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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology 5
in which they work meet the requirements of minimising
risk and harm, while at the same time facilitating new skill
development and ongoing expansion of the profession.
Community expectations
Through access to the Internet and other forms of media,
consumers are now better informed about health care
services. They have a greater expectation that services
provided will reflect best practice and will provide value for
money. This expectation requires practitioners to remain
abreast of current knowledge and practice, and the
information gleaned will arm consumers with the confidence
to question practices which may be inappropriate or
outdated. In addition, consumers may request services they
have read or heard about which our profession considers to
be unsupported by evidence. Speech pathologists will
therefore need to be aware of the evidence across the
range of their practice and be able to explain and defend
their recommendations for management.
Increased consumer expectations will also inevitably
lead to demand for more convenient location of services,
including services closer to home and actually in the
home. Practitioners therefore will need to consider new
models of service delivery. As services increasingly move
from secondary and tertiary medical settings to primary
care (community-based) settings, practitioners may need
to extend their repertoire of skills in needs assessment,
training of others, delegation of tasks and supervision and
mentoring of assistants, volunteers and carers.
Telehealth offers considerable promise for more flexible
community-based and domiciliary service delivery. Elspeth
pathology using high-end video-teleconference suites
is already in use across Australia, enabling practitioners
in major centres to provide services to rural and remote
clients. Elspeth pathology using web-based delivery into
clients’ homes is rapidly becoming an option (Theodoros,
2008). These developments raise a number of ethical
and legal concerns including maintaining privacy,
confidentiality and security of information transmitted
and held in electronic health records (Stanberry, 2000);
ensuring standards for providing legally and professionally
recognised services (Reed, McLaughlin & Milholland,
2000); and sorting out issues of reimbursement for
services delivered by telehealth (Chetney, 2002). A growing
ethical concern about telehealth in any form (via video-
teleconference suites or webcam) is the impact it may
have on what Stanberry (2000) refers to as the “traditional
clinician–patient relationships” (p. 615). Cornford and
Klecun-Dabrowska (2001) caution against “substitution of
care with treatment” (p. 161). Speech pathologists do not
yet have enough experience with telehealth to know how it
impacts on consumer satisfaction with services.
The views of Australian speech
pathologists regarding emerging
ethical risks to practice
The authors ran a workshop at the National Conference of
Speech Pathology Australia in Sydney in May 2006 to
ascertain what Australian speech pathologists perceived as
emerging ethical risks to practice. After a brief presentation
summarising some of the above trends, some 50 speech
pathologists were asked to discuss in small groups and
then summarise emerging ethical issues. These are
presented in table 1. The emerging ethical issues identified
by workshop participants fell into 10 categories of concern.
make ethical decisions around service delivery for each of
our clients” (p. 94). Undoubtedly, it is an ethical
responsibility for individual clinicians to know what the
literature says and what the available evidence is.
It is also critically important that speech pathologists stay
abreast of developments in clinical knowledge and practice
by engaging in continuing professional development
(CPD) – this is an ethical responsibility, as reiterated in
the Association’s Code of Ethics (2000): “We strive to
continually update and extend our professional knowledge
and skills… and work towards the best possible standards
of service to our clients” (p. 3).
Ethical concerns may arise, however, when due to
caseload and other demands, time is not available to
undertake CPD and/or access to relevant facilities and
technology, such as the Internet, is restricted. This may be
particularly the case for those services limited by budget
and for those clinicians in rural and remote areas where
access is not reliable. Such situations raise questions
of “whose responsibility is it to ensure competence
and fitness for practice: the employer’s or the speech
pathologist’s?” Where employers decline or are unable to
support CPD, our ethical duties to clients and colleagues
and the profession mean individual speech pathologists
must assume responsibility (and cost, in dollars and time)
for their own CPD. The means by which a practitioner ensures
currency of knowledge and ongoing fitness to practise may
require creative and lateral thinking. A willingness to access
mentoring, to engage the assistance and expertise of
colleagues, as well as devote time to ongoing education
may conflict with long waiting lists and organisational
targets.
Extended scope of practice
The ongoing development of our profession together with
workforce re-engineering precipitated by the health
workforce shortage will lead to changes in our scope of
practice. At one end of the continuum, scope of practice
will extend to include roles and tasks not currently part of
our practice, and at the other end our scope of practice
may retract as more tasks are delegated to assistants or
other professionals. Considerations in relation to changed
scope of practice highlight a number of key professional
issues: identifying the scope of speech pathology practice,
determining the role of governance and risk management
frameworks, specifying responsibilities for supervision of
those to whom tasks are delegated, and determining the
boundaries of legal liability.
Speech pathology practice in Australia is informed by
key Association documents such as Scope of Practice
in Speech Pathology (Speech Pathology Australia, 2003)
and Parameters of Practice (Speech Pathology Australia,
2007a). Association position papers further inform
specific areas of specialist clinical practice – for example,
Dysphagia: Modified Barium Swallow; Tracheostomy
Position Paper; Fiberoptic Endoscopic Evaluation of
Swallowing (Speech Pathology Australia, 2005a, 2005b,
2007a). However, a speech pathologist’s involvement in
particular clinical practices will always be dependent upon
a number of key factors including the preferred model of
service delivery of an employing organisation, the support
and explicit authorisation of an employing organisation
for speech pathologists to perform particular tasks,
access to training and demonstration of competence, and
consideration of clinical governance issues. The challenge for
the practitioner will be to ensure that service delivery models