JCPSLP Vol 15 No 2 2013_lores

49 / 60

JCPSLP Volume 15, Number 2 2013 99
Keywords
casuistry
clinical
education
ethical grid
ethics
This article
has been
peer-
reviewed
Michelle Quail
(top), Brooke
Sanderson
(centre) and
Suze Leitão
Traditionally, speech-language pathologists have adopted
a “principles approach” towards ethical reasoning (Speech
Pathology Australia Ethics Board, 2011). This approach
draws on the Speech Pathology Australia Code of Ethics
(Speech Pathology Australia, 2012) as the core basis for
decision-making but is less suited for use in proactive
planning. As a point of contrast, the casuistry approach
to ethical reasoning (Speech Pathology Australia Ethics
Board, 2011) encourages speech-language pathologists
to draw on their previous experiences and map these onto
the underlying principles of our profession to inform future
planning.
The Seedhouse ethical grid (Seedhouse, 1998) is a
useful tool (Figure 1) that can be applied within the casuistry
approach to facilitate ethical reasoning. The grid is made
up of four layers; at the core is the “Basis or rationale for
health care”, surrounded by “Duties aligning to key ethical
principles”, “Consequences” and finally the outermost layer,
“Other contextual factors”. The four layers within the grid
allow for the analysis of ethical issues at a range of levels,
from the principles-based core of the traditional approach
to broader considerations where consequences and effects
can be considered (Seedhouse, 1998). The grid can be
used flexibly, targeting the layers and components that
are most relevant for a particular issue (Body & McAllister,
2009). In this way, the grid supports speech-language
pathologists working through ethical issues by looking at
the whole story, rather than at the issue in isolation.
This tool is valuable in the context of clinical education
because of its multifactorial nature, which reflects the
complexities of clinical education beyond those that may
be represented by the principles alone. The process and
outcome of clinical education is dictated to a large extent
by the type and extent of experience of both the student
and the clinical educator. In this context, the use of the
Seedhouse grid within the casuistry approach (where
experience is of particular value) facilitates the opportunity
for dynamic and comprehensive ethical reasoning and
decision-making.
In this article, the casuistry approach will be used to
identify a number of key ethical challenges posed to all
stakeholders involved in clinical education and discuss
these within the multiple layers of the Seedhouse ethical
grid (Seedhouse, 1998). This article also provides a
framework which can be used to facilitate proactive ethical
reasoning and assist clinical educators in finding the
balance between their ethical obligations to their students,
their clients and themselves.
Ethical reasoning within the context of clinical
education is explored using the casuistry
approach to ethical decision-making through
the layers of the Seedhouse ethical grid (a
decision-making tool). The casuistry approach
guides clinicians’ actions by encouraging
them to map previous experiences onto the
profession’s underlying principles in order to
help them proactively plan for future clinical
education experiences. In this paper, we
present a model which highlights the unique
and delicate balance between the multiple
stakeholders involved in clinical education,
and the shift in responsibilities and
relationships that can occur. The need to
understand ethical decision-making
processes, be proactive with ethical thinking,
and ensure clarity in expectations is
discussed. A framework is proposed to assist
clinical educators in finding the balance
between their ethical obligations to their
students, their clients and themselves.
Ethical reasoning skills are fundamental to all
professional practice, allowing “the highest standards
of integrity and ethical practice” and creating the
foundation for evidence based practice (Speech Pathology
Australia, 2012, p. 3). Speech-language pathologists
constantly engage in a process of ethical reasoning when
making decisions on both a professional and a personal
level. This complex process is made more challenging
within the context of clinical education, where, given the
number of stakeholders, there is an ongoing shift in the
responsibilities and relationships for all involved. This
highlights the importance of proactive ethical planning
within clinical education.
The ethical issues that speech-language pathologists
face within the context of clinical education are unique in
origin but not in action. As for any area of clinical practice,
the use of theoretical frameworks in ethical reasoning is
an essential component of the decision-making process.
Ethical frameworks can assist us in not only working
through ethical problems, but also in being proactive in
preventing these.
Ethical conversations
Ethical reasoning in
clinical education
Achieving the balance
Michelle Quail, Brooke Sanderson and Suze Leitão