JCPSLP Vol 17 Supplement 1 2015_lores

millennia past, health professionals have striven to practice ethically. This desire was driven mainly from altruistic principles of client-centred care and a need for professionals to be seen as acting with integrity so as not to impugn the good name of their professions. These motivations undoubtedly still remain but are now located within contexts of increasingly complex societies and workplaces. Four pressures facing speech language pathologists are: increasingly complex caseloads, increasing workplace pressures, increasing litigation and increasing demands for evidence-based practice. Given the diverse settings in which speech-language pathologists work, the inadequacy of biomedical approaches as frameworks for discussions of ethics in speech pathology is also considered. Increasingly complex caseloads Increasing neonatal and adult trauma survival rates, lifesaving and life-prolonging medical and surgical technologies and procedures, increasing adult trauma survival rates, and the ageing of the population, among many other advances in modern medicine, have lead to increased rates of disability in schools and community settings. As a result, health professionals now routinely work with clients with complex, life-threatening or disabling conditions. The case study of Mary in the Ethics Education Package illustrates just such a case. Key features of the case study include: • Mary is 32 years of age; she has spastic quadriplegia, severe dysphagia, aspiration of all food and fluid consistencies, severe communication impairment and is malnourished; • team members recommend only non-oral feeding; • Mary and family want to continue oral feeding (issues of quality of life and autonomy); • nursing staff and paid carers fear risks of oral feeding. This case study involves conflict between all the ethical principles and duties outlined earlier. Consideration of ethical issues in this case is compounded by the fact that Mary lives with a chronic disability, staff are engaged in long term, caring relationships with her, and care about her quality of life. For these reasons, codes of ethics which are founded only on biomedical principles are inadequate in Most codes of ethics in the health professions are derived from a biomedical paradigm of practice (Beauchamp & Childress, 1994). However, speech pathologists, like many allied health professionals, work across biomedical, social and educational models of practice. We are engaged in sustained relationships with our clients, and as a result have an ongoing duty of care. We are concerned with quality of life issues, not just issues of “saving of life”. Noddings (1984) has written extensively about an “ethic of care”. How can we as speech pathologists integrate and foreground this ethical principle of care into our existing principles? How might this ethic of care be expressed in our daily work? In addition, the relational nature of our work and the use of self-astherapeutic agent mean decision-making is not “clinical” or “black and white”. Instead as Schön (1987) suggests, professional practice deals in the “grey areas” and “the swampy lowlands” of professional practice. To act ethically in contemporary speech pathology practice forces guiding action to resolve the issues involved. Limitations of our current biomedically oriented ethical principles

of ethics. By not attempting the impossible task of prescribing and delimiting what is ethical behaviour and proscribing unethical behaviour, the code has the potential to encourage speech pathologists to think ethically and integrate ethical principles into their diverse, complex and rapidly changing daily work practices. However, my discussions as a mentor with speech pathologists about ethical matters suggests that this diffusion into everyday thinking and practice is not easily or routinely occurring for all clinicians. Ethics is more than following ethical decision- making protocols. As Midgely (1993, p. 25) noted: judging is not simply accepting one or two ready made alternatives as the right one. It cannot be done by tossing up. It is seeing reason to think and act in a particular way. It is a comprehensive function, involving our whole nature, by which we direct ourselves and find our way through a whole forest of possibilities … We are always moving into new territories. All the same, some explicit maps and some general guidelines for explorers do exist and can be referred to. There is constant use of rationality; the area is cognitive; we can know things. We are not just guessing or gambling. In pursuing our ideals as a profession for ethical conduct of members, we need to do more than focus just on ethical dilemmas. In the absence of research into ethics in our profession we can extrapolate from other health professions (such as occupational therapy), which share similar underpinning values about client relationships, to guide considerations of an expanded view of what it means to think and act ethically. Wright-St Clair and Seedhouse (2004, p. 18) argue that: By their very nature, professional codes of ethics contribute a shift in emphasis from morality being considered as integral to relating in the everyday practice world towards being something that directs decisions about how to act, particularly in ethically challenging situations. They suggest that the commonplace nature of morality consigns it to routine, habitual ways of acting in the world and that these ways are rarely subjected to scrutiny. They suggest that it is only when something unusual happens, such as the presentation of an ethical dilemma, that the way we think and act with regard to ethics is considered. I ask speech pathologists to consider whether this “fascination in extraordinary events” (Wright-St Clair & Seedhouse, 2004, p. 19) in the form of ethical dilemmas, rather than the moral practice of everyday work, also occurs in speech pathology. I question whether the focus of the Ethics Education Package on a decision-making protocol to resolve ethical dilemmas inadvertently reinforces this notion that ethics comes into play only when we are faced with unusual, rather than daily situations. Moving beyond a focus on dilemmas, I also suggest that as a profession we may be too focused on our ethical duties to clients, to the neglect of meeting our ethical duties towards community, employer, profession and colleagues. There may be many good reasons for this and I want to move on now to a consideration of some of the pressures which obscure awareness of the broad ethical context in which we operate. Pressures on ethical thinking and action Since the founding of health care professions and the promulgation of the Hippocratic Oath for doctors in

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JCPSLP Volume 17, Supplement 1, 2015 – Ethical practice in speech pathology

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