
j.  Operate efficiently within the healthcare system, which includes demonstrating responsible resource management.

3.  RESPONSIBILITY TO SELF AND THE PROFESSION

a.  Practitioners must be accountable for their actions when practising dietetics. Being aware of the power and privilege is critical to understanding how to be accountable. This awareness will aid practitioners in meeting requirements to avoid exploiting power imbalances.
b.  Accountability to the profession extends to public platforms and communication where practitioners must act in the interest of public health.
c.  Engage in reflective practice, identify learning needs, and participate in continuing education and ongoing training, including learning about Equity, Diversity, Inclusion and Belonging (EDI-B). Stay up-to-date on best practices, including AI ethics and technology change, for continued competence, quality assurance, quality improvement, and professional growth. Support and foster learning together with colleagues and students.
d.  Uphold a compassionate approach, consistent with professional obligations, when interacting with individuals and technology during practice.
e.  Assume responsibility for your physical and mental well-being, and avoid practising dietetics when your capacity to deliver appropriate and competent services is compromised.
f.  Ensure decision-making remains independent of third-party interests, accountable to clients, and client-focused (i.e., putting the client’s interests first) to foster trust and credibility.
g.  Be reflexive and identify how personal biases impact interactions with people.
h.  Refrain from verbal/physical/emotional/sexual harassment.
i.  Practise within the limits of individual competence and scope of practice. Know when to consult, refer and collaborate with an inter-professional team to support collaborative care, communication, and respect for colleagues.
j.  Be collegial, understand how to work effectively with others and manage interpersonal and collaborative relations. Refrain from harassing, abusing, or discriminating against others, such as colleagues, employees, or students. 

For questions, please feel free to contact the College's Practice Advisory Service by email or by phone at 416-598-1725 / 1-800-668-4990, ext. 397.

REFERENCES
1.  College of Dietitians of Ontario (2019). Code of Ethics. Retrieved from https://www.collegeofdietitians.org/cdo-masterpage/news/news-items/2019/the-new-code-of-ethics-is-available.aspx

2.  Partnership for Dietetic Education and Practice (PDEP). Integrated Competencies for Dietetic Education and Practice (ICDEP) (2020). https://www.pdep.ca/library/PDEP-Policies/Integrated-Competencies-For-Dietetic-Education-And.aspx

3.  Stinson, J. (2018). What are Indigenous and Western Ways of Knowing? Retrieved from https://www.criaw-icref.ca/images/userfiles/files/Fact%20Sheet%202%20EN%20FINAL.pdf

4.  Palermo C. (2020). Leadership and practice in times of complexity and uncertainty. Nutrition & dietetics: the journal of the Dietitians Association of Australia, 77(5), 487–489. https://doi.org/10.1111/1747-0080.12646  

5.  Chatelan, A., Clerc, A., & Fonta, P. A. (2023). ChatGPT and Future Artificial Intelligence Chatbots: What may be the Influence on Credentialed Nutrition and Dietetics Practitioners? Journal of the Academy of Nutrition and Dietetics, 123(11), 1525–1531. https://doi.org/10.1016/j.jand.2023.08.001 

6.  Adapted from the Canadian Physiotherapy Association (2022). Code of Ethical Conduct.  Retrieved https://physiotherapy.ca/app/uploads/2022/08/code-of-conduct-en.pdf

7.  College of Dietitians of Ontario (2017). Standards and Guidelines for Professional Practice – Conflict of Interest. Retrieved from https://www.collegeofdietitians.org/resources/standards/standards-and-guidelines-coi.aspx

8.  College of Occupational Therapists of Ontario (2022). Culture, Equity, and Justice in Occupational Therapy Practice. Retrieved from https://www.coto.org/docs/default-source/culture-equity-justice/coto-culture-equity-and-justice-in-occupational-therapy-en.pdf?sfvrsn=4392a2c6_16

9.  Adapted from the International Committee Medical Journal Editors (2021). Disclosure of Interest (Updated February 2021).  Retrieved from https://www.icmje.org/disclosure-of-interest/

10.  Rodwin MA. Attempts to redefine conflicts of interest. Account Res. 2018;25(2):67-78. doi:10.1080/08989621.2017.1405728. Epub 2017 Dec 6. PMID: 29172685. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29172685/

11.  Rubino, F., Puhl, R.M., Cummings, D.E. et al. Joint international consensus statement for ending stigma of obesity. Nat Med 26, 485–497 (2020). Retrieved from https://www.nature.com/articles/s41591-020-0803-x

12.  Beauchamp, TL. & Childress, JF. (2001). Principles of biomedical ethics. 5th Edition. Oxford: Oxford University Press. 

DEFINITIONS

“Bias”: The Ontario Human Rights Commission defines bias as a predisposition, prejudice or generalization about a group of persons based on personal characteristics or stereotypes.
 
“Client”: Client is the recipient of dietetic service regardless of setting (e.g., an individual, population, employee, business, employer, agency, etc.).
 
“Client-Centred Care”: Client-centred practice is not merely about delivering safe services where the client is located. It involves advocacy, empowerment, and respecting the client’s autonomy, voice, self-determination and participation in decision-making. You can access the College’s practice advisory resources related to client-centred care here for more information.
 
“Conflict of Interest”: A conflict of interest is a situation in which secondary interests or obligations risk compromising (or appearing to compromise) an individual’s primary obligation to make decisions in the public’s interest and based on the best available evidence. For more information on conflicts of interest, please see the College’s Standards and Guidelines for Professional Practice – Conflict of Interest.
 
"Cultural humility”: “Cultural humility is a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a learner when understanding another’s experience.” For this definition and more information relating to cultural humility, see the First Nations Healthy Authority resource entitled Cultural Safety and Humility.
 
“Equity Deserving Groups” refers to communities or individuals who have historically experienced disadvantages, discrimination, or inequities in society. These groups may include but are not limited to racialized peoples and ethnic minorities, 2SLGBTQIA+ individuals, people with disabilities, Indigenous peoples, and other marginalized communities. The term emphasizes the need for equitable treatment and opportunities to address historical and systemic disparities.
 
“Evidence-informed practice” combines the best available research evidence and the dietitian's experiential knowledge with the client’s preferences, context, and available resources in decision-making (Integrated Competencies for Dietetic Education and Practice (ICDEP), 2020).
 
“Practitioner”: The term practitioner includes registered dietitians, dietetic practicum students, and applicants. Also, as per The Integrated Competencies for Dietetic Education and Practice (ICDEP), the term “candidate” refers to a student in an academic program, an intern in a practicum program or an individual writing the CDRE, according to context.
 
“Peoples”: Peoples means a distinct group of persons linked by a common identity, culture, history, and collective interests.
 

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FOOTNOTES

[1] The Ontario Human Rights Code (OHRC), a provincial law in Ontario, Canada, provides legal protections against discrimination and harassment based on certain grounds. It sets out the rights and responsibilities related to human rights in various areas of public life, including employment, housing, goods and services, and education.
[2] RDs are well-positioned to clarify media perceptions of food and appropriately disclose partnerships.
[3] This refers to whether the perceived risk or harm is based on logical, evidence-based reasoning or if emotional, unfounded, or irrational beliefs and fears drive it. When assessing potential harm in dietetics, it's important to consider whether the concerns are grounded in sound reasoning and evidence or based on irrational or emotional reactions that may not be supported by evidence.
[4] RDs can play an important role in identifying systemic discriminatory practices and advocating for change.
[5] Mandatory reports are legally mandated, necessitating submission to the designated authority for specified reasons.