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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology 51
Ethical issues in augmentative and alternative communication
3. the appropriate communication device, aid or strategy
must be selected, with a particular focus on the
inclusion of the communication aid user or family
members, remembering the need for multi-modal
intervention;
4. advocacy for an individual using AAC is imperative to
enable the person to communicate effectively in the
face of many practical limitations.
The “Participation model” as described by Beukelman
and Mirenda (2005) provides practitioners with a
comprehensive framework for AAC assessment and
intervention. It identifies the barriers to participation that
must be addressed if a person using a communication
aid is to become a successful communicator. To
identify such barriers, a comprehensive assessment of
the skills and abilities of the communication aid user
(identify access barriers) is required, together with a
review of relevant factors in the environment (identify
opportunity barriers). Traditionally speech pathologists
have developed a high level of skill in dealing with the
individual with the communication difficulty, in this
case the AAC user and the access barriers related to
the individual. However, they also need to address the
opportunity barriers related to the environment in which
the person communicates. In reality, the essence of AAC
intervention is based on a balance between what is ideal
for the person, what the system provides, and what the
therapist can deliver.
The scenarios below highlight some of the ethical
issues AAC practitioners may face. These issues apply to
both electronic communication aids (e.g., a Dynavox™
or Lightwriter™) and non-electronic communication aids
(e.g., a picture-based communication book or board, or
alphabet board). In addition to these aided strategies,
they also apply to unaided strategies, such as key word
signing (e.g., Makaton). The issues that arise will be
considered within the ethical principles of: beneficence
and non-maleficence (do no harm); truth; justice
(fairness); autonomy; and professional integrity.
Case scenario: Jenny
Background
Jenny is a 4-year-old little girl with Down’s syndrome,
who lives with her mum Mandy, and 8-year-old brother, in
a small regional town. Jenny is starting to show signs of
frustration when she wants something and her mum
cannot understand what she wants. Jenny does not use
In this edition of Ethical conversations we consider
ethical issues that may arise when working with
people who require an augmentative and alternative
communication device. Communication is a basic
human right. This fact is at the core of all debate
about augmentative and alternative communication
(AAC) and ethical practice. Everyone has the right to a
means of communication. People have the right to the
communication aid and strategy that will enable them to
have the best quality of life.
I was happy with my communication device without
voice output, until I saw a voice output device.
Although it took months and months to acquire the
voice output device, I did not mind. I had something
to look forward to. Now I know the empowerment
of voice, I do not like being without it. I can manage
without voice output, but I do not like going back to
second best. (AAC user)
These rights have been clearly endorsed in the United
Nations Declaration on the Rights of People with Disability
(2006; http://www.un.org/disabilities/convention/facts.
shtml) to which Australia is a signatory. For the first time
ever, communication using an AAC device or strategy
is recognised as a legitimate means of communication
for people who do not speak, just as sign language
is recognised as the communication system used by
people who are deaf. As a signatory, Australia has made
a commitment to work towards practice of these human
rights for people who require and use AAC.
The complexity of providing AAC intervention is
embodied in the belief that “a communication disability
does not just belong to the individual. It belongs to the
entire environment of which that person is the focal
point” (Sandwell Centre, UK, personal communication).
AAC intervention cannot succeed without the inclusion
of people and issues related to the “entire environment”.
AAC intervention is also applied across a wide range
of disabilities and cognitive levels. It may include
electronic communication devices and/or non-electronic
communication aids and strategies.
For the speech pathologist working with an individual
who uses AAC, four areas of intervention are key:
1. all aspects related to the individual, including physical
ability, cognitive level, and diagnosis must be
considered;
2. focus must also be upon environmental factors which will
impact the success of the AAC intervention in real life;
Ethical issues in
augmentative and
alternative communication
Barbara Solarsh and Meredith Allan
Barbara Solarsh
(top) and
Meredith Allan