Regulation Matters 2020 - Issue 1, May

Ethics and Professionalism

Knowing and Doing During the COVID-19 Pandemic


When we held our annual workshops last Fall on Ethics and Professionalism, we could not have imagined a worldwide pandemic was just around the corner. We did not know that the concepts we examined in the workshop would become the focus of the Practice Advisory Service calls and emails during this COVID-19 crisis. 

In this article, we reflect on what we learned, how we worked together with colleagues and  College members to find a path through this pandemic. We also share statistics and answers to questions that arose from the ethics workshops.

RDs Face Ethical Challenges in the Pandemic

Ethical and professional practice dilemmas are not easy under normal circumstances. The challenges dietitians are facing in this pandemic unfolded over time, in unique circumstances, in different practice environments, and with different client populations.  Like some of the scenarios we reviewed in the workshop last fall, these challenges are messy and complex. There are no easy answers.
It has not been business as usual for the College’s Practice Advisory Service. In these unchartered pandemic waters, we have had to be creative in how we support dietitians to protect the public.

We knew that you were balancing multiple demands and it wasn’t easy. We joined the Dietitians of Canada’s COVID-19 Facebook group to learn about what dietitians were grappling with in Ontario and across Canada. We participated in conference calls with dietitians, and with our provincial and national regulatory partners.  We discussed your questions at length amongst ourselves and with practice advisers from other colleges. We asked questions and we tried our best to listen, to empathize and to provide the best guidance possible when you called.

Your inquiries helped us understand what dietitians were facing and continue to face during this pandemic. This informed our resource development, our frequently asked questions (FAQs) and the Pandemic Guide.  Thank you for contacting us and helping us understand what you were dealing with.

Ethics in Action

We wanted to share a brief summary of what we heard from you on our practice advisory calls, as together we reflected on the Code of Ethics, and the four healthcare ethical principles which guide dietetic practice: beneficence (to do good), non-maleficence (do no harm), respect for persons/justice and respect for autonomy.


Many dietitians were redeployed, and we observed you discover, learn, and apply new knowledge. We saw you pulling together to share resources and care for others, protecting those who were most vulnerable – your clients. We heard about your participation in decision-making for client care with interprofessional colleagues. We observed you staying informed, supporting each other, and remaining flexible to changes requiring critical thinking and quick decision-making.


We received your inquiries on implementing appropriate measures to protect personal health information and safeguard client confidentiality while practicing with new technologies, through telephone and web-based practice.  We heard you consider your individual competence when being asked to take on new tasks in practice. You demonstrated a risk-aware mindset and you identified risk of harm, seeking clarification on directives and emergency orders, thinking about how to keep your clients and colleagues safe.


You asked questions about obtaining informed consent in virtual settings. You considered your clients’ needs and wants to provide client centered services, finding creative and alternate ways to provide essential nutrition care to clients, helping them feel safe in time of uncertainty and fear.


During our calls, we discussed your advocacy efforts for your clients and working with your employers to keep your clients safe and to provide equitable service.

Overall, our practice advisory experience over this pandemic strengthened our understanding that ethics and professionalism is constantly evolving. We saw examples of true professionalism. We saw that professionalism does not come  from just obeying written professional codes; it is a mind set and it is informed by your training, your experience, and the professional relationships you build.  It is often made up of many smaller decisions over time.

In dietetic practice, we all try to put processes in place to ensure that we will do the right thing. When we think of ethics and professionalism, it is a lifelong journey to not just avoid bad things but to actively pursue good. We heard dietitians making decisions, taking time to contemplate and consult with others. We heard dietitians applying the Code of Ethics as a tool to help them make good decisions in the moment, even if their decisions may not have been the most convenient or easy for themselves. In this time of crisis, you showed up, you pulled together, you cared for others. Your professional attitudes shone through.

As Ontario is planning for the next phase of the pandemic with a staged approach to lifting restrictions; stay tuned for specific practice guidance for dietitians. As always, we invite you to continue to contact us with your questions, thoughts, and comments. 


