JCPSLP Vol 17 Supplement 1 2015_lores

Ethics in ordinary everyday practice In her role as Vice-President Communication of Speech Pathology Australia, in a review of major types of complaints to the Ethics Board of Speech Pathology Australia, Russell noted that some major reasons for consumers’ complaints are due to failure of speech pathologists to think and act ethically about ordinary events amidst busy professional lives (personal communication, 1 May 2005). Clients complained about their concerns over what they were being billed for and perceptions of overbilling, and about reports not being provided in a timely fashion. These two scenarios are avoidable by using good planning skills to make time for paper work, including report writing, and good communication skills to explain what we are doing and why. Problems that may prevent honouring agreements, such as sending reports within the agreed timeframe, need to be discussed. There are many other potential sources of complaint arising in ordinary clinical practice. Many are related to failure to explore the assumptions, expectations and emotional needs of clients and to consider these in communicating clinical management decisions, for example, those pertaining to service delivery models and therapy approaches offered, and discharge planning (Hersh, 2003). “Thinking ethically” would allow professionals to pre-empt such situations by sensing and discussing concerns clients might have and addressing them before they become problems. Becoming ethically aware and thinking ethically What would it mean to be always thinking and acting ethically in the workplace? According to Purtilo (1999), this would mean acting as a “moral agent” in the workplace, acting with personal integrity, despite personal and professional costs that may ensue. We may have to engage in conflict with management when polices or management decisions block our ability to act with integrity. We may need to engage in difficult discussions with staff who are not acting beneficently towards clients, not honouring clients’ rights to autonomy, not pursuing justice for their clients, and perhaps even acting maleficently by not being competent to provide services they are, or should be offering, in line with best practice. We may, in extreme cases, need to report colleagues to supervisors/managers, or to the Ethics Board. Such acts require courage and support from mentors, supervisors or colleagues. At the very least, acting as a moral agent in the workplace means seeking to raise awareness in others about ethical issues, through conversation, role modeling or professional development. Professional development of ethical reasoning How can we increase our ethics awareness and abilities to think and act ethically? There is little research into ethical reasoning and conduct in speech pathologists. I would suggest that, like most professional skills, ethical and moral reasoning develop with experience, and that this development can be supported through mentoring, workplace supervision and professional development programs. Benner (1984) noted that with increasing expertise, skills become automatic and require little conscious attention, unless a novel or extraordinary situation arises. “Being aware” also becomes somewhat automatic with experience. Torbert (1978) suggested that there are four

interacting qualities of experience: the outside world, one’s own behaviour, thought and feeling, and intuition, intention, and consciousness. He believed that while the outside world can be accessed through our senses, the other three qualities are accessible only through attuning our attention to their interplay. He believed that normally we “do not educate our attention to commute between figure, ground, and region, among focus, feeling, and intention, among task, process, and purpose” (Torbert, 1978, p. 112), to achieve a higher quality of attention. Torbert (1978) argued that a heightened awareness, what he called a “higher quality of attention”, becomes a constant state of being in experienced professionals. In contrast, for less experienced professionals, awareness requires a deliberative focus (Dreyfus & Dreyfus, 1985). Deliberative focus (a cognitive process) on potentially ethically challenging situations is likely to be difficult for less experienced professionals to sustain amidst the myriad of things to which they must pay attention. However, recent work in emotional intelligence (Goleman, 1995), in professional reasoning in nurse educators (Titchen, 1998) and in reasoning in clinical educators (McAllister, 2001), highlights the role of intuition and feelings in bringing heightened emotional awareness to professional work. Titchen (1998) in her critical companionship model, identified a rationalityintuitive domain which she saw as a blend of technicalrational and intuitive approaches to educating. Two of the concepts identified by Titchen in this domain, intentionality (conscious self-aware thoughtfulness) and saliency (the ability to know consciously or intuitively what is important), are useful concepts for consideration in developing ethical and moral reasoning. McAllister (2001) found that participants in her study both intuitively and consciously knew what was important to attend to. Further, as described in Titchen’s model, they used both conscious and intuitive levels of awareness, depending on experience and ability, what seemed important at the time and what factors were influencing attention levels. The more experienced clinical educators used conscious and intuitive levels of both cognitive and emotional awareness. Less experienced educators relied more on emotional awareness but could later think through information obtained through intuition and what they referred to as “gut feeling”. Mentoring, supervision and professional development would have therefore important roles to play in helping less experienced professionals utilise feelings and emotions about ethical situations to develop ongoing cognitive awareness and ethical reasoning. In the absence of an evidence base on developing ethical awareness and reasoning, there is a need for research which could inform systematic professional development of ethical and moral reasoning. I would encourage the profession, at both workplace and association levels, to develop professional development programs aimed at raising consciousness about ethics, heightening awareness of potential ethical issues and learning to think and act ethically in ways that are deeply embedded in routine practice. These skills and attributes would be additional to skills in identifying and resolving dilemmas. Such professional development could consist of formal presentations, discussion groups about real or hypothetical ethical issues and dilemmas, and regular case reviews. There remains however, the need for individual speech pathologists to develop their own ethical reasoning. Reflection-on-practice is a hallmark of professionals (Schön, 1987). This could be extended to include reflection on ethical practice, using whatever tools sit most comfortably

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

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