October 2008: Question 1
In your opinion, is it ethical to recommend a patient or client consume alcohol as described in the article? Why, and what would you recommend?
posted by Emily Moore @ 7:16 AM
19 comments
ISU Dietetic Internship Journal Club
Objective: To become familiar with current scientific literature on a variety of nutrition topics and to gain experience in gathering, organizing, critically evaluating, presenting and facilitating group discussion of the literature and the implications to practice.
19 Comments:
For me, personally, I do not think that it is ethical to recommend a patient to consume a moderate amount of alcohol. I think it really depends on the situation and the client. If the client does not drink, ever, or does not believe in drinking because of his or her morals or beliefs, I would have a very hard time recommending them to drink. If a client does drink and asks about the benefits of alcohol, I then would explain to them the research and recommendations for consuming alcohol in moderation. I would never want a client to get the wrong impression if I would recommend drinking, and them take that out of context and think, “it’s okay to drink, my dietitian said so.” Now, I would not have any issues discussing alcohol intake in moderation and explaining to the client that recent research has shown 1-3 drinks per day has been associated with reduced morbidity and mortality. With alcohol, we need to remember that age, gender, body weight, and medications determine how their bodies respond, everyone’s body will all react differently to alcohol. I still think this issue is ongoing and more research must be done for me to really recommend a client to consume alcohol.
I totally agree with the idea of 'moderation;' however, the term 'moderation' in the current study has a broad definition to me. One to three drinks per day is considered a moderate amount. In my opinion, one alcoholic beverage per day is a lot different than three. I really cannot see myself recommending this to a patient or client, even if there are some studies with positive results. Yes, there may be some health benefits of alcoholic beverages, but again, there is a fine line that some patients/clients may not understand. In my experiences, those who consume alcohol on a daily basis do not really eat a healthy diet, as the current study explains. Again, more research would have to be completed before I recommend patients/clients to consume 1-3 alcoholic beverages each day.
From my experience so far in the clinical setting, there are so many patients that have cirrohis or are alcoholics. I would never want to be the one that made a person start drinking because I said it was healthy. You also have to consider all the medications a person is on. Usually it is very dangerous to consume alcohol with different medications and so I don't think recommending to drink 1-3 glasses per day would be appropriate. So, no I don't think it is very ethical to recommend a patient to consume alcohol on a regular basis.
Britt,
I liked that you pointed out how the study mentions those who consume alochol have a healthy diet as well. I tend to agree with you when you say that those who consume alcohol aren't usually consuming a healthy diet. I have had many patients who have said that alcohol takes their appetite away and they just don't eat much.
Meredith-
I liked how you mentioned to look at the medications a person is on. It's always important to check that out and see what complications alcohol could have on that patient. I also think that it is interesting how you have seen many alcoholics and that most of them don't have an appetite, resulting in an unhealthy diet...good point!
Just to be clear, the article stated that those who drank small amounts on a regular basis...say a glass or two of wine with dinner, tended to eat a healthier diet overall, compared to those who could be considered binge drinkers (greater than 5 standard drinks per sitting). I agree that individuals who drink in excess, or in immoderate ammounts, will replace healthy calories from food with "empty" calories from alcohol. A person with an alcohol addiction will not have an improved appetite and quality of diet.
To me there are so many different beliefs on alcohol that I would have a hard time ethically telling a client to consume alcohol. If you were seeing them for the first time and you didn't have a full history, and you told a recovering alcoholic to drink, that would be like telling a diabetic to consume all the carbohydrates they want. If I were to tell a client about alcohol I would want to give them all the information possible; like the definition of moderation, the actual amounts that are considered a serving, and that it is up to them if they choose to drink. There are several different ways to reduce the risk of morbidity and mortality than just alcohol that they may want to explore those options first. A couple options would be an exercise program or following a healthy diet.
Tori McRoberts
Britt,
I agree with you on the idea that alcohol in moderation is a good idea. We need to remember that counseling patients in the hospital is very different than counseling those on an outpatient basis also. But educating patients on the definition of moderation in the outpatient setting might not be such a bad idea even if it is part of a healthy diet education.
Tori McRoberts
I think it would be ethical and fine to point out the potential health benefits of low to moderate alcohol consumption, to those who already consume alcohol.
I think it would be unnecessary, and perhaps unethical to try to recommend alcohol consumption for health benefits to those who don't already drink alcohol.
But if I knew a patient had a history of alcoholism themselves, or in their family, I would bypass talking about health benefits of alcohol and rather point them to more traditional things (ex. better diet and exercise).
Tori,
I agree with you, that without knowing a clients history with alcohol, it's better to err on the side of caution and not to emphasis drinking alcohol for health. And that if it did come to that point, a lot of education would be needed to define what type and amounts of consumption confer the potential benefit.
Myra
I do not think it's ethical to recommend someone to drink alcohol. I think it is ok to answer any questions they may have regarding things they have read about the health benefits of moderate alcohol consumption. It is also important for them to know the detrimental consequences of alcohol consumption.
I agree Mere, I wouldn't want someone to over consume alcohol because they misunderstood my information/recommendations about alcohol consumption. Some people have a history of substance abuse or tendencies and you may not be aware of them.
I don't think recommending alcohol consumption to a patient would be ethical. There can be benefits to some beverages but the flip side is usually negative. There are a lot of areas to consider, present illness, family history, meds and what about the clients personality. If I recommended that and they had an addictive personality they may become an alcoholic and I don't want that responsibility.
Susan
I don't think that it is crossing the ethical border to recommend to patients to consume one drink per day. You would be making this recommendation under medical supervision; it is no more unethical than putting patients on a liquid diet for weight loss. Again, like the article said, this is assuming the person you are counseling is not an alcoholic, and can reasonably monitor their intake of alcohol.
The intention of the one to two drinks a day is not made with the intention to alter the person's mental status. For most people, even older adults, one drink sipped at a moderate rate, would not be enough to affect mental and physical functioning.
Kat,
I agree you have to be able to address the patients questions. I believe you need to clear up any information that may not be correct and back it up with evidence. All the more reason to research this topic.
Susan
I would say that it is ethical to suggest that a pt/client that is of legal drinking age to have 1-2 drinks per day. At the same time I would provide evidence similar to what was in this article on why I am suggesting them to do so. I may be more inclined to push the issue if the pt/client has had a history of or is at high risk of heart disease. There seem to be so many benefits to those at risk for heart disease it may be unethical not to.
I'm glad we got some mixed responses! I probably agree with Myra, that if someone ASKS, I would be more likely to recommend a drink a day, or at least explain the possible health benefits AND risks. But it is a fine line that needs to be walked with caution.
Meredith,
You make a valid point about there being so many pts with cirrhosis of the liver. I have not been in a clinical environment yet but I expect to see many pts with liver problems like you have. It would be a terrible feeling to suggest the pt to start incorporating alcohol into their diet and see them come back into the hospital with a problem associated with the alcohol. Although I think that it would be highly unlikely that a pt would have liver problems if they only had 1-2 drinks per day.
Myra does bring up a good point that if a patient asks us about this topic, it may not be a bad idea to sum up some study results and make some recommendations. Again, though, there is that fine line that some of us have mentioned dealing with patient's perceptions of what we are really telling them.
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