January 17, 2006 Feature

Recognizing When Strings Are Attached

In our professional and personal lives, we regularly make decisions that affect and ultimately determine our actions, our friends and associates, the places we conduct activities, and the value that we place on each of those things in shaping our lives. For each choice that we make, we weigh the options and consider which combination of variables carries the most weight. And, for each choice, there are consequences.

ASHA's Code of Ethics compels us to consider our obligations to the people we serve professionally, to maintain the highest level of competence, and to honor our responsibility to the public, to the professions, and to our colleagues. Inherent in these responsibilities is the need for honesty and integrity, both personal and professional. While the Principles of Ethics form the moral basis for the Code of Ethics, the Rules of Ethics describe minimally acceptable professional conduct and behavioral prohibitions. Together they provide a framework for ethical decision-making.

Our Code of Ethics has, for a number of years, included the statement that practices representing conflicts of interest are unethical. Although the specific language addressing that issue occurs in Principle of Ethics III, Rule B, which states that "individuals shall not participate in professional activities that constitute a conflict of interest," the underlying principle is that we need to maintain objectivity in all professional activities, across all settings, and with everyone with whom we interact. In order to maintain objectivity, we are directed to avoid situations in which personal and/or financial considerations might compromise judgment in clinical service, teaching, research, administration, or any other area of professional conduct. The "Conflicts of Professional Interest" in ASHA's "Issues in Ethics Statements" provides guidance in this area.

Watching for Strings

While we are obligated to avoid situations and activities that constitute a conflict of interest, it is occasionally difficult to recognize when there are "strings attached" to the decisions we make. For example, in our relationships with friends and family members, something as simple as accepting an invitation to lunch might carry with it an expectation of reciprocity. Similarly, being a part of a social or religious group might involve the expectation of attendance at various functions, as well as the provision of financial support.

In a professional setting, while it is clear that accepting direct financial rewards for purchasing or selling products is unacceptable, it might be less obvious that accepting referrals from a colleague might carry with it an implied "string." For example, a physician who refers his patients with hearing loss to you for selection and fitting of amplification might expect that you reciprocate by sending all of your patients to him for medical or surgical management of ear disease. Similarly, a colleague in an academic setting with whom you work on a committee or board might expect you to recommend her graduate program to others. Honest and open communication can establish whether strings are attached.

In our professional relationships, in addition to avoiding situations in which there is an actual conflict of interest, it is important to consider the potential for perceived conflicts of interest. For example, after weighing the variables in a given situation, it might seem clear to us that we can maintain objectivity, despite our having a history with the individuals involved or having prior knowledge that could color our current perceptions of the situation. We might be convinced that we will be able to overlook that information in moving forward.

However, while our perceptions about our own behavior might be accurate, other people involved might believe that history is playing a role in affecting our current behavior. In those circumstances, it is prudent to consider whether the perceived conflict will result in compromising the integrity of the relationships with our colleagues or outcomes with those we serve. Since it is difficult to know how other individuals might view our behavior or intent, erring on the side of caution is advised, and asking about others' perceptions is appropriate. In addition, full disclosure of our own concerns about the potential impact of real or perceived strings is essential.

The ASHA Code of Ethics provides a framework for professional conduct that is above reproach. In order to maximize our effectiveness with students, colleagues, and the persons we serve, maintaining integrity and objectivity is essential. Given the potential negative consequences of real or implied conflicts of interest in the form of "strings," we must be vigilant when considering our past and current involvement with individuals or situations and must engage in direct and open communication about concerns as they arise.

Jaynee Handelsman, is the assistant director of the Vestibular Testing Center in the Department of Otolaryngology Head and Neck Surgery at the University of Michigan Health Systems, and is a member of the Board of Ethics. Contact her by e-mail at Jaynee@med.umich.edu.

cite as: Handelsman, J. (2006, January 17). Recognizing When Strings Are Attached. The ASHA Leader.


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