JCPSLP Vol 17 Supplement 1 2015_lores

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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology 3
Emerging trends in contemporary ethical issues
KEYWORDS
ETHICS
EVIDENCE-
BASED
PRACTICE
HEALTH
WORKFORCE
POPULATION
TRENDS
RESOURCE
ALLOCATION
SCOPE OF
PRACTICE
T he speech pathology profession has undergone
significant change over the past 15–20 years, and
these changes have important implications for the
ethical practice of speech pathology. The knowledge and
skill-set of the discipline have changed dramatically due
to both internal and external forces. Changes in work
settings, types and complexity of clients, new technologies
in health care, and reimbursement for services continue
to raise new challenges for speech pathologists as they
seek to implement evidence-based ethical practice.
Emerging technologies that can be used for telehealth,
a growing trend for working in developing countries, and
social models of practice offer exciting opportunities for
expanding our practice along with increased risks to ethical
practice.
Key trends impacting on
ethical practice
A number of key trends raise the possibility of ethical risks
to speech pathology practice as a whole.
Increasing health demands from an
ageing population
The fact that Australia’s population is ageing contributes to
an increasing need for health services both in primary and
tertiary care (Australian Government Productivity Commission,
2005). The increasing demand for limited health services
poses a number of ethical considerations for the health
practitioner. There is a need to ensure the limited health
dollar is used most effectively and efficiently, but also to
determine, at a transparent level, who will benefit from the
limited health dollar and who will miss out. Often the
speech pathologist must adhere to the directives of
individual organisations regarding prioritisation of caseload,
while at the same time making independent decisions
regarding how prioritisation should look. This often presents
many ethical challenges for clinicians who must work hard
to meet both client and organisational needs in an ethical
manner.
Furthermore, the increasing demographic of well-
educated, articulate and financially well-off elders will
see a rise in demand for more intensive and conveniently
located services, in community settings and/or client’s
homes. The challenges and opportunities this will pose
in relation to service provision by speech pathologists
are likely to include the increasing use of allied health
assistants, the use of telehealth and an increased emphasis
The significant societal, systemic and
technological changes of the past two
decades have contributed to a number of
specific challenges that the health system
now faces. The increasing diversity and
sophistication of health technology, the
proliferation of legislation, the ageing health
workforce and changing community
demographics are key trends impacting on
the future viability of health service provision
within Australia and internationally. These
trends will also impact on health
practitioners’ ability to provide care that
meets demand while simultaneously meeting
the moral and ethical considerations which
are inherently tied to health service provision.
In 2006, Speech Pathology Australia members
identified a number of key ethical concerns
related to these trends and challenges,
including not only those that arise at an
individual client–practitioner level but also at
a systemic level. Specifically, Speech
Pathology Australia members expressed
concern regarding prioritisation of services,
the impact of fiscal constraints on service
delivery, and the potential for conflict
between professional values and values that
may underpin management decisions and
health policies. Ethical issues associated with
the delegation of tasks, the need for
continuing professional development and the
use of evidence-based practice were also
identified. For the profession to meet current
and future challenges, it is essential to remain
vigilant and responsive to trends and
changes that will impact on service provision.
Practitioners must also demonstrate an
ethical awareness that extends beyond
specific “ethical dilemmas” as may arise in
clinical practice to thinking and acting
ethically in our daily routines.
Emerging trends impacting
on ethical practice in
speech pathology
Marie Atherton and Lindy McAllister