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JCPSLP
Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology
Journal of Clinical Practice in Speech-Language Pathology
views of the patient/client and their carers, and the
strength, experience and limitations of individual disciplines.
Teamwork efficiency is promoted by clear team and
organisational processes which support teams in their
efforts to be effective and efficient (Clark et al., 2007).
In reviewing teamwork within an ethical framework, the
principles of beneficence, non-maleficence, truth, integrity,
respect for autonomy and justice must be considered by
the interprofessional team and should be reflected in how
clinical decisions are made (Clark et al., 2007; SPA 2010).
For example, an effective family meeting may involve a
treating team “pre-meeting” to explore treatment options
and ensure a shared understanding of the current clinical
picture before presenting the realistic achievable options to
patients and their families. It could also include discussion
in relation to how team members can demonstrate mutual
respect for each contribution to the patient’s goals.
Clark et al. (2007) propose a conceptual framework
to assist health care teams to understand the ethical
parameters of interprofessional teamwork. This comprises
three elements which function at individual, team and
organisational levels:
•
Principles
– general guidelines for behaviour based
on ethical concepts. For example, accepted practice
standards of the professions in a team.
•
Structures
– formal and informal processes which
include forms of knowledge and patterns of behaviour
for individuals and collectively related to teamwork within
an organisation. For example, shared awareness of the
practice of other professionals on a team.
•
Processes
– procedural factors of interprofessional
practice. For example, the development of open
communication and dialogue.
The use of such a framework can assist speech
pathologists and their teams to further the “discourse
on interprofessional ethics” (p. 601) in order to better
understand these issues and develop solutions to address
them (Clark et al., 2007). Furthermore, collaboration
should be understood as a human process as much as a
professional one, encompassing both what we know and
who we are (D’Amour et al., 2005).
An interprofessional ethic of care therefore may better
facilitate patient-centred decisions, particularly if considered
within a reflective framework such as the one described.
IPC practice-based interventions
IPC practice-based interventions are strategies put into
place in health care settings to improve work interactions
and processes between two or more types of health care
professionals (Zwarenstein et al., 2009). In their review of
the literature, Zwarenstein and colleagues (2009) describe a
small number of promising activities which were shown, to
varying degrees of robustness, to have positive effects on
IPC. These included interprofessional rounds,
interprofessional meetings and externally facilitated
interprofessional audit processes.
Speech pathologists may have the opportunity to
participate in these forms of interventions in their workplace
and, where interprofessional skills are not practised,
consider advocating for their adoption. For instance,
they could reflect on how ward rounds and meetings
may be adapted so that perceived power imbalances
could be addressed allowing for more opportunities
for shared goals and planning. In considering resource
allocation, organisations may also need to empower health
professionals with the necessary time to participate in IPC.
Interprofessional education
Interprofessional education (IPE) is also seen as one area
which may offer a potential avenue for improved
collaboration and patient care (Reeves et al., 2008). IPE
facilitates an opportunity for different health professionals to
engage in shared learning in order to improve collaborative
practice and the health care of patients. It therefore has
greater potential for improving IPC than multidisciplinary
(where there are shared learning experiences but no
interaction) or uniprofessional education (where
professionals learn independently from one another)
(Reeves et al., 2009). Further detailed information in relation
to interprofessional health education can be found in the
comprehensive literature review completed by the Learning
and Teaching for Interprofessional Practice (LTIP) Australia
project team (2011).
It is noted that application of an interprofessional
approach is growing in student education by higher
education providers (LTIP, 2011). A work culture that
facilitates this practice is thus important so that students do
not disengage when they enter the workforce.
Expanded scope of practice
Currently in Australia, there is much discussion about
expanded scope of practice roles particularly for nursing
and allied health practitioners; for example, see work
undertaken by Health Workforce Australia (2013). These
changes in understandings of professional boundaries may
lend themselves to conflict and concerns both intra- and
interprofessionally (Shulman et al., 2009). For instance, the
concept of speech pathologists being credentialed to
independently perform FEES or suction through a
tracheostomy has led to much controversy in some work
places in relation to competency and to issues of potential
quality and safety impacts.
Implications for speech
pathologists
As members of the health care team, speech pathologists
play an important role in the successful application of
interprofessional clinical and team-based care in practice.
However, as we have endeavoured to demonstrate,
interprofessional ways of working may result in speech
pathologists facing a range of complex ethical challenges.
In updating and revising the 2002 SPA Ethics Education
Package, the SPA Ethics Board has taken the approach
of encouraging speech pathologists to integrate ethical
decision-making into every day practice, including the way
in which ethical dilemmas are viewed and the approaches
taken to resolve them. To assist this process, the existing
Ethics Education Package
is being updated and revised
to include additional protocols and tools designed to help
clinicians to explore, better understand and resolve ethical
issues.
These tools provide an excellent resource to assist
speech pathologists grappling with issues in relation to
interprofessional collaboration. Clinicians are encouraged to
reflect on these issues as relevant to their own context and
to explore ways to improve interprofessional practice in the
interests of enhanced patient care.
Conclusion
As stated in the profession’s Code of Ethics, speech
pathologists observe the highest standards of integrity and
ethical practice as a fundamental professional responsibility
(SPA, 2010). In undertaking this work, speech pathologists
are obliged to consider our clients in a broad context and in