Issues in Ethics: Prescription
About This Document
Published 2015. This Issues in Ethics statement is a revision of Prescription (2010 and 2001). The Board of Ethics reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.
Issues in Ethics Statements: Definition
From time to time, the Board of Ethics determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics and intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided ethical decision-making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.
Principle of Ethics IV, Rule J of the Code of Ethics (2010r) of the American Speech-Language-Hearing Association states:
- Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.
This rule has prompted questions from several certificate holders. The primary concern seems to focus on the definition of the word prescription and on the implication of that definition for certificate holders who are engaged in clinical practice. The term prescription is most commonly used in medical settings, and it refers to a written statement by a physician that directs that professional services be offered to meet the needs of the individual client.
Prescription is often used solely as a request for the initiation or continuation of speech-language pathology and/or audiology services. When that is the case, prescription may be regarded as synonymous with referral, and it is a useful instrument in the total treatment program for a client. In addition, a written request for services from a physician may be required if the speech-language pathologist or audiologist intends to seek reimbursement for clinical services from third-party payers such as Medicare, Medicaid, or private insurance companies. The Board of Ethics does not consider certificate holders to be in violation of the Code of Ethics for accepting a prescription referral that represents only a request for initiation or continuation of speech-language audiology or pathology services.
On occasion, however, the language of a prescription unduly restricts speech-language pathologists or audiologists in exercising their professional responsibility to develop and/or implement appropriate clinical services because the prescription specifies the content, frequency, or duration of services to be provided. Health maintenance organizations (HMOs), Medicare, Medicaid, private insurance companies, and Individualized Education Programs (IEPs) developed for students with disabilities under the Individuals with Disabilities Education Act (IDEA) may prescribe services, protocols, and procedures which they then authorize and/or approve for reimbursement. These entities may also require updates and the issuance of new “prescriptions” for the continuation of services. Within these regulatory entities there are mechanisms for speech-language pathologists or audiologists to challenge, appeal, or seek modification of requirements. Should speech-language pathologists or audiologists be pressured by any source to provide services that are against their best professional knowledge and judgment (e.g., provide services with inappropriate frequency or intensity or when no benefit can be expected), they have the responsibility to challenge such pressure or prescription. Indeed, if a certificate holder did not challenge prescriptive mandates where the welfare of the person served is at risk, the certificate holder could be held in violation of the Code of Ethics.
Speech-language pathologists or audiologists often work in concert with other human services professionals, and the issue of restriction of professional responsibilities may be difficult to interpret in circumstances of collaborative effort. Examples of such might include serving on an IDEA-defined Individualized Education Program planning team in the schools developing an Individualized Education Program (IEP), serving on an IDEA-defined early intervention multidisciplinary team developing an Individualized Family Service Plan (IFSP), or serving on a multidisciplinary team in medical or rehabilitative agencies. In these clinical service decision-making models team members may convey interpretations of their individual test data to a single professional on the team who then synthesizes the information and conveys the findings and interpretations of the speech-language pathologist or audiologist to the client. Not only is this an efficient procedure but, more important, it may be in the best interest of the client to have test results from one discipline interpreted in the context of test findings from other professions.
As to such coordinated efforts, speech-language pathologists or audiologists should be cautioned that they continue to have a responsibility, recognized under the laws of many states, to correctly and completely communicate to the client their findings and recommendations for treatment, including the risks associated with any treatment plan. If the speech-language pathologist or audiologist is not the person communicating the findings and recommendations directly to the client, that speech-language pathologist or audiologist remains responsible for ensuring that the findings and recommendations are communicated to the client and relayed correctly and completely by a competent professional.
In all circumstances, it is incumbent on the speech-language pathologist or audiologist to determine when to accept limitations on professional responsibility. As long as the speech-language pathologist or audiologist maintains independence of judgment and preserves the professional prerogatives to plan and provide speech-language pathology or audiology services that are in the best interest of the individual client and accepts responsibility for the plan and services so provided, there is no violation of the Code of Ethics.