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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology 47
populations who might benefit. In order to reach an ethical
decision in a rapidly expanding field, clinicians are reminded
to appraise any new strategy on its theoretical foundations
and evaluate these in relation to existing research and
published evidence on AAC. Clinicians need to be mindful
of the value of the full range of communication strategies
and techniques that might be necessary in addition to any
high technology options, including non-AAC intervention
(e.g., training communication partners to interpret
behaviours as communicative), unaided AAC (e.g., sign and
gesture), and low or light technologies (e.g., communication
boards, single message devices). A person’s
communication needs are not likely to be met with the
provision of one type of communication aid, and often a
range of multi-modal communication options need to be
explored (Beukelman & Mirenda, 2005).
Consenting to assessment
and intervention
According to the Speech Pathology Australia Code of
Ethics (2010), clinicians “strive to ensure informed consent
has been obtained from clients for the services we offer” (p.
2). Thus, people with complex communication needs must
be given the opportunity to provide informed consent to a
particular procedure or intervention, either directly or, in
situations in which they have been assessed as being
incapable of providing consent, through a proxy (primary
support person or legal guardian). Some people with
intellectual disability are deemed to be not competent in
decision-making about services and interventions. As such,
speech pathologists seek to gain informed consent from a
person responsible, involve the person with disability to the
level of his or her capacity, and strive to attain the ability to
recognise when the person’s assent is provided. Observing
the person’s behaviours and non-verbal communications
can assist clinicians in determining the person’s wishes, but
these interpretations should be checked with people who
know the person with disability well and are familiar with their
communicative behaviours (see Goldbart & Marshall, 2011).
It can be difficult to determine a person’s consent
for a service when the person does not already have a
functional method of communication. To address this
problem, clinicians may need to establish a functional
and effective method of communication with the person
with complex communication needs for the process of
obtaining consent for future decisions. Obtaining consent
would involve providing information about decisions in
formats that are accessible to people with communication
difficulty – an ethical imperative according to the World
Health Organization (2010). Communication supports for
the process of ascertaining the person’s willingness, assent,
or consent to decisions include accessible information
sheets and consent forms, information displays, schedules,
appropriate photographs, pictographs, sign or gesture
or objects to help the person participate in each decision
to the extent that they are able or desire. Reliance upon
a yes/no system is common in the early stages of an
AAC assessment. However, the person with complex
communication needs must have every opportunity to
participate with more than a yes/no response wherever
possible.
Ensuring that the AAC authentically
represents the voice of the person
The ethical principles of veracity or truthfulness and
autonomy also inform the design of AAC systems, which
to AAC that all practitioners need to be aware of. These
are:
• the ethical imperative to maintain and expand clinical
competence in AAC
• a rapidly expanding field
• consenting to assessment and intervention
• ensuring that the AAC authentically represents the voice
of the person
• ethical resource allocation in AAC: working within
available resources, and seeking to expand resources.
• mobile technologies: an expanding range of AAC
options
• risks to privacy and confidentiality in AAC
communications.
The ethical imperative to maintain and
expand clinical competence in AAC
Although speech pathologists will graduate with knowledge
and skill in the range of practice of multi-modal
communication (Speech Pathology Australia, 2011), there
are many clinicians in the field who have had limited clinical
experience in the area and who might actively avoid
introducing AAC because of their knowledge limitations
(Sutherland, Gillon, & Yoder, 2006). Indeed, few speech
pathologists feel competent in advising on AAC
interventions or developing AAC programs (Sutherland et
al., 2006). Communication is a fundamental characteristic
of human interaction (Kaiser & Goetz, 1993) and is
recognised as a human right (see United Nations, 2006,
Articles, 2, 3, 9, 16, 17, 21, and 24). People with
communication disorders should not be denied the
opportunity to communicate to the best of their ability and
in their preferred mode(s). Therefore, clinicians meeting
clients who would potentially benefit from AAC – that is,
those who cannot rely upon spoken language to
communicate – face an ethical imperative to maintain and
extend their skills where a demand or need for a service
exists. Their actions would include striving to practise the
highest standards of professional competence and
extending professional knowledge through professional
development, consulting the literature, collaborating with
more skilled members of the AAC team, and engaging the
support of a mentor or supervisor in the field (see the
Association’s Clinical Guideline on Augmentative and
Alternative Communication).
A rapidly expanding field
AAC is a dynamic and rapidly expanding field due to
advances in technology and active international research
endeavours. This situation has given rise to two important
ethical issues for clinicians in the field. First, an untested but
promising AAC intervention might be promoted directly to
consumers through social media and accompanied by
anecdotal evidence (e.g., blogs, YouTube videos) resulting
in consumer uptake prior to a formal assessment. Once
involved in assessing a person’s communication needs,
speech pathologists have an ethical responsibility to
conduct a full assessment, and consider all available
options and the potential risks and benefits of these prior to
recommending intervention options. This includes
consideration of options already selected by people with
complex communication needs and their families prior to
the assessment. Second, owing to the rapid expansion of
available assistive technologies, it might not be possible or
feasible for clinicians to keep abreast of all technological
advances of tools for AAC, or for any expansion in