February 17, 2004 Feature

A Consensus Model for Making Ethical Decisions in a Less-Than-Ideal World

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In an ideal world the pressures of deadlines, workforce demands, and uncertainties related to expanding professional roles would not exist. Bosses wouldn't push, clients wouldn't argue, and children wouldn't talk back. In the real world, however, we are continuously confronted with personal and professional challenges stemming from conflicting values, interests, and beliefs. The questions we ask ourselves when faced with these situations engage reflections on the permissibility or obligatory nature of our actions, and hence form the basis of our ethical thinking. "Ethics is about questions," says M. R. McLean, "about who asks, what they ask for, and how we as individuals and communities respond."

Ethical decision-making is an inherent aspect of professional practice. Unfortunately, in today's professional climate, ethics is often viewed only in the minimalistic light of what professionals "have to do" or the legalistic sense of what professionals "cannot do." This is not necessarily a surprise, given recent ethical transgressions involving business executives and political leaders. However, neither the minimalistic nor the legalistic perspective captures the essence of ethics. Ethics is really about helping one to make good decisions, which in turn helps one develop a good character. But how can we as speech-language pathologists and audiologists "know" that we have made the "right" or "best" choice for those we serve?

A consensus model that considers professional norms and ethical principles, as well as clients' and clinicians' cultural heritages and the influence of diverse values, can provide a framework to address ethical questions and lead to confident resolutions and good professional practices. This framework enables us to move from questions like "What is right?" or "What should I do?" to broader ethical reflection.

Consensus is agreement to proceed in a certain way. It is not 100% unanimity, nor is it a compromise, understood in the typical sense of each party giving up values and beliefs to reach agreement. Importantly, a decision that achieves consensus does not impinge upon the personal and professional integrity of those involved.

The process begins with the question, "Am I facing an ethical dilemma?" If the situation is one in which personal and professional integrity are being challenged, the answer will likely be "yes." Before an appropriate decision can be made about whether an ethical problem exists, all relevant facts, values, and beliefs are considered with attention given to the different perspectives about the issue. In addition, all individuals who have an interest in the outcome are identified. Many ethical dilemmas originate from a lack of all the facts and values involved in a given situation, or from the failure to clearly explicate the problem.

Once it is established that an ethical dilemma exists, the questions addressed include: "What possible courses of action are permissible, impermissible, or necessary?" and "What are the effects (benefits and burdens) of each action?" A flexible and thorough approach is essential to avoid overlooking reasonable solutions to the dilemma (thinking outside the "ethical" box, so to speak). Consideration is given to immediate conflicts that may arise, as well as to the long-term implications of each action under consideration.

The proposed course of action is examined in relation to personal interests, social roles and expectations, and the ensuing obligations that accompany these roles. It is then evaluated in consideration of the ASHA Code of Ethics and of the ethical principles that form the philosophical basis of these professional norms. The questions addressed at this point are whether the action maintains and promotes the standards of the profession, is in accord with ethical principles, and is in the best interest of those we serve.

The final step in the model is to determine whether the proposed course of action leads to consensus. If consensus has been achieved, deliberation may be complete. If it has not been, the information that influenced the decision is re-assessed and other solutions or interpretations proposed.

Ethical decision-making is not always easy, but it is always important (see Josephson). We hope that we have amplified the significance of ethical thinking and facilitated the confidence with which ethical choices are made in our less-than-ideal world. 

Ethical Decision-Making  [PDF]

Shelly S. Chabon, is professor and chair of the department of communication sciences and disorders at Rockhurst University. She teaches courses in cultural diversity, professional issues, and health ethics. She is an ASHA fellow, has served on the Council for Clinical Certification, and is currently a member of the Board of Ethics. Contact her by e-mail at shelly.chabon@rockhurst.edu.

John F. Morris, is an associate professor of philosophy at Rockhurst University. He has published papers on ethics and medical ethics. He is a former member of the Ethics and Human Values Committee at St. Joseph Health Center in Kansas City, MO, and a current member of the American Occupational Therapy Association's Standards and Ethics Commission. Contact him by e-mail at john.morris@rockhurst.edu.

cite as: Chabon, S. S.  & Morris, J. F. (2004, February 17). A Consensus Model for Making Ethical Decisions in a Less-Than-Ideal World. The ASHA Leader.


Josephson, M. (2002). Making ethical decisions. Marina del Rey, CA: Josephson Institute of Ethics.

McLean, M. R. (2003). A framework for thinking ethically about human biotechnology. BioProcess International, 1(6), 26–29.

Morris, J. F. (2003). Is it possible to be ethical? OT Practice, 8, 18–23.


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