JCPSLP Vol 17 No 3 2015

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Fresh science and pioneering practice
JCPSLP Volume 17, Number 3 2015 159
Speech language pathologists (SLPs) are
regularly confronted with complex ethical
dilemmas in clinical practice. These dilemmas
are particularly challenging for student
speech pathologists who, without years of
clinical experience, often feel uncertain in
their clinical reasoning and decision-making.
While university course content can explain
the different ethical theories and frameworks,
hypothetical scenarios provide real-life
examples to make this content meaningful.
This article presents the perspective of a
student speech pathologist as she applied
two contrasting approaches to addressing
ethical dilemmas to unravel a hypothetical
ethical dilemma concerning the breaching of
client confidentiality, and the perspectives of
teaching staff involved in this activity. This
exploration points to the potential for ethical
frameworks to guide ethical decision-making
and increase confidence, for both student/
novice clinicians and experienced clinicians
alike.
This article presents the reflections and perspectives of
three individuals (authors) following a simulated client
interview and ethical dilemma activity conducted
as part of a speech language pathology university course.
During the activity, students interviewed the client (carer of
a young man with traumatic brain injury (TBI) played by an
experienced speech-language pathologist (SLP)) and then
discussed an ethical dilemma. Perspectives are presented
from the lecturer who designed the activity, a student who
completed the activity, and the SLP who acted as the
carer. The hypothetical ethical dilemma is analysed using
two contrasting approaches – the principles-based and
the narrative approaches – to share the complex thought
process the participants engaged in during the activity and
to illustrate the differences and respective benefits of each
approach. The potential for these tools to guide ethical
reasoning and decision-making is discussed, as well as
the value of using hypothetical cases and simulated client
interviews to support student learning.
Helen Corbould
(top), Andy Smidt
(centre), and
Emma Power
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
KEYWORDS
CASE-BASED
LEARNING
CONFIDENTIALITY
ETHICS
NARRATIVE
APPROACH
PRINCIPLES
APPROACH
Teaching ethics
Application of ethical frameworks to an ethical dilemma
based on a simulated client interview
Helen Corbould, Andy Smidt, and Emma Power
The perspectives
Lecturer
As a university lecturer, it is difficult to present realistic
challenges to students within a controlled environment. This
activity involved students meeting a simulated client in order
to collect case history information (MacBean, Theodoros,
Davidson, & Hill, 2013). The activity was implemented within a
case-based curriculum where students integrate a number
of learning objectives around a single case (McCabe,
Purcell, Baker, Madill, & Trembath, 2009). The meeting with
the simulated client allowed students to experience
face-to-face interviewing, to then produce a report using
contrasting writing styles (for a carer and a medical
audience), and to use reflective journaling to consider their
own skills. The final task within the activity was to consider
an ethical dilemma within one of several suggested ethical
frameworks. As the lecturer, the challenge was to allow
students to experience this as an authentic activity and to
support them as they reflected on the challenges and the
lessons to be learned (Meyers & Nulty, 2009).
Student
As a student SLP, I attend lectures and tutorials on
phonology, language, voice, swallowing, and neurogenics
and then apply this material to my placements. As for
ethics, however, the transition from the classroom to real life
is not so straightforward (Stansfield & Handley, 2010). The
difficulty of translating ethics is especially true for ethical
dilemmas, where the appropriate conduct is not easily, if at
all, discernible. As part of the Masters of Speech Language
Pathology program at the University of Sydney, we were
required to apply one or more frameworks to a hypothetical
ethical dilemma based on a simulated client interview. The
simulated client interview added a dimension of authenticity
to the ethical dilemma and allowed me to approach the
ethical dilemma with empathy for the client’s circumstances.
Overall, this task allowed me to develop skills in ethical
reasoning and to structure my decision-making based on
the procedures sanctioned by the narrative (Charon, 2001)
and principles (Beauchamp & Childress, 2001) approaches.
In using such frameworks we can develop ethical problem-
solving skills, comply with the SPA (2010) Code of Ethics
guidelines, and be sensitive to our clients’ and their families’
circumstances.
Simulated client
As a lecturer within the degree program not involved in this
unit of study (UOS), I had two roles in this ethical learning