American Speech-Language-Hearing Association

2011 Student Ethics Essay Award – 2nd Place

Clinical Clash of Cultures

Ambily Abraham
Seton Hall University
South Orange, New Jersey
NSSLHA Chapter Advisor: Natalie Glass

Eid Mubarak! Taken out of context, this statement may sound foreign to some speech-language pathologists or like absurd speech babble to the unaware. In actuality, this is a traditional Muslim greeting used in celebration of the Muslim festivals of Eid. In the wake of one of the most horrific terrorist attacks our country has ever experienced, the lines of what is deemed appropriate and inappropriate have been blurred, particularly for the Muslim population. Discrimination happens daily because of our human nature to be analytical. Our responsibility as professionals is to not let this inherent trait interfere with our professionalism and code of conduct. What, then, is one to do if the lines of discrimination are further skewed due to the set relationship between a clinical supervisor and student? These issues will be discussed in this essay, as well as methods to address such a situation and how an ethically acceptable outcome might be attained.

There is beauty and truth in all the main world religions. A common thread with Christianity and Islam is to love and respect one another. The ASHA Principles of Ethics coincide well with what it means to be a moral citizen of our communities and of the world. Principle of Ethics I states that we should "hold paramount the welfare of persons we serve professionally." Principle of Ethics IV states "individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of other professions and disciplines." These Principles will be further examined in the following case scenarios.

Many case situations can fall under the dilemma of opposed cultures. This essay will discuss three of focal importance. This first case scenario involves a female graduate student of Muslim faith who wears a hijab (veil) as part of her faithful practice of Islam. When communicating to her supervisor on the phone, the relationship seems to run smoothly and communication is open. However, while initially meeting, the graduate student feels unwelcomed by her supervisor. The graduate student hopes it may be just a bad day for her supervisor, but as the semester starts, she realizes she is being treated unfairly. The student reaches her boiling point when she overhears her supervisor make an inappropriate comment about her hijab to a parent.

The best way for the student to approach this scenario if she feels uncomfortable addressing it alone, is to involve her graduate program's director of clinical education (DCE) to act as a liaison. First, the student can discuss the facts with the DCE and provide documentation of specific examples of the supervisor's unprofessional behavior. Together the student and the DCE can tackle the problem by having open communication with the supervisor in a scheduled meeting. The DCE can explain what the importance of wearing the hijab is and how the student feels she has been treated unfairly. Under Principle of Ethics IV, it states "individuals shall not discriminate in their relationships with colleagues, students, and members of other professions and disciplines on the basis of race or ethnicity, gender, gender identity/gender expression, age, religion, national origin, sexual orientation, or disability." Consequently, if the supervisor cannot abide by this rule, the supervisor can be sent to the ASHA Ethics Committee for further action. It is important not to approach the supervisor as an attack, but to handle it in a way where both parties can have an open conversation on how to solve the problem. Ideally, both parties can then come to a consensus of the expectations for respecting each other and each other's religious beliefs and practices. The student can continue to try to work with this supervisor, again documenting any perceived wrongful actions if they should continue. It is the moral responsibility of the supervisor to be more considerate of her colleagues, to abide by the Code of Ethics, and to demonstrate respect as stated in ASHA's "Issues in Ethics: Cultural Competence" article – Principle of Ethics II, Rule C "reminds clinicians of the importance of lifelong learning to develop the knowledge and skills required to provide culturally and linguistically appropriate services."

The second scenario involves a male graduate student who insists to his supervisor that he must pray twice during his clinical hours as a requirement of his religious practices. While the supervisor can attest to the student's competent clinical skills, the supervisor does not agree to the student taking time out of treatment to pray. The student feels helpless because he wants to practice his prayer devotedly, but his supervisor sees the busy caseload taking priority. He does not understand how this is fair because he frequently observes his supervisor taking cigarette breaks.

This scenario is much like the first. It is also a violation of Principle of Ethics IV. The student needs to contact the director of clinical education at his school to help mediate this problem. Together they can negotiate allotted time for the student to pray and still stick to a schedule for the rigorous caseload. There needs to be flexibility on both sides in order for the clinical supervisor-student relationship to work. Everyone has their own priorities in life and it is important to respect other's needs even if they are not in accordance to our own values.

The third scenario represents a supervisor and student relationship that is well matched. The two work so closely together that by the middle of the semester the supervisor casually jokes with the student. The student enjoys the camaraderie because she feels accepted by her supervisor. The lighthearted air of the speech therapy room dissipates when they see the name "Tariq Muhammad" on their list of referrals and the supervisor starts making inappropriate jokes about Muslims that make the student shrivel with discomfort. The student decides to ignore it in order to maintain the friendship with her supervisor. The student realizes the supervisor takes Tariq off the list of students she will evaluate. When the student brings this to her supervisor's attention, the supervisor makes the comment, "They don't need our help after what they did to us on 9/11."

The student should cite that under Principle of Ethics I, it states "individuals shall not discriminate in the delivery of professional services on the basis of race or ethnicity, religion, national origin". It would be a disservice to that child if he was denied speech and language services based on a speech-language pathologist's biased opinion. This issue should be discussed openly with the clinical supervisor so he or she has the opportunity to learn from their own mistakes. If necessary, the student can bring the director of clinical education in to intervene. Often we hold personal grudges that can interfere with our everyday lives, and sometimes just talking about these thoughts can help release the burden of the grudge itself.

Open communication, documentation, and reiteration of ASHA Ethics Code are essential with all three scenarios mentioned. This can help make a person more receptive of what is really important, such as the welfare of the individuals we serve and maintaining respect for each other. In summary, the golden rule holds true: treat others as you would like to be treated, no matter what cultural background they may come from.


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

American Speech-Language-Hearing Association. (2005). Cultural Competence [Issues in Ethics].
Available from  

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