2012 Student Ethics Essay Award – 1st Place
Impaired Practitioners: A Collective Call for Action
by Kendra Schmitt
University of Iowa, Iowa City, Iowa
Chapter Advisor: Jean K. Gordon
Most men would rather deny a hard truth than face it —George R.R. Martin
A clinician walks into a Wednesday morning staffing with the lingering odor of alcohol on her breath. A researcher spends countless hours contemplating death or suicide and loses all interest in his current project. The fact that clinicians or researchers may face mental illness or battle substance abuse during their career is not new, but increased awareness of this problem in various professions has brought the issue to prominence. Despite the heightened awareness in the field, the exact number of "impaired professionals" is unknown for a variety of reasons. For example, professionals may not be correctly diagnosed or treated despite having a condition that may affect their job performance (Boisaubin & Levine, 2001). However, quantifying the subset of impaired practitioners is not the most pressing issue. The imperative question to consider is who is ethically obligated to act when mental illness or addiction affects the workplace. When a tendency toward denial or feigned ignorance is the easier route to take, who should be held accountable by the field or the public when a practitioner is unable to fulfill his or her responsibilities due to mental illness or addiction?
Ethics formulate the core of what distinguishes a profession from other types of fields. A profession dictates "that its practitioners adhere to a set of ethical principles and rules of professional conduct" (Davidson & Denton, 2010, p. 71). The current American Speech-Language Hearing Association (ASHA) Code of Ethics (ASHA, 2010) clearly outlines that it is the utmost responsibility of the professional to look after the welfare of the individuals they serve and to provide competent services (Principle of Ethics I; Principle of Ethics II). Clinicians and researchers not only need to be accountable to those whom they serve, but also to their profession, colleagues, students and professionals from other disciplines (Principle of Ethics IV). The ethical responsibilities of the impaired practitioner cannot be ignored. Individuals who are adversely impacted by drug addiction or mental health conditions accept the responsibility of seeking professional assistance and/or withdrawing from practice, an ethical obligation agreed upon when they first become a professional serving the field (Principle I, Rule Q). Even if impaired practitioners are able to achieve competence and adequate performance by seeking assistance, it is still the responsibility of the individuals to continuously reevaluate their status. Furthermore, proactive measures (e.g., providing an interim plan) for the sake of clients' wellbeing should be taken in the event a clinician must abandon clients for reasons related to mental health or addiction (ASHA Issues in Ethics, 2010). A professional's willingness to seek out help and follow the best possible course of action does not solely benefit his or her clients. An impaired practitioner is likely to experience loss of license or destruction of family and personal life if no course of action is taken (Boisaubin & Levine, 2001). Clinicians, therefore, must play an active role in dealing with their impairment for their own sake as well as the wellbeing of others.
The weight of ethical accountability does not fall solely on the shoulders of the impaired practitioner. It is the responsibility of ASHA members and certified professionals to file a complaint if they believe someone has violated any portion of the Code of Ethics. However, the Board of Ethics recommends colleagues, employers, and/or supervisors work with the individual of concern as soon as possible in order to prevent any violations requiring a formal complaint (Davidson & Denton, 2010). If a problem is suspected, but not obviously encountered in the workplace, a sincere expression of concern for the practitioner's wellbeing may provide enough encouragement for the individual to seek assistance. The priority in these scenarios is an obligation to protect the clients to whom the colleague or employee may do harm if the effects of impairment spiral out of control. All clients should have the expectation met that any professional they encounter in the field of communication sciences and disorders will provide competent care (Boisaubin & Levine, 2001). Lastly, there is not only a professional but moral obligation to help a coworker understand the problem and get treatment. As one advocates for a client with impairments, one must also be an advocate for any person in the field who needs help.
The Code of Ethics, as a representation of ASHA, is not merely an inspirational standard. The Code of Ethics also serves as a necessary enforcement tool. Therefore, ASHA has to maintain its longstanding responsibility to enforce the Code and accept complaints in order to maintain the profession's positive light in situations involving impaired practitioners (Davidson & Denton, 2010). When an impaired clinician or researcher violates an aspect of the Code of Ethics, there is no sanction that is universally appropriate. The range of sanctions available to the Board of Ethics to deal with a breech of ethics allows not just for penalization, but education and rehabilitation of the guilty individual. The ultimate findings by the Board of Ethics must strike an appropriate balance between serving the interests of the affected party and the practitioner. As a governing body, ASHA is in a position to oversee the conduct of certified professionals and needs to assume this role in the scope of impaired practitioners. Providing awareness of this topic through discussions, publications and ethics training is one potential role for ASHA.
But what happens, then, if no one takes action? The worst case scenario is not hard to imagine. The populations served in this field are vulnerable due to their communication disorders or differences. For example, for those with the language disorder of aphasia, speech-language pathologists serve as a primary source of assistance. As aphasia is a deficit in language, SLPs serve as the front lines for improvements in communication beyond spontaneous recovery. Therapy is targeted at helping individuals regain or compensate with as much communicative skill as possible and provide counseling to the family and caregivers. The amount of trust an individual with aphasia, as well as their family, needs to place in a SLP to provide appropriate services is immense. An impaired practitioner whose problems directly interfere with his or her ability to provide competent and professional service breaches this delicate trust and hinders a client's potential improvement when time is of the essence.
Ultimately, the problem of impaired practice falls under everyone's ethical responsibility. Certified speech-language pathologists and audiologists need to constantly verify that they meet and promote ethical standards. Regulatory boards and employers have an obligation to enforce regulations and provide necessary treatment programs in order to ensure that impaired practitioners are not allowed to endanger clients or the reputation of the field (Query Daniel, 1984). Heightened awareness, knowledge, and acknowledgment of substance abuse and mental illness by professions are important preliminary steps in addressing the issue of impaired practitioners. Such information is ideally supplied and regulated by ASHA. In return, the clients we serve (past, present and future) will be made more aware of the "character, integrity, and reputation" of the profession (Davidson & Denton, 2010, p. 71). If, instead, the above parties choose the easy road of denial, they ultimately sacrifice the trust we place in the public's hands.
American Speech-Language-Hearing Association. (2010). Client Abandonment [Issues in Ethics]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2010). Code of Ethics [Ethics]. Available from www.asha.org/policy.
Boisaubin, E.V., & Levine, R.E. (2001). Identifying and assisting the impaired physician. The American Journal of the Medical Sciences, 322(1), 31–37.
Davidson, S.A., & Denton, D.R. (2010). Ethics compliance: Enforcing ASHA's code of ethics. Perspectives on Fluency and Fluency Disorders, 20(3), 71–76.
Martin, George R.R. (1997). A game of thrones (a song of ice and fire, book 1). New York, NY: Bantam Dell.
Query Daniel, I. (1984). Impaired professionals: Responsibilities and roles. Nursing Economic$, 2, 190–193.