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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology 35
interventions is made, will the speech pathologist lose a
client?
I began by saying real-life is complex and can be messy
and in the end, the evidence may or may not be clear about
the effectiveness of all our interventions. However, it IS our
ethical responsibility to know what the available evidence
tells us. Every individual client is different and will respond
to interventions differently. The best evidence needs to be
integrated with clinical reasoning in order to make ethical
decisions around service delivery for each of our clients.
References
Atherton, M. (2007). The workforce of the future: Key
trends, ethical considerations. Presentation given at the
2007 Speech Pathology Australia National Conference,
Sydney, Australia.
Gillam, R., Frome Loeb, D., Hoffman, L., Bohman, T.,
Champlin, C., Thibodeau, L., Widen, J., Brandel, J., &
Friel-Patti, S. (2008). The efficacy of fast forword language
intervention in school-age children with language impairment:
A randomised control trial. Journal of Speech, Language, &
Hearing Research, 51, 97–119.
Hoffman, L. (2008). ASHA Special Interest Division
1 – Discussion forum. Retrieved 19 June 2008
from http://www.asha.org/Forums/shwmessage.
aspx?ForumID=9227& MessageID=263
McAllister, L. (2006). Ethics in the workplace. ACQ, 8 (2),
77–80.
Reilly, S., Douglas, J., & Oates, J. (Eds). (2004). Evidence
based practice in speech pathology. London: Whurr
Publishers.
Speech Pathology Australia. (2000). Code of ethics. Mel­
bourne: Speech Pathology Association of Australia Limited.
This article was originally published as: Eadie, P., &
Atherton, M. (2008). Ethical conversations. ACQuiring
Knowledge in Speech, Language, and Hearing , 10(3),
92–94.
Pathology (Reilly, Douglas & Oates, 2004), the new
SpeechBITE™ initiative from Speech Pathology Australia
and the University of Sydney (http://www.speechbite.com/)
It is important to balance clinical expertise with the
necessity for evidence from systematic clinical trials of
interventions. For example, a randomised control trial
recently published by Gillam et al. (2008) draws some
important conclusions about different treatment conditions
(e.g., computer-assisted language intervention and
individualized language intervention) and the variety of
activities that can facilitate development. In a recent ASHA
forum, Hoffman (2008), a practising speech pathologist and
researcher, reflected on her experience of participating in
this large clinical trial:
For every child who ate a particular type of treatment
up with a proverbial spoon, there was one for whom
that treatment was as appealing as dry toast. It was
then that I truly understood the necessity of large scale
trials … I could see that clinical expertise is built on
individual results, it very clearly shows the trees, but
across a large scale that particular compass can’t
guide one out of the forest very well.
With the best available evidence on intervention
outcomes, a conversation between Geraldine and the
speech pathologist can begin to consider:
• the available evidence for each intervention type;
• what improvements Julie might be expected to make;
• what commitments, both time and financial, the family
will need to make;
• what language and educational support Julie can expect
to get within her school;
• any other information Geraldine would like to help her
with her decisions. This might include, for example,
research on long-term outcome for children with
language impairments.
This conversation must also lay plain the potential conflict of
interest for the speech pathologist – if a choice between