JCPSLP March 2013

JCPSLP

Volume 15, Number 1 2013

Journal of Clinical Practice in Speech-Language Pathology

Ethical conversations

Keywords

access

ethics

information

privacy

stuttering

telehealth

associated with the emergent virtual world platforms, with

regard to the provision of speech-language pathology (SLP)

services. The second aim of this paper is to outline for SLPs

some major ethical concerns associated with embracing

these emergent and evolving technologies; that is, serving a

digital community while abiding by the profession’s Code of

Ethics. We commence our discussion of these applications

of the web in regards to people with communication

disorders (PWCD) through a short review of the more

established area of telehealth.

Telehealth

Telehealth is not a new digital phenomenon. Modern telehealth

started in the 1960s largely driven by the needs of the military

and of space exploration. Early technologies included the use

of television and the telephone (World Health Organisation

[WHO], 2010). Contemporary telehealth includes:

The delivery of health care services, where distance is

a critical factor, by all health care professionals using

information and communication technologies for the

exchange of valid information for diagnosis, treatment

and prevention of disease and injuries, research and

evaluation, and for the continuing education of health

care providers, all in the interests of advancing the health

of individuals and their communities. (WHO, 2010, p. 38)

The provision of health services to remote sites is

supported by a wide range of technologies (see Table 1 for

a list of resources commonly used by SLPs to support their

service delivery). Technologies such as videoconferencing

suites, email, tele-imaging, and more recently, rich

multimedia approaches such as video-streaming are

commonly used (WHO, 2010). The use of fixed, high-tech

videoconferencing suites to provide telehealth services

through public health departments is well established. One

example of the use of this technology occurs within the

Southern Inland Health Initiative which delivers telehealth

services including videoconferencing and remote diagnosis

to outpatients in rural and remote areas in Western

Australian (Department of Health, 2011). A second tool is

the portable

e-hab

system, developed by Theodoros and

colleagues, for telehealth service delivery to people with a

range of communication and swallowing impairments (see

for example, Sharma, Ward, Burns, Theodoros & Russell,

2011). Another technology being investigated for service

provision is desktop videoconferencing applications such

as Skype, which are envisaged to play an important role in

future delivery of low-risk clinical functions (Armfield, Gray &

Smith, 2012; Carey et al., 2010).

The world wide web offers the promise and

means of continual development and

improved access to speech-language

pathology services for people with communi

cation disorders. In this paper we describe

practices and possibilities for service provision

for this population, using telehealth and

emergent virtual worlds. We illustrate these

technologies with a particular focus on

research and developments for people with

communication disorders. We then highlight

some of the ethical risks associated with the

web in terms of the promotion of non-

evidence based practices, client–patient

relationships and the storage and access of

client data. These concerns are discussed

with reference to Speech Pathology

Australia’s Code of Ethics, and provide

guidance to speech-language pathologists

regarding the potential dangers associated

with service provision over digital platforms.

ast year the world wide web (the web) turned 21,

and now over 72% of Australian households are

connected to it (Australian Bureau of Statistics,

2011). The web is a collection of web pages which function

as a resource of the Internet (the world’s largest network

consisting of millions of linked computers) (Morley, 2011).

Today, the Internet and the web enable people around the

world to communicate, interact, and share information

on a large scale for activities such as commerce, health

care, education, socialising, and gaming. However,

global inequality of access and knowledge of information

and communication technologies (ICT), known as the

digital divide

(Wei, Teo, Chan, & Tan, 2011) does exist.

Consequently, the Australian federal government has

recently begun rolling out its highly publicised National

Broadband Network (NBN) which aims to connect all

Australians to a high-speed web by 2020, enabling a

digitally supported economy (Department of Broadband,

Communications & the Digital Economy, 2011).

As an ICT infrastructure develops, it is the role of all

public sectors, including health, to utilise and plan for its

inclusion into a digital future. The first purpose of this paper

is to outline developments within telehealth, and work

Digital possibilities and

ethical considerations:

Speech-language

pathologists and the web

Grant Meredith, Sally Firmin and Lindy McAllister

Grant Meredith

(top), Sally Firmin

(centre) and

Lindy McAllister