JCPSLP Vol 17 Supplement 1 2015_lores

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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology 27
Ethics in the workplace
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accurate information, strive for equality in service provision,
respect the rights of our clients to self-determination, maintain
competence in our practice, and honour professional
commitments (Speech Pathology Australia, 2002). The bio­
ethical principles, described in the Code of Ethics, provide
an aspirational guide rather than rigid rules of ethical
practice. Thus, speech pathologists must interpret and
apply these principles in their individual work settings.
What is an ethical dilemma?
Clinical decision-making often requires a professional to
consider more than one ethical principle. An ethical
dilemma may arise when there is a conflict among personal
and/or professional values, organisational philosophies and
expectations for standards of practice. Such conflict poses
a problem in making decisions based on standards of
fairness, justice and responsibility (Hinderer & Hinderer,
2001). For example, a speech pathologist may be
concerned that providing a client with an accurate diagnosis
and prognosis may adversely affect a client’s motivation to
participate in a rehabilitation program. The ethical principles
of truth, autonomy, beneficence/non-maleficence and
professional integrity may be at stake in this dilemma
between the client’s “right to know” and the professional’s
intention to avoid harm by controlling the content or timing
of information. This dilemma may be further complicated if
carers request that medical information is withheld from a
client. Additionally, conflict may occur between principles of
autonomy and beneficence when clients or carers refuse
intervention or seek support for quality of life decisions with
potentially harmful medical consequences. The client’s right
to self-determination is at odds with the professional’s
desire to benefit the client by providing evidence based
practice.
Further ethical conflict may stem from caseload
management policies. Speech pathologists managing large
caseloads and long waiting lists may experience ethical
conflict between principles of fairness (providing an equal
but limited service to many clients) versus beneficence
(providing a quality service to a small group while others
remain on the waiting list). The caseload management
strategy of withdrawing treatment in response to clients’
poor attendance or compliance with home activities is
also ethically fraught. Is it fair that Jack, who has a severe
language disorder but inconsistently attends treatment
sessions, should receive ongoing intervention when
there are many clients on the waiting list who may derive
significantly more benefit from the service? Will Jack be
Ethics in clinical
decision-making
Belinda Kenny
Ethics are an integral factor in effective
clinical decision-making. While codes of
ethics do not provide a recipe for resolving
ethical dilemmas, knowledge and open
discussion of bioethical principles may
facilitate ethical practice in the speech
pathology profession. This paper focuses
upon some of the ethical issues that may
confront speech pathologists in
contemporary health care practice and aims
to facilitate discussion of ethical practice in
the speech pathology profession.
Ethics seek to determine how human actions may
be judged right or wrong (Garrett, Baillie & Garrett,
2001). Professional ethics encompass diverse aspects
of clinical work including intervention planning, management
and outcome evaluation. Furthermore, professional ethics
are important when defining professional relationships
with clients, carers, managers and the community. While
ethical decision-making may be focused towards doing the
“right thing”, the complexities of clinical practice may present
challenges for a speech pathologist. Unfortunately, it is
not always easy to determine the “right thing” when there
may be differences between clients’ and professionals’
perspectives of good health care outcomes, quality of life
and expectations for standards of care. Clinical decision-
making may require speech pathologists to examine “grey
areas” in client management where there may be multiple
“half right” or “not as bad” options. Consider, for example,
the issues encountered by a speech pathologist who is
managing the swallowing and communication needs of
a young adult diagnosed with a progressive neurological
disorder in a community setting. What is a “good” versus
harmful outcome for this client?
Professional associations, including Speech Pathology
Australia, have developed codes of ethics to guide
members’ decision-making towards “right” or “good”
actions and outcomes consistent with professional values.
Our Code of Ethics identifies five bioethical principles:
beneficence/non-maleficence; truth; fairness (justice);
autonomy; and professional integrity (Speech Pathology
Australia, 2000). Adhering to ethical principles is the
hallmark of professional behaviour. To practice ethically,
speech pathologists are urged to seek benefit and avoid
harm to others, to tell the truth, deal fairly with others, provide