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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology 25
interacting qualities of experience: the outside world, one’s
own behaviour, thought and feeling, and intuition, intention,
and consciousness. He believed that while the outside
world can be accessed through our senses, the other three
qualities are accessible only through attuning our attention
to their interplay. He believed that normally we “do not
educate our attention to commute between figure, ground,
and region, among focus, feeling, and intention, among
task, process, and purpose” (Torbert, 1978, p. 112), to
achieve a higher quality of attention. Torbert (1978) argued
that a heightened awareness, what he called a “higher
quality of attention”, becomes a constant state of being in
experienced professionals. In contrast, for less experienced
professionals, awareness requires a deliberative focus
(Dreyfus & Dreyfus, 1985).
Deliberative focus (a cognitive process) on potentially
ethically challenging situations is likely to be difficult for less
experienced professionals to sustain amidst the myriad
of things to which they must pay attention. However,
recent work in emotional intelligence (Goleman, 1995), in
professional reasoning in nurse educators (Titchen, 1998)
and in reasoning in clinical educators (McAllister, 2001),
highlights the role of intuition and feelings in bringing
heightened emotional awareness to professional work.
Titchen (1998) in her critical companionship model,
identified a rationalityintuitive domain which she saw as
a blend of technicalrational and intuitive approaches to
educating. Two of the concepts identified by Titchen in this
domain, intentionality (conscious self-aware thoughtfulness)
and saliency (the ability to know consciously or intuitively
what is important), are useful concepts for consideration
in developing ethical and moral reasoning. McAllister
(2001) found that participants in her study both intuitively
and consciously knew what was important to attend to.
Further, as described in Titchen’s model, they used both
conscious and intuitive levels of awareness, depending on
experience and ability, what seemed important at the time
and what factors were influencing attention levels. The
more experienced clinical educators used conscious and
intuitive levels of both cognitive and emotional awareness.
Less experienced educators relied more on emotional
awareness but could later think through information
obtained through intuition and what they referred to as
“gut feeling”. Mentoring, supervision and professional
development would have therefore important roles to play
in helping less experienced professionals utilise feelings
and emotions about ethical situations to develop ongoing
cognitive awareness and ethical reasoning.
In the absence of an evidence base on developing ethical
awareness and reasoning, there is a need for research
which could inform systematic professional development
of ethical and moral reasoning. I would encourage the
profession, at both workplace and association levels,
to develop professional development programs aimed
at raising consciousness about ethics, heightening
awareness of potential ethical issues and learning to
think and act ethically in ways that are deeply embedded
in routine practice. These skills and attributes would be
additional to skills in identifying and resolving dilemmas.
Such professional development could consist of formal
presentations, discussion groups about real or hypothetical
ethical issues and dilemmas, and regular case reviews.
There remains however, the need for individual speech
pathologists to develop their own ethical reasoning.
Reflection-on-practice is a hallmark of professionals (Schön,
1987). This could be extended to include reflection on
ethical practice, using whatever tools sit most comfortably
Ethics in ordinary everyday practice
In her role as Vice-President Communication of Speech
Pathology Australia, in a review of major types of
complaints to the Ethics Board of Speech Pathology
Australia, Russell noted that some major reasons for
consumers’ complaints are due to failure of speech
pathologists to think and act ethically about ordinary events
amidst busy professional lives (personal communication, 1
May 2005). Clients complained about their concerns over
what they were being billed for and perceptions of
overbilling, and about reports not being provided in a timely
fashion. These two scenarios are avoidable by using good
planning skills to make time for paper work, including report
writing, and good communication skills to explain what we
are doing and why. Problems that may prevent honouring
agreements, such as sending reports within the agreed
timeframe, need to be discussed. There are many other
potential sources of complaint arising in ordinary clinical
practice. Many are related to failure to explore the
assumptions, expectations and emotional needs of clients
and to consider these in communicating clinical
management decisions, for example, those pertaining to
service delivery models and therapy approaches offered,
and discharge planning (Hersh, 2003). “Thinking ethically”
would allow professionals to pre-empt such situations by
sensing and discussing concerns clients might have and
addressing them before they become problems.
Becoming ethically aware and
thinking ethically
What would it mean to be always thinking and acting
ethically in the workplace? According to Purtilo (1999), this
would mean acting as a “moral agent” in the workplace,
acting with personal integrity, despite personal and
professional costs that may ensue. We may have to engage
in conflict with management when polices or management
decisions block our ability to act with integrity. We may
need to engage in difficult discussions with staff who are
not acting beneficently towards clients, not honouring
clients’ rights to autonomy, not pursuing justice for their
clients, and perhaps even acting maleficently by not being
competent to provide services they are, or should be
offering, in line with best practice. We may, in extreme
cases, need to report colleagues to supervisors/managers,
or to the Ethics Board. Such acts require courage and
support from mentors, supervisors or colleagues. At the
very least, acting as a moral agent in the workplace means
seeking to raise awareness in others about ethical issues,
through conversation, role modeling or professional
development.
Professional development of ethical
reasoning
How can we increase our ethics awareness and abilities to
think and act ethically? There is little research into ethical
reasoning and conduct in speech pathologists. I would
suggest that, like most professional skills, ethical and moral
reasoning develop with experience, and that this development
can be supported through mentoring, workplace
supervision and professional development programs.
Benner (1984) noted that with increasing expertise,
skills become automatic and require little conscious
attention, unless a novel or extraordinary situation arises.
“Being aware” also becomes somewhat automatic with
experience. Torbert (1978) suggested that there are four