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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology 53
Conclusion
The two scenarios outlined above demonstrate that AAC
practice is highly complex, with many factors influencing the
outcomes from the preschool classroom to the courtroom.
Further, although people who apply to the Aids and
Equipment Programs for communication aids across the
country usually do receive a device, funding differs
markedly between states. In Victoria, for example, 700
communication aids are allocated per year, where statistics
indicate there are 10,220 people with complex
communication needs (ABS, 2006). Our concerns are not
only with those who never receive the AAC intervention they
require, but also with those who do receive an AAC device
without the appropriate support. When technology fails
repeatedly, the desire to communicate decreases (Williams,
Krezman, & McNaughton, 2008). Our journey towards
ethical practice and AAC has just begun – a long road lies
ahead.
References
Australian Bureau of Statistics (ABS). (2006). http://www.
abs.gov.au
Beukelman, D.R., & Mirenda, P. (2005). Augmentative
and alternative communication: Supporting adults and
children with complex communication needs . Baltimore,
MD: Brookes Publishing.
Williams, M.B., Krezman, C., & McNaughton, D. (2008).
Reach for the stars: Five principles for the next 25 years of
AAC. Augmentative and Alternative Communication, 24 (3),
194–206.
1. Also known as CAUS – Communication Aid Users Society
http://www.caus.com.au/
2. Communication support worker (CSW): CSWs are specifically
trained to understand a range of communication methods and
devices, and support and/relay communication from a person
with little or no speech to another person (Communication
Rights Australia)
support workers (CSW), none of whom are available at that
time. If Rachel could find someone to take that role, CRA
would offer the required training. It is very important that the
communication support worker understands the CRA Code
of Ethics (http://www.caus.com.au/Products/tabid/57/
Default.aspx) which must be complied with in carrying out
this role, to ensure that the message conveyed is what the
communication aid user intended and is not influenced by
the CSW. In addition to training the communication support
worker, CRA would also need to train members of the legal
team about hearing evidence from a person who uses a
communication aid and the role of the CSW.
Ethical dilemmas
Beneficence and non-maleficence: The issue of the court
case was brought up at the last funded speech pathology
session. Susie is in the best position to prepare Rachel for
the court case, but time for an application to TAC for
additional speech pathology hours is short. As Susie knows
Rachel’s parents would not be able to afford the fees,
should she provide a few additional sessions to Rachel in
the hope that money will be forthcoming? Preparing the
word-based communication board would certainly take 2–3
sessions to ensure that the correct vocabulary and
information was included. Having someone who is not
adequately skilled design the communication board, or not
having the communication board at the hearing could
compromise the strength of Rachel’s evidence.
Truth: Susie prognosticated early on in therapy that
Rachel’s dysarthria was severe and that she would need
AAC to meet her communication needs in the future.
However, Rachel has only reluctantly agreed to get a
Lightwriter™, which she finds frustrating due to the slow
pace of communication. Susie has continued to do basic
speech therapy while encouraging practice of the
Lightwriter™. She has wrestled with where to put the
emphasis of therapy, however, and now feels that Rachel
needs more therapy to support her to use the Lightwriter™.
TAC has indicated that Rachel should now have a break in
therapy. Susie knows Rachel needs a number of different
ways of communicating, but she feels she has not been
able to achieve this.
Justice: TAC has funded a significant number of speech
pathology hours as well as providing attendant care dollars.
Even if additional therapy hours are allocated after the
6-month break, it will not help Rachel with the court
hearing. Rachel obtained her Lightwriter™ from the Aids
and Equipment Program (http://www.dhs.vic.gov.au/
disability/supports_for_people/living_in_my_home/aids_
and_equipment_program), but Susie feels there are other
communication devices that Rachel could try when she is
ready.
Autonomy: Susie feels that Rachel’s dysarthria is unlikely to
improve further and that Rachel would be advised to use
her Lightwriter™ or word communication board in court.
However, Rachel wants to use speech and only revert to
AAC if necessary. This is her choice, although it is Susie’s
view that it may not be in her best interest.
Professional integrity: If Susie was to act as the CSW, she
would need to be trained by CRA even though she is a
qualified speech pathologist. She would need to be aware
of and understand the CSW Code of Ethics. Susie would
also have to accept that she would not be paid speech
pathology fees, but at the rate of a CSW.
Barbara Solarsh works at the Communication Resource Centre,
Scope, and for the Bendigo Health Regional Communication
Service. She has worked extensively in the field of disability in
community-based settings, both in rural South Africa and in
regional Australia, and has been involved in multi-professional
student training. She has a strong interest in the ethics of
sustainable interventions in underresourced areas. Meredith
Allan is a person who uses Augmentative and Alternative
Communication (AAC). Meredith is one of the very few AAC users
in Australia in the full-time open employment workforce. She was
a member of the Speech Pathology Australia Ethics Board from
2002 to 2008.
Correspondence to:
Marie Atherton
Senior Advisor Professional Issues
Speech Pathology Australia
Level 2, 11–19 Bank Place,
Melbourne VIC 3000
email:
This article was originally published as: Solarsh, B., & Allan,
M. (2010). Ethical issues in augmentative and alternative
communication. ACQuiring Knowledge in Speech,
Language, and Hearing , 12(2), 93–95.