Speak Out June 2018

Ethics news

Resources to support confident decision-making Practical examples

This is the second article in the current series using worksheets available to members on the Ethics Education page of the SPA website. These worksheets can assist in clinical decision-making. This case study uses the Casuistry approach to ethical reasoning. Disclaimer The information presented in this case study is fictional and any similarity to real people and organisations is coincidental. The information is an amalgam of many real-life scenarios, therefore the person/s described in the discussion is/are not a real person. This case study was created for the purpose of this article. Kasey is a qualified speech pathologist who has been subcontracting to a mobile private practice for the last 15 months. Kasey enjoys her current job and has regular social contact with other speech pathologists in the practice who mainly work with children. She works with a mix of adult and paediatric clients, which is both interesting and challenging as her clients experience difficulties resulting from a wide range of aetiologies. As a result, Kasey has to keep informed of an equally wide range of therapeutic interventions and often looks for evidence to support her clinical decision-making. A new referral has been received for Mr C. Study, an 87-year-old gentleman with a history of progressive neurological disease, resulting in dysphagia and dysarthria. He usually lives at home with his wife as his main carer but has been in hospital recently due to dehydration and needs a review of his swallowing function. Kasey visits Mr and Mrs Study at home. Mr Study’s speech is mostly unintelligible, however, he does not have any alternative form of communication. Mrs Study reports that his physical function, including his speech and swallowing, has deteriorated quite quickly in the last three months and he is not responding to medication as well as he used to. recommended that he only eat and drink modified food and fluid consistencies, to minimise the risk of aspiration. When Kasey attempts to discuss ongoing intake of modified texture food and fluids Mr Study becomes very agitated and indicates that he will not do so. Unfortunately, due to his severe dysarthria, Kasey is not confident that she understands why Mr Study is refusing them. He becomes very upset and leaves the room before Kasey is able to provide information about other interventions that may reduce risk. The speech pathologist in the hospital performed a videofluoroscopy while Mr Study was admitted and Case study Kasey’s story

Her professional opinion is that Mr Study should only eat and drink modified texture food and fluids. She has not worked with a client in the end stages of this particular disease before, but her experience with other clients who have had significant dysphagia and refused to modify textures was that they ended up with aspiration pneumonia quite quickly. She is worried that would have a significant impact on Mr Study’s current health and long- term quality of life. Kasey leaves the house without a plan for assisting Mr and Mrs Study to manage his dysphagia as safely as possible. She is unsure of what to do next and considers referring him to another speech pathologist, which would be a lot easier for her. Casuistry approach Using the worksheet for the casuistry approach that can be found on the SPA website, here is an example of how the situation could be examined, key underlying issues identified and considered, and a plan for future speech pathology involvement.

Worksheet available on the SPA website

Level1 /114WilliamStreet T 61 396424899

MelbourneVictoria3000

F 61 396424922

office@speechpathologyaustralia.org.au www.speechpathologyaustralia.org.au

Casuistry Approach

Whatarethemost important issuesin thiscase? Whatistheclient’s diagnosisandprognosis? Aretherequalityof life issuesto consider? Hastheclient expressedastrong preferencefororagainstanintervention? [Type your answer here] Whatisthenatureoftheethicaldilemma(withreferenceto theCodeof Ethics)? [Type your answer here]

HaveImanaged (or read about)acaselikethisbefore? How did Iapproach previouscases? Isthereempiricalevidenceto inform casemanagement? [Type your answer here]

Whatweretheoutcomes in othercases? [Type your answer here]

EthicalReasoningFrameworks:CasuistryApproach SpeechPathologyAustralia©Copyright2016

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June 2018 www.speechpathologyaustralia.org.au

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