WHILE some boundary crossings can also be a conflict of interest, they are not always the same. Regardless of whether a dietitian is encountering a conflict of interest or a boundary crossing, what’s at stake is the potential for compromised professional judgement. Dietitians should be cautious in any situation that compromises their professional judgement. Client-centred dietetic services should always be the guiding principle for safe, ethical dietetic practice. What is a conflict of interest? What is a boundary crossing? How would you recognize them?
Conflict of Interest
A dietitian is in a conflict of interest when they consider their personal interest ahead of, or instead of, the interests of their clients. A personal interest involves receiving a benefit from an action or decision made other than what is customary for the dietetic services provided to a client (e.g. payment for dietetic service). Among other things, a benefit includes gifts, advantages, rewards, discounts, status, rebates, credit or preferential treatment.
A personal benefit can be directly to the dietitian or indirectly to someone else associated with the dietitian, such as a family member or close friend. This issue is that, in a conflict of interest, the personal interest may improperly influence a dietitian’s professional judgement and cause harm to clients. Conflicts of interest apply to the RD-client relationship as well as non-therapeutic clients such as organizations, companies, municipalities, and school boards.
Here are some resources to help you identify conflicts of interests and manage them successfully.
- Standards and Guidelines: Conflict of Interest
- Learning Module : COI and Dietetic Practice: Guiding Principles
Boundary Crossing
In a boundary crossing, the personal interest involves feelings rather than a financial or other personal advantage. Feelings in the dietitian-client therapeutic relationship change when the professional relationship evolves into another type of relationship. Examples of boundary crossings include when a client becomes a friend or when they become an employee, or when the dietitian borrows money from a client. Boundary crossings, such as these, change the dynamics of the therapeutic relationship and can cause harm to clients.
A boundary crossing has a two-fold risk:
- The dietitian’s professional objectivity may be compromised due to the personal feelings that have developed towards a client. These feelings might include a desire to become friends with a client or help rescue a client by providing help that is outside of the dietetic scope and intrudes into the client’s personal life;
- Conversely, boundary crossings can compromise a client’s ability to accept or question treatment suggestions, or provide an informed, knowledgeable and voluntary consent.
Boundary crossings do not typically apply to non-therapeutic clients such as organizations, companies, municipalities, and school boards. In these contexts, some behaviours could be deemed a conflict of interest (improperly influencing professional judgement) or fall under unprofessional, dishonourable or disgraceful conduct (professional misconduct).
What about accepting gifts: is this a conflict of interest or a boundary crossing?
Whether a gift represents a conflict of interest or a boundary crossing depends on the situation. If the situation involves receiving a financial benefit or another type of advantage from another professional or an organization, then the gift most likely represents a conflict of interest. An example would be accepting a free gym membership for referring clients to that gym or accepting a trip from a large supplier to your organization.
Even when the financial value of the gift is small, it can trigger a subtle change in the dietitian-client therapeutic relationship that eventually develops into a personal relationship. This is a boundary crossing which can cause confusion in the professional therapeutic relationship. Exchanging gifts with clients can be tricky.
Regardless of whether an action or behaviour is a conflict of interest or a boundary crossing, the interests of the client must always come first and professional judgement should never be compromised.
The College has developed resources to help dietitians identify boundary crossings: Boundary Guidelines for Professional Therapeutic RD-Client Relationships.
