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JCPSLP
Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology
Journal of Clinical Practice in Speech-Language Pathology
Ethics in the workplace
Deborah Hersh
(top), Suze
Leitão (centre)
and Melanie
Breese
Deborah
Speech pathologists know about the importance of
presenting oral and written information in accessible ways,
using alternative and augmentative communication,
involving family members appropriately, adapting the
environment effectively to promote communication and
checking for feedback that information has been
understood. In addition, ethical principles can help guide
the process such as through respecting autonomy, veracity
or telling the truth, and beneficence or doing the best one
can to bring benefit to the client. However, it is also worth
stating the obvious – that the quality of the relationship and
the level of trust between clinician and client have a
contribution to making information accessible. Obtaining
informed consent for treatment is not just giving information
but involves sharing information, something which is more
effective when two people understand each other well.
Perhaps it is also worth adding that if the speech
pathologist is viewed as accessible (easy to talk to,
someone who really listens, someone who is available to
answer questions and provide reassurance), then it is more
likely that the information provided will be accessible too.
Suze
I agree. On a number of occasions, family members have
talked to me about their experiences with other therapists.
Sometimes, they have not really felt comfortable with what
was going on in therapy for their loved one, and have not
really understood the reasons behind it. However, this has
been difficult for them to tackle because of the assumption
that the therapist is the expert and must know what he or
she is doing. One of the suggestions I talk through with
them is to try to make an appointment to sit and talk
through the therapy process with the speech pathologist,
and ask questions about the goals, the reasons underlying
the approach, and the process itself. It seems as though in
these cases, the clinician has not been viewed as
“accessible”.
Melanie, in your clinical practice, how do you deal with
consent for treatment in people with dementia and
cognitive damage who have already been judged as
“lacking in competence”?
Melanie
I try to consider several ethical principles in these cases:
1. Respect for human life and dignity.
Suze
When most clinicians reflect on the topic of informed
consent, they tend to think about it in the research context.
The topic of this issue of
ACQ
– Communicatively
Accessible Healthcare Environments – made me reflect on
the role that informed consent plays in making healthcare
environments accessible for our clients. It reminded me that
informed consent is also critically important in making
decisions, for example, about treatment.
Deborah
Informed consent for treatment is “not a discreet event but
a process of information exchange and autonomous
decision making” (Berglund, 2004, p. 79). It involves sharing
and understanding the details, including benefits and risks,
and choices about treatment, making a voluntary,
competent decision, and being able to express that
decision. However, we know as speech pathologists that it
is precisely a difficulty with elements of that process which
often prompts a person to seek our services in the first
place. Informed consent for treatment can be a difficult area
when judging whether someone has decision-making
capacity, whether to rely on a family member as a proxy or
to refer for guardianship. For those with capacity but with
communication disorder, speech pathologists may need to
be creative about how to make information truly accessible.
So when we think about informed consent for treatment,
it is useful to look beyond the classic choice between
two medical procedures or signing on the dotted line of a
consent form (important as those may be) to also consider
how we might enable our clients to be more fully informed
and involved in negotiations about intervention. Body
and McAllister (2009) point out that access to meaningful
information is important for health, and reduces client and
carer stress. The timing, format, and manner of delivery are
all important. Information may need to be shared regularly
and reviewed over time.
Suze
Yes, there is a responsibility for us, as speech pathologists,
to make sure our healthcare environments and the
assessments and interventions we offer within them, are as
accessible as possible. We need to ensure we present
information in a clear and concise manner. We have to
remember that our clients, and their families, may not being
making a fully informed decision about the therapy process.
Sometimes, I think we assume that “implied consent” is the
same thing as “informed consent”.
Communicatively
accessible healthcare
environments
Ethics and informed consent
Deborah Hersh and Melanie Breese talk to Suze Leitão