JCPSLP Vol 17 No 3 2015

Ethical conversations

Ethical reflections from speech pathology students

and new grads Fresh thoughts from the coalface Suze Leitão and Trish Johnson S uze and Trish are the Chair, Speech Pathology 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 story 1 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 Australia Ethics Board and Senior Advisor Ethics and Professional Issues respectively. The mission of

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

KEYWORDS ETHICAL PRACTICE ETHICS

THIS ARTICLE HAS BEEN PEER- REVIEWED

Suze Leitão (top) and Trish Johnson

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JCPSLP Volume 17, Number 3 2015

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