Examining the ethics of what’s on your patients’ dinner table


Providing safe, nutritious and environmentally sustainable food to all is a great challenge. While physicians in some U.S. cities have been writing prescriptions for patients to obtain fresh produce through healthy food outreach programs, this cannot fully reverse negative health effects of low-quality diets. If solutions addressing food quality and access are not found, costs will be high.

The October issue of AMA Journal of Ethics® (@JournalofEthics) examines a complex array of food-system ethical issues and their impact on health and nutrition outcomes. This issue also examines the nature and scope of the obligations to address these ethical issues for physicians, organizations, industries and governments.

Articles include:

How to Improve Clinical Practice and Medical Education About Nutrition.” To help patients access credible information about diet and nutrition and make informed lifestyle choices, physicians must be able to do so themselves, yet the topic to date receives little attention in medical education.

This commentary explores barriers to dietary counseling, strategies for improving medical education and clinical practice with respect to nutrition, and the ethical importance of sharing dietary information with patients.

What Lies Behind the Transition From Plant-Based to Animal Protein? Dietary changes that occur in response to economic development are collectively known as the “nutrition transition.” In one type of nutritional shift, plant proteins are replaced with animal proteins in ways that are dependent on regional cultural, religious, and ethical concerns. The protein transition, viewed in this article as a subset of the broader nutrition transition, illustrates how dietary patterns in low- and middle-income countries are shaped by societal and economic forces.

The complexity of food decisions justifies the need to integrate nutrition with the social sciences in the study of evolving food systems.

Health Professionals as Partners in Values-Based Food Procurement.” Half of American adults have one or more preventable chronic diseases, many of which are diet-related, so it is critical that health professionals engage in public health prevention strategies. These can take the form of public and private sector partnerships.

Food procurement—the processes through which institutions such as hospitals and schools purchase and serve food—offers powerful opportunities for health professionals to partner with public institutions to prioritize accessibility to nutritious, sustainable, and fairly produced food and to generate sustained benefit to population health.

Do Infant Formula Giveaways Undermine or Support Women’s Choices? Eliminating formula giveaways (“banning the bag”) has been embraced as a way to reduce the influence of formula marketing in hospitals and to increase breastfeeding rates among new mothers. However, the policy raises ethical concerns in the mind of some because it denies a useful benefit to mothers who have trouble affording formula.

Hospital policies to promote breastfeeding should be sensitive to economic and other costs associated with breastfeeding and should be consciously designed to make breastfeeding easier and not just to make formula feeding more difficult.

Listen and discuss

In the journal’s October podcast, experts discuss why clinicians should care about food ethics and what they can do to address nutrition in clinical and community settings. This episode’s guests are:

  • Jessica Fanzo, PhD, associate professor of global food and agricultural policy and ethics at Johns Hopkins’ Berman Institute of Bioethics; senior nutrition and food systems officer in the Nutrition and Food Systems Division of the Food and Agriculture Organization of the United Nations in Rome.
  • David Katz, MD, founding director of Yale University’s Yale-Griffin Prevention Research Center.
  • Haley Swartz, food and nutrition policy fellow at the National Consumers League in Washington.

Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other services.

Submit manuscripts and artwork

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

A look ahead

Upcoming issues of the AMA Journal of Ethics will focus on false beliefs in health care and physicians’ power to name. Sign up to receive email alerts when new issues are published.