ACQ Vol 12 No 2 2010

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ACQ Volume 12, Number 2 2010 95
Professional integrity: If Susie was to act as the CSW, she
would need to be trained by CRA even though she is a
qualified speech pathologist. She would need to be aware of
and understand the CSW Code of Ethics. Susie would also
have to accept that she would not be paid speech pathology
fees, but at the rate of a CSW.
Conclusion
The two scenarios outlined above demonstrate that AAC
practice is highly complex, with many factors influencing the
outcomes from the preschool classroom to the courtroom.
Further, although people who apply to the Aids and
Equipment Programs for communication aids across the
country usually do receive a device, funding differs markedly
between states. In Victoria, for example, 700 communication
aids are allocated per year, where statistics indicate there are
10,220 people with complex communication needs (ABS,
2006). Our concerns are not only with those who never
receive the AAC intervention they require, but also with those
who do receive an AAC device without the appropriate
support. When technology fails repeatedly, the desire to
communicate decreases (Williams, Krezman, &
McNaughton, 2008). Our journey towards ethical practice
and AAC has just begun – a long road lies ahead.
References
Australian Bureau of Statistics (ABS). (2006). http://www.
Beukelman, D.R., & Mirenda, P. (2005). Augmentative
and alternative communication: Supporting adults and
children with complex communication needs. Baltimore, MD:
Brookes Publishing.
Williams, M.B., Krezman, C., & McNaughton, D. (2008).
Reach for the stars: Five principles for the next 25 years of
AAC. Augmentative and Alternative Communication, 24 (3),
194–206.
1. Also known as CAUS – Communication Aid Users Society http://
2. Communication support worker (CSW): CSWs are specifically
trained to understand a range of communication methods and
devices, and support and/relay communication from a person
with little or no speech to another person (Communication Rights
Australia)
Rachel’s family has heard that Communication Rights
Australia1 (CRA) have a communication support worker
service2 which is equivalent to a sign language interpreter
service for the deaf. On making enquiries, they have been
informed that they only have a small pool of communication
support workers (CSW), none of whom are available at that
time. If Rachel could find someone to take that role, CRA
would offer the required training. It is very important that
the communication support worker understands the CRA
Code of Ethics
Default.aspx) which must be complied with in carrying out
this role, to ensure that the message conveyed is what the
communication aid user intended and is not influenced by
the CSW. In addition to training the communication support
worker, CRA would also need to train members of the legal
team about hearing evidence from a person who uses a
communication aid and the role of the CSW.
Ethical dilemmas
Beneficence and non-maleficence: The issue of the court
case was brought up at the last funded speech pathology
session. Susie is in the best position to prepare Rachel for
the court case, but time for an application to TAC for
additional speech pathology hours is short. As Susie knows
Rachel’s parents would not be able to afford the fees, should
she provide a few additional sessions to Rachel in the hope
that money will be forthcoming? Preparing the word-based
communication board would certainly take 2–3 sessions to
ensure that the correct vocabulary and information was
included. Having someone who is not adequately skilled
design the communication board, or not having the
communication board at the hearing could compromise the
strength of Rachel’s evidence.
Truth: Susie prognosticated early on in therapy that Rachel’s
dysarthria was severe and that she would need AAC to meet
her communication needs in the future. However, Rachel has
only reluctantly agreed to get a Lightwriter™, which she finds
frustrating due to the slow pace of communication. Susie
has continued to do basic speech therapy while encouraging
practice of the Lightwriter™. She has wrestled with where to
put the emphasis of therapy, however, and now feels that
Rachel needs more therapy to support her to use the
Lightwriter™. TAC has indicated that Rachel should now
have a break in therapy. Susie knows Rachel needs a
number of different ways of communicating, but she feels
she has not been able to achieve this.
Justice: TAC has funded a significant number of speech
pathology hours as well as providing attendant care dollars.
Even if additional therapy hours are allocated after the
6-month break, it will not help Rachel with the court hearing.
Rachel obtained her Lightwriter™ from the Aids and
Equipment Program
supports_for_people/living_in_my_home/aids_and_
equipment_program), but Susie feels there are other
communication devices that Rachel could try when she is
ready.
Autonomy: Susie feels that Rachel’s dysarthria is unlikely to
improve further and that Rachel would be advised to use her
Lightwriter™ or word communication board in court.
However, Rachel wants to use speech and only revert to
AAC if necessary. This is her choice, although it is Susie’s
view that it may not be in her best interest.
Barbara Solarsh works at the Communication Resource Centre,
Scope, and for the Bendigo Health Regional Communication Service.
She has worked extensively in the field of disability in community-
based settings, both in rural South Africa and in regional Australia,
and has been involved in multi-professional student training. She
has a strong interest in the ethics of sustainable interventions
in underresourced areas.Meredith Allan is a person who uses
Augmentative and Alternative Communication (AAC). Meredith is
one of the very few AAC users in Australia in the full-time open
employment workforce. She was a member of the Speech Pathology
Australia Ethics Board from 2002 to 2008.
Correspondence to:
Marie Atherton
Senior Advisor Professional Issues
Speech Pathology Australia
Level 2, 11–19 Bank Place,
Melbourne VIC 3000
email: