JCPSLP Vol 17 Supplement 1 2015_lores

make ethical decisions around service delivery for each of our clients” (p. 94). Undoubtedly, it is an ethical responsibility for individual clinicians to know what the literature says and what the available evidence is. It is also critically important that speech pathologists stay abreast of developments in clinical knowledge and practice by engaging in continuing professional development (CPD) – this is an ethical responsibility, as reiterated in the Association’s Code of Ethics (2000): “We strive to continually update and extend our professional knowledge and skills… and work towards the best possible standards of service to our clients” (p. 3). Ethical concerns may arise, however, when due to caseload and other demands, time is not available to undertake CPD and/or access to relevant facilities and technology, such as the Internet, is restricted. This may be particularly the case for those services limited by budget and for those clinicians in rural and remote areas where access is not reliable. Such situations raise questions of “whose responsibility is it to ensure competence and fitness for practice: the employer’s or the speech pathologist’s?” Where employers decline or are unable to support CPD, our ethical duties to clients and colleagues and the profession mean individual speech pathologists must assume responsibility (and cost, in dollars and time) for their own CPD. The means by which a practitioner ensures currency of knowledge and ongoing fitness to practise may require creative and lateral thinking. A willingness to access mentoring, to engage the assistance and expertise of colleagues, as well as devote time to ongoing education may conflict with long waiting lists and organisational targets. Extended scope of practice The ongoing development of our profession together with workforce re-engineering precipitated by the health workforce shortage will lead to changes in our scope of practice. At one end of the continuum, scope of practice will extend to include roles and tasks not currently part of our practice, and at the other end our scope of practice may retract as more tasks are delegated to assistants or other professionals. Considerations in relation to changed scope of practice highlight a number of key professional issues: identifying the scope of speech pathology practice, determining the role of governance and risk management frameworks, specifying responsibilities for supervision of those to whom tasks are delegated, and determining the boundaries of legal liability. Speech pathology practice in Australia is informed by key Association documents such as Scope of Practice in Speech Pathology (Speech Pathology Australia, 2003) and Parameters of Practice (Speech Pathology Australia, 2007a). Association position papers further inform specific areas of specialist clinical practice – for example, Dysphagia: Modified Barium Swallow; Tracheostomy Position Paper; Fiberoptic Endoscopic Evaluation of Swallowing (Speech Pathology Australia, 2005a, 2005b, 2007a). However, a speech pathologist’s involvement in particular clinical practices will always be dependent upon a number of key factors including the preferred model of service delivery of an employing organisation, the support and explicit authorisation of an employing organisation for speech pathologists to perform particular tasks, access to training and demonstration of competence, and consideration of clinical governance issues. The challenge for the practitioner will be to ensure that service delivery models

in which they work meet the requirements of minimising risk and harm, while at the same time facilitating new skill development and ongoing expansion of the profession. Community expectations Through access to the Internet and other forms of media, consumers are now better informed about health care services. They have a greater expectation that services provided will reflect best practice and will provide value for money. This expectation requires practitioners to remain abreast of current knowledge and practice, and the information gleaned will arm consumers with the confidence to question practices which may be inappropriate or outdated. In addition, consumers may request services they have read or heard about which our profession considers to be unsupported by evidence. Speech pathologists will therefore need to be aware of the evidence across the range of their practice and be able to explain and defend their recommendations for management. Increased consumer expectations will also inevitably lead to demand for more convenient location of services, including services closer to home and actually in the home. Practitioners therefore will need to consider new models of service delivery. As services increasingly move from secondary and tertiary medical settings to primary care (community-based) settings, practitioners may need to extend their repertoire of skills in needs assessment, training of others, delegation of tasks and supervision and mentoring of assistants, volunteers and carers. Telehealth offers considerable promise for more flexible community-based and domiciliary service delivery. Elspeth pathology using high-end video-teleconference suites is already in use across Australia, enabling practitioners in major centres to provide services to rural and remote clients. Elspeth pathology using web-based delivery into clients’ homes is rapidly becoming an option (Theodoros, 2008). These developments raise a number of ethical and legal concerns including maintaining privacy, confidentiality and security of information transmitted and held in electronic health records (Stanberry, 2000); ensuring standards for providing legally and professionally recognised services (Reed, McLaughlin & Milholland, 2000); and sorting out issues of reimbursement for services delivered by telehealth (Chetney, 2002). A growing ethical concern about telehealth in any form (via video- teleconference suites or webcam) is the impact it may have on what Stanberry (2000) refers to as the “traditional clinician–patient relationships” (p. 615). Cornford and Klecun-Dabrowska (2001) caution against “substitution of care with treatment” (p. 161). Speech pathologists do not yet have enough experience with telehealth to know how it impacts on consumer satisfaction with services. The views of Australian speech pathologists regarding emerging ethical risks to practice The authors ran a workshop at the National Conference of Speech Pathology Australia in Sydney in May 2006 to ascertain what Australian speech pathologists perceived as emerging ethical risks to practice. After a brief presentation summarising some of the above trends, some 50 speech pathologists were asked to discuss in small groups and then summarise emerging ethical issues. These are presented in table 1. The emerging ethical issues identified by workshop participants fell into 10 categories of concern.

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

www.speechpathologyaustralia.org.au