ACQ Vol 11 No 1 2009

MULTICULTURALISM AND DYSPHAGIA

E merging T rends I mpacting on E thical P ractice in S peech P athology

Marie Atherton and Lindy McAllister

Key trends impacting on ethical practice A number of key trends raise the possibility of ethical risks to speech pathology practice as a whole. Increasing health demands from an ageing population The fact that Australia’s population is ageing contributes to an increasing need for health services both in primary and tertiary care (Australian Government Productivity Commission, 2005). The increasing demand for limited health services poses a number of ethical considerations for the health practitioner. There is a need to ensure the limited health dollar is used most effectively and efficiently, but also to determine, at a transparent level, who will benefit from the limited health dollar and who will miss out. Often it is the speech pathologist who must adhere to the directives of individual organisations regarding prioritisation of caseload, while at the same time making independent decisions regarding how prioritisation should look. This often presents many ethical challenges for clinicians who must work hard to meet both client and organisational needs in an ethical manner. Furthermore, the increasing demographic of well-educated, articulate and financially well-off elders will see a rise in demand for more intensive and conveniently located services, in community settings and/or client’s homes. The challenges and opportunities this will pose in relation to service provision by speech pathologists are likely to include the increasing use of allied health assistants, the use of telehealth and an increased emphasis on community-based models of service delivery. Some of these issues will be discussed later in this article. Increased prevalence of chronic disease and disability Advances in the medical and surgical management of a range of conditions, diseases and injuries have reduced mortality, but increased morbidity and life expectancy. Examples include the improved survival rate of very premature infants and the survival of persons with severe head injuries. Life- prolonging procedures and technologies result in survivors now presenting with significant long-term disabilities that extend to communication and swallowing. As is likely the case with all health professionals, speech pathologists may hold concerns about the quality of life that ensues for people living with severe and complex disabilities. Concerns may exist in relation to service provision for persons with chronic disease and disability; specifically, where this service should sit as part of a larger caseload, and how the speech pathologist should maximise the potential of clients with chronic disease and disability within the limited available resources. Ongoing limitations in the health budget will continue to place pressure upon clinicians to demonstrate the benefits of intervention with this group of clients, as with all clients; however, such gains may be more difficult to

The significant societal, systemic and technological changes of the past two decades have contributed to the Australian health system now facing a number of specific challenges. The increasing diversity and sophistication of health technology, the proliferation of legislation, the ageing health workforce and changing community demographics are key trends impacting on the future viability of health service provision within Australia and internationally. These trends will also impact on health practitioners’ ability to provide care that meets demand while simultaneously meeting the moral and ethical considerations which are inherently tied to health service provision. In 2006, Speech Pathology Australia members identified a number of key ethical concerns related to these trends and challenges, including not only those that arise at an individual client–practitioner level but also at a systemic level. Specifically, Speech Pathology Australia members expressed concern regarding prioritisation of services, the impact of fiscal constraints on service delivery, and the potential for conflict between profes­ sional values and values that may underpin management decisions and health policies. Ethical issues associated with the delegation of tasks, the need for continuing professional development and the use of evidence based practice were also identified. For the profession to meet current and future challenges, it is essential to remain vigilant and responsive to trends and changes that will impact on service provision. Practitioners must also demonstrate an ethical awareness that extends beyond specific “ethical dilemmas” as may arise in clinical practice to thinking and acting ethically in our daily routines.

Keywords: ethics,

evidence based practice, health workforce, population trends, resource allocation, scope of practice

T he speech pathology profession has undergone significant change over the past 15–20 years, and these changes have important implications for the ethical practice of speech pathology. The knowledge and skill-set of the discipline have changed dramatically due to both internal and external forces. Changes in work settings, types and complexity of clients, new technologies in health care, and reimbursement for services continue to raise new challenges for speech pathologists as they seek to implement evidence based ethical practice. Emerging technologies that can be used for telehealth, a growing trend for working in developing countries, and social models of practice offer exciting opportunities for expanding our practice along with increased risks to ethical practice.

ACQ uiring knowledge in sp eech , language and hearing , Volume 11, Number 1 2009

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