Examples of Typical Ethics Inquiries
ASHA members and certificate holders seek ethics guidance from the National Office for a large number of diverse situations that pose serious ethical concerns and dilemmas. Although the permutations of potential ethical issues are endless and each case is unique, many of the requests for ethics guidance we receive address common themes and situations. ASHA members and certificate holders are encouraged to call the National Office whenever they need general ethical decision-making guidance or are faced with a challenging ethical dilemma.
The following is a representative sampling:
- I am a school-based speech-language pathologist. A parent of a child on my school caseload has asked me to also provide speech and language services on a private basis during the academic year or, in the alternative, later in the summer. Would that represent a conflict of interest?
- I work in a long-term care setting. My administrators are mandating a "productivity" standard that will require that I provide services to some patients who would not, in my professional judgment, reasonably benefit from those services. I am worried that if I don't comply I will lose my job.
- I am thinking about creating a Web site for my audiology practice. Can I post testimonials and laudatory comments from my clients on the site in an effort to market my practice?
- I have a private practice. Can I ethically establish a sliding fee scale to help clients from low-income families afford my services while maintaining my regular fee structure for all other clients? Someone suggested that this would be discriminatory?
- The radiologist at the hospital where I work has advised me that he will no longer be available to be in the examination room during my videofluoroscopic swallowing studies. Can I still ethically do these examinations without a radiologist present?
- My school district is in a rural part of the state and has a difficult time recruiting and retaining ASHA certified SLPs. Therefore, by necessity, the district is hiring less qualified clinicians and support personnel and delegating supervisory responsibilities to me. I already have a full caseload and I am worried that I will not be able to provide sufficient supervisory oversight. The Code of Ethics says I must appropriately supervise these support personnel. What does "appropriately" mean?
- I have an offer for a great new job. Because my new employer needs me right away I will have to resign from my current setting with only two days' notice. My current employer is complaining that she needs more time in order to hire a new clinician or my clients will go without services. She is threatening to file a complaint against me for "client abandonment." I think she is holding me hostage. Those clients are her responsibility, aren't they?
- I work in a small private practice. My employer, also a certified SLP, is demanding that, when I see children for group therapy, I bill the third-party payer for individual therapy. That is unethical, but I don't have any evidence other that what she said, and you know she will deny that. Do I still have a duty to file a complaint against her with ASHA?
- I am a school-based SLP. A parent of a child on my caseload has requested that I provide her a complete copy of my file on her child, including test protocols. I am worried that the parent may use the test protocols to "teach" her child the test. Can I deny her request for test protocols?
- I don't think I have the experience and competence to work with dysphagia patients without some continuing education, training, and/or mentoring. However, my employer (who is not a speech-language pathologist) is demanding that I do so. When I tried to explain my concerns, my employer simply said that "you are a SLP and dysphagia is in the scope of practice for speech-language pathologists…therefore, do it." Our scope of practice keeps expanding; that doesn't mean we are deemed to be competent in all areas just because something is in that scope, does it?
- Can I refuse to provide a client's file and records to another provider or doctor until the client has first fully paid his bill for my services? I don't think I will get paid otherwise.
- I have a master's degree in communication sciences and disorders and am an ASHA certified SLP. I also have a PhD in art history. When my colleagues at the facility where I work found out my doctorate was not in speech-language pathology, they advised me that it would not be appropriate for me to refer to myself as "doctor" in any matters related to my work or with clients. I earned my doctorate and I think I have a right to use "doctor" anytime I want to, right?
- I work in the public schools. Medicaid will reimburse my school for speech and language services provided by an ASHA certified SLP and for services "under the direction of a certified SLP." My school district wants me to sign off on Medicaid reimbursement requests for clinicians in other local schools who are not ASHA certified and not supervised by me. My administrator tells me that "under the direction of a certified SLP" does not mean that I have to actually supervise them. I'm skeptical and unsure exactly what my ethical responsibilities are in these circumstances.
- My uncle recently had a stroke and has been admitted to the facility where I work. His neurologist suspects he has aphasia. What is ASHA's position on whether it would be a conflict of interest for me to provide speech and language services to a member of my family?
- I am an audiologist and ASHA member. I have information and evidence of ethical misconduct by another ASHA audiology member and certificate holder that would, I believe, represent a violation of the Code of Ethics. The other audiologist has a competing audiology and hearing instrument dispensing practice and lives in my small close-knit community where she is well liked and respected. I am afraid that if I file an ethics complaint my business will suffer and I will be ostracized by friends and neighbors. What are my ethical responsibilities?
- I am an SLP working in a small, nonprofit pediatric speech and hearing center. We have discovered that several of the speech and language tests we routinely use have been updated by the publishers of those tests. Our financial resources are limited, particularly in this tough economic climate, and we, frankly, cannot afford to replace these tests with their newer versions. Are there problems associated with our continued use of older, superseded, testing instruments?
- I supervise a clinical fellow. We had an understanding that after the clinical fellow finished her clinical fellowship and was ASHA certified she would work in my practice for at least another year. She is now almost finished her fellowship and has informed me that she has accepted another job to start as soon as she is ASHA certified. That was not our understanding and I think I should be able to refuse to sign her clinical fellowship rating form and submit her paperwork to ASHA. The clinical fellow says that I am retaliating against her and that I have an ethical responsibility to submit the paperwork. I don't think my actions are unethical in light of her unfairness to me.
- If I file an ethics complaint with ASHA's Board of Ethics, are there any state government regulatory agencies that also have jurisdiction? Should I should file with these agencies as well?
- I am aware of an audiologist who continues to use the ASHA credential CCC-A even though she let her ASHA certification lapse years ago. Is that something I need to report to ASHA?
- A family recently consulted me about the possibility of providing services to their family member who is monolingual in Spanish. I do not understand or speak Spanish and there are no Spanish-speaking SLPs in my community. I would like to help this individual and think I may be able to do so in a competent manner if I can use family members as interpreters but I am unsure whether that is consistent with best practices and my ethical responsibilities.
- The parents of a child on my caseload are having a custody battle and the attorney for the mother has asked me to provide a copy of my file on the child and to testify at a custody hearing. I have not received a subpoena for my records or for my testimony. The father is telling me not to because it would violate my ethical duty of confidentiality regarding my client–clinician relationship with the child.
- My supervisor in the skilled nursing home where I work is the facility's director of rehabilitation, a nurse. She is demanding that I engage in practices that are unethical under ASHA's Code of Ethics. I want to file an ethics complaint against her with ASHA's Board of Ethics but am unsure whether the board would be able to adjudicate the case and sanction my supervisor. Exactly what are the jurisdictional limits of the Board of Ethics?
- I am dually certified and have a private practice offering speech, language, and hearing services. I want to institute a $35 fee for clients who fail to show for an appointment without providing at least a 24-hour notice of cancellation. An SLP who works for me is concerned that, if we enforce the penalty, the penalized client may file a complaint against us, alleging that he/she was charged for services that were not rendered, a violation of the Code of Ethics. Are we prohibited from charging a fee to clients who fail to cancel their appointments?
- One of my clients has asked me if I would go out on a date with him. I think that may be a problem, but I don't know. He's nice and I am attracted to him. Yikes, I don't know what to do!