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78 JCPSLP Volume 18, Number 2 2016 Journal of Clinical Practice in Speech-Language Pathology
• consultation and collaboration within local networks –
work colleagues, team leaders, managers, professional
supervisor, mentor, local interest groups, and the
national speech pathology community through SPA
online communities
• direct contact with the SPA NDIS project consultant and
professional advisors
• presentation of appropriate information back to the
NDIS, including clinical reasoning and evidence base
for the recommended intervention. As an organisation,
the NDIS has demonstrated a degree of consideration
for well-formed arguments and responded to such
discussions to inform the frameworks of the scheme.
Conclusion
Communication is an intrinsic human right, and as
professionals working with clients presenting with complex
needs within a new and, at times, challenging funding
environment, speech pathologists have the responsibility to
provide appropriate services for their clients. As
professionals supporting communicative participation, we
also have additional responsibilities to advocate for
communication rights within complex systems which may
have limited knowledge and awareness. Working within
complex and challenging situations is a worthwhile
endeavour. There is a range of ethical challenges
associated with human service delivery, and speech
pathologists provide meaningful services, making a
difference to people’s relationships, their community and
civil participation, their future and their quality of life.
Our responsibility as ethical practitioners is to utilise
methods available to us to identify the ethical issues and
challenges within our work, seek advice and support to
explore appropriate responses, then work to ensure optimal
services are available for our clients.
Disclaimer
The information in the quotes, vignettes and case studies in
this article are an amalgam of many real-life scenarios, and
were created for the purposes of this article by the authors.
The person/s described in the discussion is/are not a real
person/s. Any similarity to real people or organisations is
coincidental.
References
Eadie, T. L., Yorkston, K. M., Klasner, E. R., Dudgeon, B. J.,
Deitz, J. C., Baylor, C. R. & Amtmann, D. (2006). Measuring
communicative participation: a review of self-report
instruments in speech–language pathology. American
Journal of Speech-Language Pathology, 15, 307–320.
McAllister, L. (2006). Ethics in the workplace: More than
just using ethical decision – making protocols. Acquiring
Knowledge in Speech, Language and Hearing, 8 (2), 76–80.
National Disability Insurance Scheme (NDIS). (2014)
Factsheet: Early childhood intervention – transdisciplinary
approach to service provision. Information for NDIA staff,
service providers participant families. Retrieved from http://
approach_to_service_provisionmay2014.pdf
National Disability Insurance Scheme (NDIS). (2013).
Factsheet: Teamwork in early childhood intervention
services: recommended practices. Based on notes from
T. Moore, 2013. Retrieved from
document/factsheet-teamwork-early-childhood-i
National Joint Committee for the Communicative Needs
of Persons with Severe Disabilities. (1992). Guidelines for
support as necessary, and be prepared and willing to
discuss our requirements with our managers, employers
and colleagues, as an ongoing commitment to providing
high quality services for our clients. In this scenario, Jude
has the responsibility to educate the manager regarding
an appropriate timeframe for safe and effective service
delivery and can seek support to do this from other more
experienced members of her team.
Both case studies explore the potential effects of NDIS
on the service delivery frameworks expected by employers
and organisations. Also, NDIS participants with complex
needs are seeking to maximise the effectiveness of the
services they purchase. Our role, whether we are early
career or more experienced clinicians, includes education
for participants, managers, employers and other team
members, including planners, regarding appropriate service
delivery models for speech pathology services.
Response to ethical challenges
“For ethical problems to be effectively managed, they need
to be identified, understood, and decisions need to be
made about how to manage them” (Speech Pathology
Australia, 2014, p.27). The complexities of the NDIS, due
both to participant complexity and the funding environment,
create the need to integrate proactive ethical problem-
solving into our clinical practice. The Ethics Education
Package (2014) is a resource available to SPA members, as
a self-guided professional education tool that works
through four different theoretical models. Examining the
case studies through an appropriate theoretical approach
may assist the speech pathologist who is managing ethical
problems to identify the ethical issues and potential courses
of action. For example, the Casuistry approach, which is
grounded in the professional and clinical experience of the
speech pathologist, may assist in case study 1 to identify
the most important issues on this situation and how similar
ethical challenges have been managed previously. The
Ethics of Care approach would assist the new graduate in
case study 2 to identify the needs of the clients, her role
and responsibilities, the barriers that exist in the current
situation and the resources required to provide appropriate
management or improve the current situation.
Once the ethical issues and challenges within a particular
clinical scenario with an NDIS participant have been
identified, what happens next? The obligation to act and
make proactive ethical decisions need not weigh heavily on
the clinician’s shoulders; rather, ethical principles, standards
and decision-making frameworks can be useful tools to
identify where discourse should occur and what the key
topics should be.
As suggested by Lindy McAllister, “like most professional
skills, ethical and moral reasoning develop with experience,
and .... this development can be supported through mentoring,
workplace supervision and professional development
programs” (McAllister, 2006, p. 79). Reflection and
discussion of the ethical issues that arise in professional
practice are key components to developing awareness of
the ethical issues and potential courses of action.
In the above scenarios, the issues could be addressed in
a number of ways:
• reflection on professional and ethical obligations and
responsibilities
• discussion with the employer to describe where the issues
sit and identify an appropriate course of action, such as
identification of and participation in professional
development activities to extend clinical knowledge and
skills