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Background: Dietetic students are exposed to bioethical dilemmas on clinical placements; however, the nature of these situations has not been investigated. The present study aimed to analyse students' reports of incidents and their associated personal development plans (PDP) to assess the type of ethical incidents faced and how they cope with them., Methods: Final-year dietetic students were recruited via an announcement in class. The students' PDPs were analysed using thematic analysis to identify the type of ethical issues faced and how they felt about them. The 500-word PDPs were submitted after the final placement., Results: Thirteen (13/26) students identified 'ethics' as a learning need and most of these incidents were related to enteral feeding (10/13). Ethical issues identified related to nonmaleficence; best interest; consent and capacity; truth telling and integrity; autonomy and substituted decision-making; futile treatment; beneficence and confidentially. The themes for how the students coped included being unsure; lack of confidence or knowledge with ethics and/or with communication; lack of experience; unease/concern about shared decision-making; and their own role in the situation., Conclusions: Student dietitians are exposed to a wide range of complex ethical clinical situations, with those related to enteral feeding being the most common. Students felt unsure of what to do and lacked confidence, which resulted in unease and concern; however, students appeared to have some ethical sensitivity. Communication problems with the multidisciplinary team or families were a common theme. Clinical educators need to support students in these situations and act as role models., (© 2012 The Authors Journal of Human Nutrition and Dietetics © 2012 The British Dietetic Association Ltd.)

The Mental Capacity Act (MCA) 2005 will be implemented in England and Wales in 2007 and have consequences for dietitians who work with people who may lack capacity to make specific decisions. This paper will explore issues arising from the introduction of the Act and considers the implications for dietitians involved in the delivery of clinical care, using enteral feeding as an illustrative example. If patients lack capacity to make specific decisions, dietitians will be required to record if, how and why they reached a decision, how they are involved in the decision making process and need to be able to justify their actions in relation to those decisions. This paper discusses the importance of dietitians' involvement in best interests decision making and considers the implications of decision making where people have drawn up a Lasting Power of Attorney. The role of such advance decisions is discussed and consideration is given to the potential compatibility of perspectives between the patient and family that may give rise to disputes. Dietitians may be well placed within multidisciplinary team working to ensure patients and their carers are part of the decision making process through effective communication and support for patients. Dietitians in England and Wales must consider the implications of the MCA upon their clinical practice and others outside these jurisdictions may like to reflect on the relevance of such developments in their own contexts.