JCPSLP Vol 21 No 1 2019

Ethical conversations

Putting on a new hat Reflections on ethical speech-language pathology practice in the justice system Mary Woodward and Suze Leitão

N umerous studies in Australia and overseas have demonstrated high rates of often previously unrecognised communication difficulties experienced by young people and adults in contact with the justice system (see, for example, Anderson, Hawes & Snow, 2017; Bryan, Freer and Furlong, 2007; Justice Health & Forensic Mental Health Network, 2017; McNamara, 2012; Snow & Powell, 2008, 2011). These difficulties can contribute to someone’s challenging behaviour and/or disengagement from school and subsequent path into the justice system, and can negatively impact on an individual’s ability to participate effectively in the justice system (e.g., engaging in a police interview or trial) and benefitting from other verbally mediated interventions (e.g., offence-specific treatment programs). In recent years, there has been increasing recognition of these difficulties and the benefits of addressing communication needs more effectively. This increased awareness has led to the development of new roles in the justice system to assess and manage communication difficulties, such as communication intermediaries to support the communication of an individual with the police and courts through the investigative and trial processes, and as researchers or clinicians assessing and treating communication difficulties within custodial and community justice settings. Given their specific training and experience in assessment and management of communication difficulties, speech-language pathologists (SLPs) are ideally placed to perform such roles, which is widening the area and scope of SLP practice. Members of the profession are progressively moving into roles within and around the justice system across Australia, including working as SLPs in youth or adult justice settings (custodial and community), or as communication intermediaries assisting with the communication between an individual with communication needs and the police/courts in order to enable them to participate more fully in the justice process. SLPs therefore find themselves encountering new, often complicated situations which give rise to complex ethical issues, which in turn can lead to ethical unease and dilemmas. This article will summarise some of the approaches on which SLPs can draw, and illustrate these using example scenarios. Scenario 1 Michelle is working as a communication intermediary, and has been asked to assess the communication skills of an elderly lady, June, who has a mild intellectual disability, so as to advise the police and court how best to enable her to participate in an interview with

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the police and a possible future trial. Michelle meets June in her nursing home, and begins the assessment. During the assessment, a member of staff brings June a cup of tea. Michelle observes June coughing while drinking the tea, and is concerned that she may have swallowing difficulties that have not been previously recognised. Michelle asks June if her swallowing has ever been assessed, but June is unsure. Michelle does not know what to do. In her intermediary training, it was stressed that an intermediary should only assess and advise on communication as it pertains to the justice process, and that it is not within the intermediary’s role to comment or advise on other aspects of someone’s care and treatment. However, as a trained SLP she is aware of the potentially life-threatening risks of dysphagia and she feels uneasy not highlighting this to those involved in June’s care. Michelle is aware that, as an SLP, she has agreed to know, understand and abide by the Speech Pathology Australia (SPA) Code of Ethics (SPA, 2010). The SPA Code of Ethics (2010) recognises the following principles , considered of equal value and interrelated: 1. Beneficence and non-maleficence: we try to benefit others in our role as an SLP, and we do not harm others when fulfilling our professional duties; 2. Truth: we tell the truth and provide accurate information to people with whom we come into contact in our everyday practice; 3. Fairness (justice): we deal fairly with everyone with whom we come in contact irrespective of race, religion, gender, sexual preference, marital status, age, disability, beliefs, contribution to society, and/or socioeconomic status; 4. Autonomy: we respect the rights of our clients to make their own informed decisions; 5. Professional integrity: we are respectful, competent, and work within the ethical and legal guidelines of the profession. Michelle has also recently completed the SPA Ethics Education Package (Leitão et al., 2014) which included a discussion of the principles approach to applying these ethical principles to everyday clinical practice, to guide professional behaviour proactively, and to help solve ethical issues and problems as they arise. She accesses the Principles-Based Decision Making Protocol template from the SPA website at https://www.speechpathologyaustralia. org.au/SPAweb/Members/Ethics/Ethics_Education.aspx and uses this to guide her thinking and decision-making.

Mary Woodward (top) and Suze Leitão

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JCPSLP Volume 21, Number 1 2019

Journal of Clinical Practice in Speech-Language Pathology