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JCPSLP
Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology
Journal of Clinical Practice in Speech-Language Pathology
Ethical issues in augmentative and alternative communication
Bronwyn
Hemsley
range of practice of the Competency-Based Occupational
Standards (CBOS) for speech pathologists (Speech
Pathology Australia, 2011), existing theoretical frameworks
(e.g., participation model of AAC, the International
Classification of Functioning, Disability, and Health [World
Health Organization, 2001]), and the Speech Pathology
Australia Clinical Guideline on Augmentative and Alternative
Communication (2012b) are useful resources to help
guide clinicians in arriving at good clinical decisions. If at
all possible, at all stages in the process of providing AAC
services (see the participation model of AAC, Beukelman &
Mirenda, 2005), the person with complex communication
needs and their communication partners are engaged in
informing and making decisions on the course of action for
intervention (Williams, Krezman, & MacNaughton, 2008).
As do professionals in other areas of practice, speech
pathologists will continue to be confronted with situations
where the course of action might not be clear to all parties
involved in the decision. Complexities arise in clinical
decisions about communication interventions as people
with severe communication disabilities frequently have high
support needs owing to physical or cognitive impairments
and many areas of life participation are affected.
Ethical decision-making with the person with complex
communication needs or any other person responsible
includes consideration of: the facts on assessment findings,
all available intervention options and associated evidence,
risks and benefits associated with each course of action,
and values and beliefs of those involved in and affected
by the decision. Tension might exist between doing what
one
ought
to do and doing what one might be
able
or
supported to do within the clinician’s competencies and
available resources, wishes of the client, and workplace or
residential care policies. As such, it is important that speech
pathologists apply not only the Code of Ethics of the
Association (Speech Pathology Australia, 2010), but also
a theoretically sound ethical decision-making framework
(e.g., Speech Pathology Australia, 2002, 2012a; Markula
Centre, 2012). Arriving at an ethical decision also requires
consideration of a person’s rights (see United Nations
Convention on the Rights of Persons with Disabilities, 2006)
and legal position, as well as risks or benefits relating to
many other aspects of the person’s life and preferences.
Other ethical considerations
In addition to the general principles and issues noted
above, there are a number of ethical considerations relating
In this “Ethical conversations” some common
ethical issues and resources relevant to the
provision of augmentative and alternative
communication (AAC) or multi-modal
communication in Australia are discussed.
Guiding theoretical frameworks and
Association documents are related to topical
situations in speech pathology management
in populations with complex communication
needs. This paper is not intended as a review
of the literature or as a guideline in relation to
AAC practice which is forthcoming in the
Association’s Clinical Guideline on
Augmentative and Alternative
Communication. Rather, common issues that
might confront clinicians in the dynamic field
of AAC are discussed in the light of existing
theoretical frameworks and Association
documents. Bringing these issues to light at
this time of rapid change in the field may help
clinicians to arrive at good decisions to the
benefit of people with complex
communication needs and their families.
Guiding frameworks and principles
According to the St James Ethics Centre (n.d.), “Ethics is
about answering the question ‘What ought I to do?’” – a
question that arises in any clinical decision, ideally well
before any conflict or dilemma might arise. In recognition of
the importance of ethical decisions in speech pathology,
there are several resources pertaining to ethical practice
(see Body & McAllister, 2009; Chabon, Denton, Lansing,
Scudder, & Shinn, 2007; Speech Pathology Australia, 2002,
2010, 2012a) that are relevant in (a) assisting clinicians and
all stakeholders to arrive at good, balanced, and evidence
based decisions that are in the best interests of the person
with complex communication needs, and (b) providing
guidance to both prevent and resolve conflicts and
establish positive working relationships among all those
affected by a decision.
In the dynamic field of augmentative and alternative
communication (AAC), the multi-modal communication
Ethical issues in
augmentative and
alternative communication
Bronwyn Hemsley