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168 JCPSLP Volume 19, Number 3 2017 Journal of Clinical Practice in Speech-Language Pathology
responsibility for translating empathy into appropriate
actions. In Jess and Kate’s workplace, a culture of care
may be facilitated by modelling effective care behaviours,
including showing concern for others, demonstrating that
colleagues are valued by the way we speak with them
and about them, and by openly discussing strategies
for self-care. Opportunities for face-to-face contact with
colleagues, team collaboration, and the perception that
contributions are valued by others, may mediate speech
pathologists’ work stressors (McLaughlin, Lincoln, &
Adamson, 2008). Frequent interactions demonstrating
care may also make it a little easier for Jess to approach
a colleague or her manager for support and for Kate to
initiate a conversation regarding observed professional
behavioural changes and concerns. Kate may also benefit
from accessing specific resources available for developing
mentally healthy workplaces (National Mental Health
Council, 2013). Importantly, Jess as a caregiver is ethically
responsible for providing competent intervention by taking
active steps to monitor and maintain her health. Kate is
ethically responsible for taking actions that will facilitate her
colleague’s efforts to address issues that may have harmful
consequences for clients or the workplace.
Ethical considerations from a
health care consumer’s perspective
Health care consumers may expect that health
professionals, including speech pathologists, have a
reasonable understanding of mental health conditions they
may be dealing with in daily practice – for example,
understanding the incidence of postnatal depression in
mothers, and that this disorder may be impacted by
complications at the time of birth or by other complex
medical or social issues for the family.
A challenge for speech pathologists is to tread that
fine line between “normalising” a mental health condition
e.g., being sensitive to the possibility that depression
may accompany a major change in health status (e.g.,
CVA or TBI), and trivialising or putting aside the profound
impacts of such conditions on clients and families.
Consider, for example, the potential outcomes of referring
to postnatal depression as “baby blues”. Sometimes we
may avoid using a mental health term, for example, a
depressive illness in Jess’s case, and this may be a sign of
discomfort in talking openly about mental health. However,
acknowledging mental health issues in a more open way
can assist professionals overcome the perception that
“this only happens to someone else”; that “someone else”
may be my client, my colleague or myself as a practising
clinician.
Speech pathologists working with clients who have
mental health issues need to understand not only what
mental health “looks like” by identifying a list of symptoms
but also what it “feels like”, by listening to consumers’
stories of lived experiences with mental health and well-
being. New initiatives in this area include recovery colleges
where people with lived experience may share insights
with practising health professionals. For example, South
Eastern Sydney Recovery College .
offers education
and training programs, developed and delivered by people
with lived experience of mental health concerns and health
professionals to help carers and professionals acquire
better understanding of mental health concerns and to
support people during their recovery.
demanding her time and attention. Jess perceives
herself as a competent speech pathologist but feels
anxious and overwhelmed by workload and family
pressures. Jess finds it increasingly difficult to manage
client care and complete administrative tasks. She
frequently arrives late following problems sleeping,
but works through lunch and takes incomplete tasks
home. Jess avoids discussing her experiences with her
manager because she perceives she will be “judged”
as not coping, and it is difficult to find permanent
positions in her local area.
Kate notices concerning changes in her colleague’s
behaviour. Jess avoids interacting with team
members, professionally and socially. She appears
tired and frequently complains of headaches. Jess
is constantly busy but not productive. When Kate
commences intervention, with two clients Jess
assessed, she finds an incomplete report and no
record of a recommended referral to occupational
therapy. However, Kate understands that Jess has a
demanding family situation and overall Jess is a great
therapist. Kate wants to help but has her own busy
caseload to manage.
Reflect upon the following questions when considering
your response to the scenario:
1. What are key ethical concerns for Jess and Kate?
2. What potential consequences may result from not
addressing these concerns?
3. What steps can Jess and Kate take to respond ethically
in this scenario?
Our Code of Ethics (Speech Pathology Australia, 2010)
states that respect and care for ourselves and colleagues
is a core professional value: “We maintain our personal
health and well being to effectively fulfil our professional
responsibilities” (section 1. Values, Respect and Care). For
Jess, it is important to reflect upon ethical principles of
beneficence, non-maleficence and professional integrity.
Is her health status impacting her skills to provide quality
intervention? What are potential risks to her clients? Is she
currently functioning as a competent team member who
can meet professional commitments and fulfil her “Duties to
clients and her employer”?
Kate has equally important ethical considerations. The
Code specifically addresses our duties to the profession
and ourselves with an obligation to “identify and act on
concerns we may have about colleagues’ competence
or conduct” (clause 3.3.1). Furthermore, Kate may reflect
upon her duties to “uphold the reputation of the profession”
(clause 3.3.3) and support her colleagues to “develop
professional integrity, identity and ethical behaviours”
(clause 3.3.6). It is also important to note that speech
pathologists have obligations under the National Code
of Conduct for Healthcare Workers (COAG, 2015) to
report colleagues who have health concerns that may
compromise the safety or quality of client care. Herein
may lie conflict for Kate. How can Kate address her ethical
concerns in a supportive manner that acknowledges Jess
as an autonomous decision-maker and focus on positive
outcomes for her colleague, clients and employer? An
Ethics of Care framework may provide a helpful approach
to such an issue.
Ethics of care is grounded in the concept of caring
as both being “receptive to” and “responsible for”
others (Branch, 2000). A receptive speech pathologist
listens with attentiveness and empathy and then takes