Conflicts of Professional Interest

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. This Issues in Ethics statement was revised to update references to the Code of Ethics as revised in 2003.

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Introduction

This Issues in Ethics statement is presented for the guidance of ASHA members and certificate holders in matters relating to conflicts of professional interest. The following information is provided in an attempt to heighten sensitivity, increase awareness, and enhance judgments in those circumstances when conflicts of interest influence, or appear to influence, professional conduct.

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Background

For a number of years, the ASHA Code of Ethics has included a provision whereby practices that reflect conflicts of interest are deemed unethical. Recently, other professional organizations have reacted to a growing public concern over conflicts of interest by issuing their own formal statements. Among those are the guidelines adopted by the American Medical Association (AMA); these were adopted, almost immediately, by the Pharmaceutical Manufacturers Association (PMA). The adoption of the AMA guidelines by the PMA is noteworthy because pharmaceutical companies, as well as medical equipment companies, historically have provided physicians with gifts and various forms of economic benefits.

The AMA guidelines ^[1] are based on two principal concepts:

• Acceptance of gifts by a physician “should primarily entail a benefit to patients,” and

• “No gifts should be accepted if there are strings attached.”

Conflict of interest guidelines have also been established by the Association of American Medical Colleges, the American Association for the Advancement of Science, the American Association of Engineering Societies, the American Dental Association, the Federal Bar Association, and the American Association of University Professors.

It is important that speech-language pathologists and audiologists, like other professionals, maintain the highest standards of integrity during the discharge of their professional responsibilities. It is appropriate, therefore, that the Board of Ethics provide guidance relative to conflicts of professional interest in the practice of speech-language pathology or audiology.

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Definition

Conflicts of professional interest are specifically addressed by the ASHA Code of Ethics through Principle of Ethics III, Rule of Ethics B:

Individuals shall not participate in professional activities that constitute a conflict of interest.

The Board of Ethics defines “conflict of interest” as:

Situations where personal and/or financial considerations compromise judgment in any professional activity (e.g., clinical service, research, consultation, instruction, administration, etc.) or where the situation may appear to provide the potential for professional judgment to be compromised.

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Applicable Sections of the Code of Ethics

No code of ethics can be framed that will specifically identify all ethical responsibilities related to professional conduct. As a fundamental guiding principle, however, each individual must maintain objectivity in all professional activities, across all professional environments, and for all persons served.

In the process of determining the potential for a conflict of interest, the individual should first consider Principle of Ethics I:

Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or participants in research and scholarly activities and shall treat animals involved in research in a humane manner.

This clearly indicates that professional practice decisions must first and foremost promote the well-being of those served. Therefore, professional judgment and practice must not be biased by economic interest in, commitment to, or benefit from professionally related commercial enterprises. Even commonly occurring business practices should be evaluated against this principle. An individual's belief that professional judgment or objectivity is unaffected by gifts or other economic benefits of significant value is not, in and of itself, sufficient protection against conflict of interest.

Assessment of the potential for a conflict of interest should also include attention to Principle of Ethics IV:

Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of allied professions. Individuals shall uphold the dignity and autonomy of the professions, maintain harmonious interprofessional and intraprofessional relationships, and accept the professions' self-imposed standards.

All members and certificate holders have a duty to conduct themselves in such a way as to preserve and protect the public's trust and confidence in their profession(s). By becoming involved in a situation that compromises professional judgment or appears to compromise independent judgment or objectivity, a speech-language pathologist or audiologist diminishes the public's trust and confidence in the professions at large. Thus, in order to preserve the highest standards of integrity, the acceptance of gifts or benefits that may reasonably be viewed as a conflict of interest must be avoided.

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Guidance

Professional judgments and practices should be rendered without primary consideration for personal financial gain. Speech-language pathologists and audiologists should not accept gifts or benefits unless it can be clearly demonstrated that such gifts or benefits

• contribute to the welfare of persons served professionally

• do not reasonably appear to bias professional judgment

• enhance one's professional knowledge and skills

• do not diminish the dignity or autonomy of the professions

In order to provide more specific guidance relative to commonly occurring situations in a variety of professional practice environments, the following list of advisory statements is offered. The list, derived from the AMA guidelines, is intended to be illustrative, rather than inclusive.

1. Gifts or economic benefits of significant value may be accepted by the individual if they primarily benefit persons served professionally. Gifts or economic benefits of token or trivial value may be accepted if they are appropriate to the individual's professional practice. Cash gifts should not be accepted.

2. Reasonable honoraria and expenses for travel, lodging, and meals may be accepted, when providing actual consultative services or when serving as an invited speaker to a professional conference or meeting.

3. Subsidies from professionally related commercial enterprises to underwrite the costs of valid continuing education events may be accepted by the conference's sponsor for the purpose of reducing costs to those who attend the event (e.g., registration fees). Except as noted above, subsidies (including travel, lodging, or other personal expenses) should not be accepted by the individual from any source that may reasonably be viewed as having the potential to bias that individual's professional judgment or practice.

4. Individuals who participate in social events sponsored by commercial enterprises should avoid the appearance of bias to professional judgment or practice.

5. Scholarships or special funds provided to encourage students or other individuals to attend educational conferences may be permissible when the selection of such persons is made by the academic institution, the conference sponsor, or an independent panel of judges.

6. Individuals should avoid situations that may involve self-dealing (e.g., purchasing equipment from, or entering into contract negotiations with, organizations in which one has financial interest). Where self-dealing may appear to occur, timely disclosure of relevant information should be made.

7. Individuals who work in one professional setting should not refer clients exclusively to themselves in another professional setting.

8. Individuals engaged in research or administration should not benefit a sponsor through the inappropriate use of institutional resources or by withholding research or clinical treatment data.

9. Individuals should not distribute available resources in a manner that is unfair, or gives the appearance of being unfair.

10. Gifts should not be accepted if there is any direct or implied suggestion that the gift will influence professional objectivity.

Individuals must remain aware of the potential for conflicts of professional interest and take initiative to manage, disclose, or resolve potential conflict of interest situations appropriately. Voluntary and full disclosure of relevant information is strongly urged in that such disclosure demonstrates good faith on the part of the professional and may be a significant factor in evaluating whether a conflict of interest exists.

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Summary

Individuals must carefully consider all circumstances surrounding the offer of a gift or benefit, including the apparent purpose of the donor, how the transaction may reasonably be viewed by impartial observers, and the potential impact on the practice of the professions. Preservation of the highest ethical standards is vital to the conduct of independent judgment and professional practice by speech-language pathologists and audiologists, and ultimately the dignity of the professions. Conflicts of professional interest erode the public's trust in both the professional and the professions and must be avoided.

Notes