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JCPSLP

Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology

Journal of Clinical Practice in Speech-Language Pathology

Ethics and clinical education

Traditionally, speech-language pathologists have adopted

a “principles approach” towards ethical reasoning (Speech

Pathology Australia Ethics Board, 2011). This approach

draws on the Speech Pathology Australia Code of Ethics

(Speech Pathology Australia, 2012) as the core basis for

decision-making but is less suited for use in proactive

planning. As a point of contrast, the casuistry approach

to ethical reasoning (Speech Pathology Australia Ethics

Board, 2011) encourages speech-language pathologists

to draw on their previous experiences and map these onto

the underlying principles of our profession to inform future

planning.

The Seedhouse ethical grid (Seedhouse, 1998) is a

useful tool (Figure 1) that can be applied within the casuistry

approach to facilitate ethical reasoning. The grid is made

up of four layers; at the core is the “Basis or rationale for

health care”, surrounded by “Duties aligning to key ethical

principles”, “Consequences” and finally the outermost layer,

“Other contextual factors”. The four layers within the grid

allow for the analysis of ethical issues at a range of levels,

from the principles-based core of the traditional approach

to broader considerations where consequences and effects

can be considered (Seedhouse, 1998). The grid can be

used flexibly, targeting the layers and components that

are most relevant for a particular issue (Body & McAllister,

2009). In this way, the grid supports speech-language

pathologists working through ethical issues by looking at

the whole story, rather than at the issue in isolation.

This tool is valuable in the context of clinical education

because of its multifactorial nature, which reflects the

complexities of clinical education beyond those that may

be represented by the principles alone. The process and

outcome of clinical education is dictated to a large extent

by the type and extent of experience of both the student

and the clinical educator. In this context, the use of the

Seedhouse grid within the casuistry approach (where

experience is of particular value) facilitates the opportunity

for dynamic and comprehensive ethical reasoning and

decision-making.

In this article, the casuistry approach will be used to

identify a number of key ethical challenges posed to all

stakeholders involved in clinical education and discuss

these within the multiple layers of the Seedhouse ethical

grid (Seedhouse, 1998). This article also provides a

framework which can be used to facilitate proactive ethical

reasoning and assist clinical educators in finding the

balance between their ethical obligations to their students,

their clients and themselves.

Ethical reasoning within the context of clinical

education is explored using the casuistry

approach to ethical decision-making through

the layers of the Seedhouse ethical grid (a

decision-making tool). The casuistry approach

guides clinicians’ actions by encouraging

them to map previous experiences onto the

profession’s underlying principles in order to

help them proactively plan for future clinical

education experiences. In this paper, we

present a model which highlights the unique

and delicate balance between the multiple

stakeholders involved in clinical education,

and the shift in responsibilities and

relationships that can occur. The need to

understand ethical decision-making

processes, be proactive with ethical thinking,

and ensure clarity in expectations is

discussed. A framework is proposed to assist

clinical educators in finding the balance

between their ethical obligations to their

students, their clients and themselves.

E

thical reasoning skills are fundamental to all

professional practice, allowing “the highest standards

of integrity and ethical practice” and creating the

foundation for evidence based practice (Speech Pathology

Australia, 2012, p. 3). Speech-language pathologists

constantly engage in a process of ethical reasoning when

making decisions on both a professional and a personal

level. This complex process is made more challenging

within the context of clinical education, where, given the

number of stakeholders, there is an ongoing shift in the

responsibilities and relationships for all involved. This

highlights the importance of proactive ethical planning

within clinical education.

The ethical issues that speech-language pathologists

face within the context of clinical education are unique in

origin but not in action. As for any area of clinical practice,

the use of theoretical frameworks in ethical reasoning is

an essential component of the decision-making process.

Ethical frameworks can assist us in not only working

through ethical problems, but also in being proactive in

preventing these.

Ethical reasoning in

clinical education

Achieving the balance

Michelle Quail, Brooke Sanderson and Suze Leitão

KEYWORDS

CASUISTRY

CLINICAL

EDUCATION

ETHICAL GRID

ETHICS

THIS ARTICLE

HAS BEEN

PEER-

REVIEWED

Michelle Quail

(top), Brooke

Sanderson

(centre) and

Suze Leitão