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JCPSLP Volume 15, Number 2 2013 101
order to receive a service and be provided with support,
this also applies to the student – who attends the clinic to
receive support and guidance from the clinical educator.
Ethical planning is a practical strategy that can support
a balanced approach. A key component to this is the need
for transparency. Ensuring clarity among all parties underlies
the success of almost every aspect of clinical education.
There is a need for clinical educators, students and clients
to take an objective step back and discuss the processes,
relationships, responsibilities and expectations. Examples
of focus questions are provided in Table 1. This will be
facilitated by reflection on past experiences and drawing
on successes. Such a pro-ethical step could be embedded
by providing this level of detail within orientation packages
and materials placed in waiting rooms in an effort to prevent
potential ethical dilemmas from arising.
Duties aligning to key ethical principles
This layer of the grid aligns closely with that of the SPA
Code of Ethics (Speech Pathology Australia, 2012),
specifically addressing the principles of truth, fidelity,
beneficence and non-maleficence. Beneficence in the
clinical education context extends beyond the common
understanding of ensuring the “most positive good”
(Seedhouse, 1998) for our clients. It also encompasses
responsibility towards the student, and is dependent on
understanding the role clinical educators play in student
learning. It is suggested that clinical educators spend time
discussing the code with their students and reflecting on its
application to clients and clinical experiences (see Table 1).
The key component in this relationship is education.
As a clinical educator, the speech-language pathologist is
responsible for teaching, nurturing and providing feedback.
This involves taking responsibility for imparting, rather
than only expecting knowledge. Herein lies the difference
between clinical education and supervision – those who
teach and develop skills and those who monitor and assess
skills (McAllister & Lincoln, 2004). McAllister and Lincoln’s
(2004) discussion of clinical educators creating learning
contracts for themselves (in addition to using these with
their students) is a valid suggestion which emphasises
that they too need to be constantly reflecting on their
performance and experiences.
The past experiences of a clinical educator provide
significant support for decision-making if these situations
arise again. For example, when supervising a marginal
student, the clinical educator needs to take responsibility
for their role as a “gatekeeper” for future professionals,
and be honest with the student in giving them the required
feedback. These difficult decisions and discussions align
with the concept of truthfulness and loyalty, and reflecting
on previous experiences and drawing on past successful
outcomes can assist in supporting the clinical educator with
their current decision-making.
Consequences
The next layer of the grid considers a broader perspective
of ethical issues, and the potential consequences for
society, students, clients and clinical educators themselves.
For example, when considering the most beneficial
outcome for the student, the clinical educator may wish
to select clients taking into account the requirements of a
student to develop specific competencies, the level of skill
of that student and the limitations and opportunities of the
workplace. However, this may come into conflict with the
This paper will now explore some of the recurring ethical
issues that arise in clinical education, in particular those
related to balancing the needs of the client and student,
drawing on the casuistry approach and the ethical grid as a
tool (Seedhouse, 1998). The grid is presented in four layers
to highlight the need to consider these four aspects in a
comprehensive ethical analysis of a situation. It can be used
in many ways, and in this context we have chosen to start
in the innermost layer and work outwards.
Basis or rationale for health care
The core of the ethical grid addresses the key concept of
autonomy – specifically, the need to both respect and
create the opportunity for all parties to be actively involved
(Kummer & Turner, 2011). This concept underpins the
delicate balance depicted in Figure 2, in that clinical
educators are attempting to balance the opportunity for
students to develop independence, while ensuring the
clients are actively involved in the therapy and decision-
making process. The clinical educator also needs to
respect the autonomy of the client and their family to
provide and withdraw consent for working with a student at
any time, while respecting the autonomy of the student in
acknowledging and encouraging perspectives and opinions
different to their own. Although the client is attending in
Responsibility
Clinical educator
Student Client
University Profession
Figure 2. The clinical education balance
Profession
Client
University
Responsibility
Clinical educator
Student
Figure 4. The student focused clinical education balance
Profession
Client
University
Responsibility
Clinical educator
Student
Figure 3. The client focused clinical education balance