The ethical dimension of nutrition support teams and clinical nutrition professionals in dealing with disease-related malnutrition and access to nutrition care with The Troubling Trichotomy as a foundation

Summary: Nutrition support teams (NSTs) and clinical nutrition professionals (CNPs) have evolved over the years in response to changes in technology, healthcare environment, healthcare financing, and more. Two current challenges facing NSTs/CNPs are the recognition and management of disease-related malnutrition (DRM) and the need for world-wide access to nutrition care. The approach to both previous challenges has been clinical. In this article we explore an ethical additional dimension and propose that a required foundation can be provided by the Troubling Trichotomy (T3) composed of the three pillars which are technology, ethics, and law, adding to the NST/CNP's armamentarium. Most NSTs/CNPs are acquainted with technological advances related to artificially administered nutrition and hydration (AANH) but are not familiar with the nuances of research, publishing, and conflict of interest. The ethical pillar has traditionally focused on the principlism approach and end of life issues. The expanded view includes professional ethics and patient-centered care. Ten legal questions and answers regarding the U.S. legal system are reviewed. Additional needed legal topics such as licensure, top of license practice and the legal ramifications of conflict of interest in reporting, documenting and practice complete the recommended three pillars of the optimal ethical dimension. With the foundation discussed, NSTs/CNPs will be able to manage DRM via awareness, prevention, and management encompassing health promotion and disease prevention. Access to nutrition care as a human right is a pivotal obligation of NSTs/CNPs to provide the right nutrition care for the right individual at the right time in the right way.