Speak Out August 2021

Ceasing services How to do it fairly and ethically

An increasing number of members are contacting the Association's Ethics Team to discuss ceasing service delivery for a client, with a particular focus on the ethical issues that arise. If you find yourself in this situation there are a number of things to consider to ensure that ethical obligations are met and clients are being treated fairly, and to reduce the possibility of unintended consequences, such as the clients feeling abandoned. Scenario 1 You have been working with an individual with a degenerative illness for about six months, at intake they presented with a voice disorder but have made good progress with therapy. Last week they had a stroke and now need an assessment for AAC. This isn’t something that you have a lot of experience with, and you think

The first action is to look at your policy on ceasing services, and follow the steps outlined. A key obligation is to support this individual to access another speech pathologist whose skill set is appropriate for their needs. If you know of someone who would be a good fit, through personal experience or another objective means, then recommending that speech pathologist specifically can be appropriate, otherwise you should provide a number of appropriate options and let the client know that although you haven’t worked with them before, they advertise that they have the appropriate knowledge and skills to assist them further. After this, it is advisable to have a face-to-face meeting with the client, and/or their carers, explain to them the situation and why you

Ethics

are referring them on. A meeting will allow for questions to be asked and frequently results in greater understanding of why cessation of your service is appropriate, which can reduce the likelihood of a negative response. Some other points to discuss with your client include whether the services are ending right away, or if they will continue for a set period of time. Also, how handover will occur, such as, whether you will write a progress or summary report for this client, and/or provide a verbal handover to the next speech pathologist. Scenario 2 You have been working with a family for a while and the communication has been challenging since day one. They have very high expectations of what can be achieved in one hour per week, and this isn’t attainable either for you, or for their child. You are starting to feel this might be all too hard, and that

you’d like to move them along. While you can cease services at any time when you are acting in accordance with your organisation’s ceasing services policy, there is a fundamental ethical question of whether you are still able to provide benefit to this client and whether this is a situation that could be salvaged.

you might need to cease services with this client. Ceasing services with this client is an ethically appropriate course of action in this situation to ensure the client is seen by a speech pathologist with appropriate personal competencies. Action should be taken quickly due to the client’s degenerative illness.

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Speak Out | August 2021