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Beauchamp, T. (2007). The “four principles” approach to health care ethics. In Ashcroft, R., E., Dawson, A., Draper, H., & McMillan, J. R. (Eds), Principles of Health Care Ethics , (pp. 3–10). Chichester: John Wiley. Charon, R. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust. JAMA , 286 (15), 1897–1902. Charon, R., & Montello, M. (2002). Stories matter: The role of narrative in medical ethics . New York: Routledge. ComLaw. (2015). Privacy Act 1988 . Retrieved 21 April 2015 from http://www.comlaw.gov.au/Series/ C2004A03712 Jones, A. H. (1999). Narrative in medical ethics. BMJ: British Medical Journal , 318 (7178), 253–256. MacBean, N., Theodoros, D., Davidson, B., & Hill, A. E. (2013). Simulated learning environments in speech- language pathology: An Australian response. International Journal of Speech-Language Pathology , 15 (3), 345–357. doi: 10.3109/17549507.2013.779024 McAllister, L. (2006). Ethics in the workplace: More than just using ethical decision-making protocols. ACQuiring Knowledge in Speech and Language and Hearing , 8 (2), 76–80. McCabe, P., Purcell, A., Baker, E., Madill, C., & Trembath, D. (2009). Case-based learning: One route to evidence-based practice. Evidence-Based Communication Assessment and Intervention , 3 (4), 208–219. McCarthy, J. (2003). Principlism or narrative ethics: Must we choose between them? Medical Humanities , 29 (2), 65–71. Meyers, N. M., & Nulty, D. D. (2009). How to use (five) curriculum design principles to align authentic learning environments, assessment, students’ approaches to thinking and learning outcomes. Assessment & Evaluation in Higher Education , 34 (5), 565–577. doi: 10.1080/02602930802226502 Nelson, H. L. (Ed.). (2014). Stories and their limits: Narrative approaches to bioethics . New York: Routledge. Speech Pathology Australia. (2010). Code of ethics . Retrieved from http:www.speechpathologyaustralia.org.au/ library/Ethics/CodeofEthics.pdf Speech Pathology Australia. (2014). Ethics education package . Retrieved from http://www. speechpathologyaustralia.org.au Stansfield, J., & Handley, J. (2010). Communicating ethics. Speech and Language Therapy in Practice , Winter, E4–E6. World Health Organization. (2001). International classification of functioning, disability and health . Geneva: Author. Helen Corbould obtained a Bachelor of Arts with a double major in psychology at the University of Western Australia and is currently completing her final year of a Masters of Speech Language Pathology at the University of Sydney. Andy Smidt is a speech pathologist and lecturer at the University of Sydney. Her research and teaching interests include lifelong disability and AAC, ethics and evidence-based practice. Emma Power is a speech pathologist and lecturer at the University of Sydney. Her research and teaching interests include knowledge transfer and exchange (KTE) and neurogenic cognitive-communication disorders.

his lack of insight into such events, there is little reason to believe that such behaviour will discontinue. Additionally, Sharon’s hopeful attitude that he will return to his previous abilities conveys her unrealistic beliefs towards Casper, making such a statement even more questionable. The role of the narrator is to encourage multiple voices to be heard and be involved in the decision-making process rather than to focus on reaching an endpoint (Jones, 1999). Considering the first-person narrative is to be privileged (McCarthy, 2014), it is essential that Casper’s perspective be uncovered before reaching a decision. This should be the first step undertaken. Understanding the stories of those involved does point to areas where particular care and counselling should be provided. For example, informing Sharon about her and her son’s rights to refuse the medication and helping them gain a more realistic understanding of what can be expected for Casper and his recovery present as pressing issues. Student’s reflection on the two approaches The narrative approach encourages us to delve into the emotional and psychological landscapes of clients and their families and in doing so we are better able to identify how to work with them (Nelson, 2014). Because this activity involved a simulated interview, as the student in this exercise, I was able to actually listen to Sharon and console her as she discussed the recent difficulties of her son since the accident. This helped me to appreciate the way emotions, stories and perspectives of those involved can shape the way we may respond to an ethical dilemma. They interplay with the principles within the Code of Ethics (2010) and complicate the situation as we try to weigh up the outcomes of different responses to the dilemma as they influence those involved. In contrast, the principles-based approach guides our reasoning so that the key themes of an ethical dilemma are logically and thoughtfully considered principle by principle. Our personality and predispositions may make one approach more appealing than another; however, this article stands as evidence for the application of either of these approaches, as each promotes a depth of analysis and understanding beyond our own personal judgements. Ideally though, a combination of both approaches should be attempted as it allows us to come to a more comprehensive understanding of the needs and considerations of our clients and their family and will allow us to better fulfil the ethical standards of our practice. This is a key learning objective for student SLPs ahead of graduation, and a challenge for both novice and experienced clinicians as they navigate a range of ethical dilemmas in clinical practice. In the classroom, ethics instruction can appear devoid of real-life application. As the student in this activity, I came to understand the use of these frameworks to structure my thinking so that multiple perspectives and issues can be clearly and carefully deliberated. Halfway through my course, I now feel equipped with the tools that will allow me to provide a service that reflects a higher level of ethical reasoning than if addressed purely on my own moral accord. These frameworks do not only provide students with a structure to address ethical dilemmas, but can also enhance the quality of care provided by speech pathologists of all levels of expertise in their clinical practice. References Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics . New York: Oxford University Press.

Correspondence to: Dr Andy Smidt University of Sydney phone: (02) 9351 9008 email: andy.smidt@sydney.edu.au

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JCPSLP Volume 17, Number 3 2015

Journal of Clinical Practice in Speech-Language Pathology