American Speech-Language-Hearing Association

2011 Student Ethics Essay Award – 1st Place

A Domino Effect of Unethical Decisions

By Monique King
Northwestern University
Evanston, Illinois
NSSLHA Chapter Advisor: Tracy Cafferty

A seven-year-old boy and his family recently moved into a new school district. He has a moderate-to-severe receptive and expressive language delay. His delays impact his access to the general education curriculum, his social interaction with peers, and his self-esteem. Unfortunately, no one is aware of the true nature of his impairment. Let me tell you why.

Six months ago, his teacher referred him for an initial speech and language evaluation. At the time, the school's full-time speech-language pathologist (SLP) was overwhelmed with the magnitude of her caseload, which recently climbed to a new high of sixty-eight. The week of the child's evaluation, the SLP had four re-evaluations and three meetings for Individualized Education Programs—in addition to regularly scheduled therapy. Although the SLP had the part-time aid of a graduate student clinician completing a school practicum that semester, she desperately asked her friend and colleague, the school's occupational therapist, to conduct the seven-year-old boy's speech and language evaluation while her graduate student administered therapy to other children. The tests were administered and scored by the occupational therapist. The SLP reviewed the results and determined that the child did not qualify for services. She, herself, never spent any time with the child.

The SLP's graduate student clinician was gravely concerned about the ethicality of the situation, but ultimately chose to overlook the incident for fear of confrontation during his last semester of graduate school. He tried to rationalize the situation as "seemingly harmless."

Several concerns arise from the scenario above. The child's welfare was not maintained when his academic, social and vocational future were entrusted to an individual, albeit knowledgeable, who was unlicensed and untrained in the specialty field of speech and language. In addition, a situation acknowledged as unethical was not actively addressed.

The SLP's behavior was prompted by a desire to manage a substantial caseload with minimal manpower. Her decision prompted a domino effect when her graduate student chose to ignore an unethical practice in order to avoid confrontation. By doing so, however, he neglected a critical professional responsibility that he had even as a graduate student member of the American Speech-Language-Hearing Association (ASHA). He fully understood that ASHA's current Code of Ethics (Principle of Ethics I, Rule E; Principle of Ethics II, Rules A, D) prohibits the delegation of tasks that require the unique skills, knowledge, and judgment that are within the scope of our profession to individuals who do not hold, or are in an educational program to hold, the Certificate of Clinical Competence.

In a scenario such as the one described above, or any instance in which a graduate student has difficulty addressing an unethical issue with a supervisor, he/she should seek the counsel of another ASHA professional. In this scenario, the graduate student could have easily gained the support system and advice of the individual who coordinated his school practicum, his clinical advisor, or even the director of his clinic. Alerting other professionals to a potential problem, and doing so in an objective manner, will not elicit confrontation. In this situation, it would have demonstrated the student's preparedness to graduate, enter the field, service clinical populations, and maintain the professional standards of licensed SLPs.

In addition to finding another professional to counsel students on their approach in unethical situations, it helps to understand one's options. For instance, the SLP in this scenario could have asked the school's case manager if it was possible to change the meeting schedule to increase her flexibility or obtain help from other SLPs within the district to manage the number of upcoming re-evaluations. Perhaps knowing such options would have made it easier for the student to voice his opinion when the problem first surfaced. Pursuing either of these options, or other ethical options that could not be considered at the time due to the SLP's level of stress and anxiety, would have eliminated the need for delegation of an important task to someone who could not fulfill the responsibility sufficiently. In addition, the welfare of a seven-year-old child, who has already gone without services for too long, would not be jeopardized.

In essence, as graduate student clinicians we never want to overstep our bounds with supervisors. When an unethical decision occurs, however, we have to be willing to uphold our responsibilities to our profession and to our clients even if it causes us temporary discomfort. Luckily, we will have the support of other supervisors and university personnel to give us counsel when needed. We just have to be willing to ask.


American Speech-Language-Hearing Association. (2010). Code of Ethics [Ethics]. Available from  

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