Exploring the ethical challenges of oral nutritional supplements in clinical practice

Registered Dietitians (RDs) are responsible for prescribing oral nutritional supplements, but they often face ethical challenges. Some patients have reduced decision-making ability. In these cases, dietitians may need to use persuasive strategies to help improve the patient’s nutritional intake. But how do they do that while still respecting the patient’s autonomy? Nutritional drinks can feel like a safe solution, but what happens when they’re used for too long? While oral nutritional beverages can help meet dietary needs, they may also replace regular meals—leading to social consequences.

“Sometimes the rules say one thing, but your conscience says another, and this can cause moral distress. Similar ethical challenges arise in all clinical decision-making, but dieticians’ experiences are less well-researched,” says Susanna Pohjola, District Nurse, PhD student at Uppsala University’s Centre for Research Ethics & Bioethics and author of a paper recently published in Nursing Ethics.

The results presented are drawn from interviews with 13 RDs working in primary care and hospital settings. They describe ethical challenges, such as discomfort due to financial or systemic barriers and using paternalistic persuasion and show a need for clearer guidelines, more equitable access to care, and stronger ethical support for dietitians working in complex clinical environments.

By Anna Holm Bodin

Pohjola S, Grauman Å, Höglund AT, Lövestam E, Nydahl M & Liljeberg E. Ethical challenges among registered dietitians in oral nutritional supplement prescription. Nursing Ethics. 25 June 2025. DOI: 10.1177/09697330251350390