For the latest information and FAQs about the pandemic, consult the following:

Workshop Survey Evaluation Results

  • 273 RDs (34% response rate) responded to the workshop evaluation survey.
  • 88% of respondents felt that overall the workshop was a worthwhile learning experience.
  • 99% of respondents agreed or strongly agreed that they understand what it means to make a promise to society to accept and maintain trust as regulated health professionals and that values are the building blocks to safe, ethical practice. 

Two questions posed in the evaluation we felt needed further clarification.

Question 1: “I'm not clear on how my personal values directly relate to ethical practice. What if my personal values do not align with the College's Code of Ethics?”

Generally, we can agree that dietitians hold personal values that align with the principles described in the Code of Ethics — to do good, to do no harm, to show respect for persons, which means treating clients fairly, equitably, and respecting client decision-making. However, as the COVID-19 pandemic has made clear, applying the Code of Ethics in practice is not always easy. At the heart of a dilemma or crisis is where you may find that personal values do not necessarily align with professional ethics. Nonetheless, as regulated health professionals, Registered Dietitians are held accountable to a Code of Ethics and rigorous standards of practice. How, then, can dietitians align their decisions with the Code of Ethics, even when it clashes with personal values?
We recently came across an article, Building an Ethical Career in the Harvard Business Review that we think can help explain the link between values and ethics in more detail. It is worth the read! To briefly summarize, authors Kouchaki & Smith (2020) discuss how personal bias, peer pressure and work culture can cloud our judgment as healthcare professionals and lead us to make decisions that compromise professional and ethical values. They emphasize how planning is important in making good professional and ethical decisions; being prepared, taking the time to think about ethical issues, and consulting with others can help us resolve ethical dilemmas, especially when our personal values are at play.
Kouchaki & Smith state that we all have the potential to transgress our professional code of ethics if we are not vigilant. The Code of Ethicsets out the ideals that all dietitians must strive to achieve. Applying the Code can help us make good healthcare decisions in the moment, even if, at times, our decision may not be congruent with personal values. 
Question 2: “I felt the video animation style was friendly, approachable and warm; however, personally, I would prefer a video style that involved real people and more body diversity.”
Thank you for your feedback – we heard the need for more body diversity in our resources and we are committed to being attentive and mindful that healthy bodies come in all shapes and sizes.  Based on communication best practices, we’ve opted to use animations in our videos which keeps the costs down as the use of real people increases our expenses. However, as you’ll note on our website, we use photos of real people whenever possible.

Workshop Statistics

We’d like to thank participants and our host sites - we enjoyed facilitating and are very appreciative of the discussions that ensued throughout each session. 

From September to December 2019, we facilitated 32 in-person, 6 Ontario Telemedicine Network Workshops and one online webinar.

  • 807 dietitians participated (19% of the membership) with 94 dietetic interns joining.  This is the highest participation in workshops to date.
  • Webinars: Given the interest expressed for an online webinar, we provided one session in December 2019. This year, we are planning to offer additional webinars. Stay tuned, there will be more opportunity to connect online with us.  And, if you missed the Fall 2019 session, you can view the recording  here.

Participants expressed their ‘Ah-Ha’ Moments about the Workshops

“Ethical dilemmas can be tricky and can’t be resolved with snap decisions – it’s ok to take time when deciding how to proceed and reaching out to necessary resources – colleagues, College, etc.”

“It’s helpful to be aware of what your values are and to understand the values of others who may be making decisions differently than you.”

“Really enjoyed the practice scenarios – brought up some interesting conversations and created the need for personal reflection.”

“In a short time, I felt that I better understood practice dilemmas other dietitians are faced with. It’s very easy to become isolated where one works – this is where we can learn from each other and it’s truly valuable.”

“ My activity on social media could reflect poorly on my professionalism if it’s not well thought out.”