JCPSLP Vol 15 No 2 2013

Ethical conversations

Ethical reasoning in clinical education Achieving the balance Michelle Quail, Brooke Sanderson and Suze Leitão

Ethical reasoning within the context of clinical education is explored using the casuistry approach to ethical decision-making through the layers of the Seedhouse ethical grid (a decision-making tool). The casuistry approach guides clinicians’ actions by encouraging them to map previous experiences onto the profession’s underlying principles in order to help them proactively plan for future clinical education experiences. In this paper, we present a model which highlights the unique and delicate balance between the multiple stakeholders involved in clinical education, and the shift in responsibilities and relationships that can occur. The need to understand ethical decision-making processes, be proactive with ethical thinking, and ensure clarity in expectations is discussed. A framework is proposed to assist clinical educators in finding the balance between their ethical obligations to their students, their clients and themselves. E thical reasoning skills are fundamental to all professional practice, allowing “the highest standards of integrity and ethical practice” and creating the foundation for evidence based practice (Speech Pathology Australia, 2012, p. 3). Speech-language pathologists constantly engage in a process of ethical reasoning when making decisions on both a professional and a personal level. This complex process is made more challenging within the context of clinical education, where, given the number of stakeholders, there is an ongoing shift in the responsibilities and relationships for all involved. This highlights the importance of proactive ethical planning within clinical education. The ethical issues that speech-language pathologists face within the context of clinical education are unique in origin but not in action. As for any area of clinical practice, the use of theoretical frameworks in ethical reasoning is an essential component of the decision-making process. Ethical frameworks can assist us in not only working through ethical problems, but also in being proactive in preventing these.

Traditionally, speech-language pathologists have adopted a “principles approach” towards ethical reasoning (Speech Pathology Australia Ethics Board, 2011). This approach draws on the Speech Pathology Australia Code of Ethics (Speech Pathology Australia, 2012) as the core basis for decision-making but is less suited for use in proactive planning. As a point of contrast, the casuistry approach to ethical reasoning (Speech Pathology Australia Ethics Board, 2011) encourages speech-language pathologists to draw on their previous experiences and map these onto the underlying principles of our profession to inform future planning. The Seedhouse ethical grid (Seedhouse, 1998) is a useful tool (Figure 1) that can be applied within the casuistry approach to facilitate ethical reasoning. The grid is made up of four layers; at the core is the “Basis or rationale for health care”, surrounded by “Duties aligning to key ethical principles”, “Consequences” and finally the outermost layer, “Other contextual factors”. The four layers within the grid allow for the analysis of ethical issues at a range of levels, from the principles-based core of the traditional approach to broader considerations where consequences and effects can be considered (Seedhouse, 1998). The grid can be used flexibly, targeting the layers and components that are most relevant for a particular issue (Body & McAllister, 2009). In this way, the grid supports speech-language pathologists working through ethical issues by looking at the whole story, rather than at the issue in isolation. This tool is valuable in the context of clinical education because of its multifactorial nature, which reflects the complexities of clinical education beyond those that may be represented by the principles alone. The process and outcome of clinical education is dictated to a large extent by the type and extent of experience of both the student and the clinical educator. In this context, the use of the Seedhouse grid within the casuistry approach (where experience is of particular value) facilitates the opportunity for dynamic and comprehensive ethical reasoning and decision-making. In this article, the casuistry approach will be used to identify a number of key ethical challenges posed to all stakeholders involved in clinical education and discuss these within the multiple layers of the Seedhouse ethical grid (Seedhouse, 1998). This article also provides a framework which can be used to facilitate proactive ethical reasoning and assist clinical educators in finding the balance between their ethical obligations to their students, their clients and themselves.

Keywords casuistry clinical education ethical grid ethics

This article has been peer- reviewed

Michelle Quail (top), Brooke Sanderson (centre) and Suze Leitão

99

JCPSLP Volume 15, Number 2 2013

www.speechpathologyaustralia.org.au