JCPSLP Vol 17 No 3 2015

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JCPSLP Volume 17, Number 3 2015 163
Ethical conversations
Suze Leitão
(top) and Trish
Johnson
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
KEYWORDS
ETHICAL
PRACTICE
ETHICS
Ethical reflections from
speech pathology students
and new grads
Fresh thoughts from the coalface
Suze Leitão and Trish Johnson
his comprehension. Expressively, he would only utter
cycles of “yes “or “no”, or repeat random numbers. We
were unable to demonstrate formally that he had the
baseline communication skills needed for rehabilitation.
Within concrete social situations however, he appeared
to have a higher level of comprehension. For example,
when frustrated or needing assistance, he would shout
profanities until someone understood his needs. He
once called me back in the room after an assessment
to hand me the pen I left behind. He also understood
when told that he would be transferred to a nursing
home, and became angry. My clinical educator and
I believed these and other examples demonstrated
insight, memory, and some functional communication,
and that he had potential to benefit from rehabilitation.
The ethical issues at stake (SPA Code of Ethics, 2010)
were justice (2.3), beneficence and non-maleficence
(2.1), and patient advocacy (3.1.6). By denying this
gentleman rehabilitation, he was not being given an
opportunity to have the best possible quality of life and
overcome his disability. Placing him in a nursing home
at his age without rehabilitation to maximise his ability
to participate in life would be detrimental to his
well-being, and was not acting in his best interests.
I worked with my clinical educator and a team of allied
health staff to advocate for him. My clinical educator
encouraged me to continue to work with him and try
different ways to demonstrate his abilities. We documented
every success and wrote several reports. After many
unsuccessful attempts, he was finally accepted into
rehabilitation. The day that he was told that he was
accepted into rehabilitation, you could not wipe the
smile from his face. This experience taught me that even
as a student, I am still able to act as a representative
for those who may not have the ability to voice for
themselves. Discussion and determination can lead to
outcomes which are fair and act in the best interest of
the patient.
Suze Leitão and Trish Johnson – ethical
reflections
This case scenario, by a final-year speech pathology
student on clinical placement, clearly illustrates the dynamic
and fluid nature of ethical reasoning used by newly
graduated speech pathologists and described in the
dynamic model of ethical reasoning proposed by Kenny,
Lincoln and Balandin (2007). This conceptual framework
incorporates elements of awareness, independent and
Suze and Trish are the Chair, Speech Pathology
Australia Ethics Board and Senior Advisor Ethics
and Professional Issues respectively. The mission of
the SPA Ethics Board and these two leaders is to get the
“ethics” message out and support the profession in moving
to a proactive approach to professional ethics. We are
grateful for the contributions from our final year students
and new graduates that have allowed us to hear their story1
and reflect on the themes that emerge.
“It is fundamental to the professional responsibilities
of speech pathologists that we observe the highest
standards of integrity and ethical practice.” (SPA Code
of Ethics, 2010)
In keeping with the theme of “fresh science and
pioneering practice”, the SPA Ethics Board asked for
contributions from current students and newly graduated
speech pathologists. We asked them to reflect on ethical
issues and dilemmas in their clinical practice and how
they had addressed these. In this “Ethical reflections”
column, we present three contributions in their own words,
followed by our reflections on the themes that emerge.
We also make links to the SPA Ethics Training Package
(Leitão et al., 2014) with suggestions that may support
other new graduates. Overall, these submissions highlight
the ways in which students and newly graduated speech
pathologists do consider the SPA Code of Ethics (2010) in
their daily practice, and the importance of having access to
experienced clinicians to support decision-making.
A final year student
GG
The ethical dilemma I faced while on placement involved
a man who had been in hospital for some [several]
months. He had suffered a stroke, which rendered him
severely aphasic and for the most part immobile. The
man was not elderly and prior to his admission was
completely independent. As he demonstrated severely
impaired cognitive communication and did not have
any family that could provide care for him, he was
deemed an unsuitable rehabilitation candidate, and
was waiting to be placed in a nursing home. This
situation seemed unjust for a man of his age.
There was a clash of ethical values between the
allied health staff about the alternative actions. Initially,
he had severe dysphagia and was non-verbal, but over
time he was able to enjoy a normal diet and showed
limited communication skills. Despite these gains,
language assessments did not show consistency in