JCPSLP Vol 17 Supplement 1 2015_lores

Ethical issues in augmentative and alternative communication

Ethical issues in augmentative and alternative communication Bronwyn Hemsley

In this “Ethical conversations” some common ethical issues and resources relevant to the provision of augmentative and alternative communication (AAC) or multi-modal communication in Australia are discussed. Guiding theoretical frameworks and Association documents are related to topical situations in speech pathology management in populations with complex communication needs. This paper is not intended as a review of the literature or as a guideline in relation to AAC practice which is forthcoming in the Association’s Clinical Guideline on Augmentative and Alternative Communication. Rather, common issues that might confront clinicians in the dynamic field of AAC are discussed in the light of existing theoretical frameworks and Association documents. Bringing these issues to light at this time of rapid change in the field may help clinicians to arrive at good decisions to the benefit of people with complex communication needs and their families. Guiding frameworks and principles According to the St James Ethics Centre (n.d.), “Ethics is about answering the question ‘What ought I to do?’” – a question that arises in any clinical decision, ideally well before any conflict or dilemma might arise. In recognition of the importance of ethical decisions in speech pathology, there are several resources pertaining to ethical practice (see Body & McAllister, 2009; Chabon, Denton, Lansing, Scudder, & Shinn, 2007; Speech Pathology Australia, 2002, 2010, 2012a) that are relevant in (a) assisting clinicians and all stakeholders to arrive at good, balanced, and evidence based decisions that are in the best interests of the person with complex communication needs, and (b) providing guidance to both prevent and resolve conflicts and establish positive working relationships among all those affected by a decision. In the dynamic field of augmentative and alternative communication (AAC), the multi-modal communication

range of practice of the Competency-Based Occupational Standards (CBOS) for speech pathologists (Speech Pathology Australia, 2011), existing theoretical frameworks (e.g., participation model of AAC, the International Classification of Functioning, Disability, and Health [World Health Organization, 2001]), and the Speech Pathology Australia Clinical Guideline on Augmentative and Alternative Communication (2012b) are useful resources to help guide clinicians in arriving at good clinical decisions. If at all possible, at all stages in the process of providing AAC services (see the participation model of AAC, Beukelman & Mirenda, 2005), the person with complex communication needs and their communication partners are engaged in informing and making decisions on the course of action for intervention (Williams, Krezman, & MacNaughton, 2008). As do professionals in other areas of practice, speech pathologists will continue to be confronted with situations where the course of action might not be clear to all parties involved in the decision. Complexities arise in clinical decisions about communication interventions as people with severe communication disabilities frequently have high support needs owing to physical or cognitive impairments and many areas of life participation are affected. Ethical decision-making with the person with complex communication needs or any other person responsible includes consideration of: the facts on assessment findings, all available intervention options and associated evidence, risks and benefits associated with each course of action, and values and beliefs of those involved in and affected by the decision. Tension might exist between doing what one ought to do and doing what one might be able or supported to do within the clinician’s competencies and available resources, wishes of the client, and workplace or residential care policies. As such, it is important that speech pathologists apply not only the Code of Ethics of the Association (Speech Pathology Australia, 2010), but also a theoretically sound ethical decision-making framework (e.g., Speech Pathology Australia, 2002, 2012a; Markula Centre, 2012). Arriving at an ethical decision also requires consideration of a person’s rights (see United Nations Convention on the Rights of Persons with Disabilities, 2006) and legal position, as well as risks or benefits relating to many other aspects of the person’s life and preferences. Other ethical considerations In addition to the general principles and issues noted above, there are a number of ethical considerations relating

Bronwyn Hemsley

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

Journal of Clinical Practice in Speech-Language Pathology