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ACQ
uiring knowledge
in
sp eech
,
language and hearing
, Volume 11, Number 1 2009
31
MULTICULTURALISM AND DYSPHAGIA
Key trends impacting on
ethical practice
A number of key trends raise the possibility of ethical risks to
speech pathology practice as a whole.
Increasing health demands from an
ageing population
The fact that Australia’s population is ageing contributes to
an increasing need for health services both in primary and
tertiary care (Australian Government Productivity Commission,
2005). The increasing demand for limited health services
poses a number of ethical considerations for the health
practitioner. There is a need to ensure the limited health
dollar is used most effectively and efficiently, but also to
determine, at a transparent level, who will benefit from the
limited health dollar and who will miss out. Often it is the
speech pathologist who must adhere to the directives of
individual organisations regarding prioritisation of caseload,
while at the same time making independent decisions
regarding how prioritisation should look. This often presents
many ethical challenges for clinicians who must work hard to
meet both client and organisational needs in an ethical
manner.
Furthermore, the increasing demographic of well-educated,
articulate and financially well-off elders will see a rise in
demand for more intensive and conveniently located services,
in community settings and/or client’s homes. The challenges
and opportunities this will pose in relation to service
provision by speech pathologists are likely to include the
increasing use of allied health assistants, the use of telehealth
and an increased emphasis on community-based models of
service delivery. Some of these issues will be discussed later
in this article.
Increased prevalence of chronic disease
and disability
Advances in the medical and surgical management of a range
of conditions, diseases and injuries have reduced mortality,
but increased morbidity and life expectancy. Examples
include the improved survival rate of very premature infants
and the survival of persons with severe head injuries. Life-
prolonging procedures and technologies result in survivors
now presenting with significant long-term disabilities that
extend to communication and swallowing. As is likely the
case with all health professionals, speech pathologists may
hold concerns about the quality of life that ensues for people
living with severe and complex disabilities.
Concerns may exist in relation to service provision for
persons with chronic disease and disability; specifically,
where this service should sit as part of a larger caseload, and
how the speech pathologist should maximise the potential of
clients with chronic disease and disability within the limited
available resources. Ongoing limitations in the health budget
will continue to place pressure upon clinicians to demonstrate
the benefits of intervention with this group of clients, as with
all clients; however, such gains may be more difficult to
Keywords:
ethics,
evidence based practice,
health workforce,
population trends,
resource allocation,
scope of practice
T
he speech pathology profession has undergone significant
change over the past 15–20 years, and these changes have
important implications for the ethical practice of speech
pathology. The knowledge and skill-set of the discipline have
changed dramatically due to both internal and external forces.
Changes in work settings, types and complexity of clients,
new technologies in health care, and reimbursement for
services continue to raise new challenges for speech
pathologists as they seek to implement evidence based ethical
practice. Emerging technologies that can be used for
telehealth, a growing trend for working in developing
countries, and social models of practice offer exciting
opportunities for expanding our practice along with increased
risks to ethical practice.
E
merging
T
rends
I
mpacting on
E
thical
P
ractice
in
S
peech
P
athology
Marie Atherton and Lindy McAllister
The significant societal, systemic and technological
changes of the past two decades have contributed to the
Australian health system now facing a number of specific
challenges. The increasing diversity and sophistication of
health technology, the proliferation of legislation, the
ageing health workforce and changing community
demographics are key trends impacting on the future
viability of health service provision within Australia and
internationally. These trends will also impact on health
practitioners’ ability to provide care that meets demand
while simultaneously meeting the moral and ethical
considerations which are inherently tied to health service
provision. In 2006, Speech Pathology Australia members
identified a number of key ethical concerns related to
these trends and challenges, including not only those that
arise at an individual client–practitioner level but also at
a systemic level. Specifically, Speech Pathology Australia
members expressed concern regarding prioritisation of
services, the impact of fiscal constraints on service
delivery, and the potential for conflict between profes
sional values and values that may underpin management
decisions and health policies. Ethical issues associated
with the delegation of tasks, the need for continuing
professional development and the use of evidence based
practice were also identified. For the profession to meet
current and future challenges, it is essential to remain
vigilant and responsive to trends and changes that will
impact on service provision. Practitioners must also
demonstrate an ethical awareness that extends beyond
specific “ethical dilemmas” as may arise in clinical
practice to thinking and acting ethically in our daily
routines.