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.
As we have become increasingly aware of the power of external factors to distort interpretation and reasoning, as well as to undermine objectivity, all of the professions have begun to pay more attention to conflicts of interest. Principle of Ethics III, Rule of Ethics B, of the ASHA Code of Ethics specifically prohibits conflicts of professional interest. “Individuals shall not participate in professional activities that constitute a conflict of interest.”
The Board of Ethics defines “conflict of interest” as a situation in which personal and/or financial considerations have the potential to influence or compromise professional judgment in clinical service, research, consultation, instruction, administration, or any other professional activity.
It is important to notice that it is not necessary for such influence or compromise to have occurred before a situation can be identified as a conflict of interest. It is sufficient for the situation to appear to provide the potential for professional judgment to be compromised.
As stated in Principle I of the ASHA Code of Ethics, “Individuals shall honor their responsibility to hold paramount the persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner.” This clearly indicates that in professional practice decisions must first and foremost promote the best interests of those who are being served. Normally there is no conflict between the professional's interest and the interests of those she or he serves. This is because both the professional and the client typically share the same interests (the clinician and the patient both want the patient to improve as much and as quickly as possible; the teacher and the student both seek the student's intellectual and professional advancement; the researcher and the journal in which research is published both seek to advance understanding). Moreover, professionals are usually quite skilled in keeping their own personal interests and preferences separate from their professional responsibilities.
Unfortunately, situations arise in which it can become unusually hard for a professional to maintain the separation of personal interest from professional service. These situations often involve professionally related commercial enterprises or financial arrangements in which the professional is involved and from which the professional personally benefits. Some studies have shown, for example, that physicians who are part owners of imaging practices are somewhat more likely than other physicians to refer patients for imaging. But conflicts of interest can also arise in situations in which clients, relatives of clients, or contractors offer gifts that may predispose the professional to favor them at the expense of others. Even being involved in the professional assessment (clinical, academic, or administrative) of someone who is a friend can constitute a conflict of interest.
An individual's belief that his or her professional judgment or objectivity is unaffected by gifts, other economic benefits of significant value, or personal ties is not, in and of itself, sufficient protection against conflict of interest. This is partly because the influence and distortion introduced by personal interests may be very subtle. The person affected may be totally unaware of the way in which her or his judgment has been biased. But it is also because even the appearance of a conflict of interest can be damaging to professional relationships and to the public perception of the profession as a whole.
According to Principle of Ethics IV and Principle IV, Rule A, "Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of other professions and disciplines," and "Individuals shall uphold the dignity and autonomy of the professions, maintain harmonious interprofessional and intraprofessional relationships, and accept the professions' self-imposed standards."
All ASHA 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 appears to have the potential to compromise independent judgment or objectivity, a speech-language pathologist or audiologist diminishes the public's trust and confidence in the professions at large.
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Conflicts of interest can occur in teaching, in research, and in clinical practice. They may be obvious (and for that reason comparatively easy to identify and avoid) or extremely subtle. No code of ethics or brief “Issues in Ethics” statement can be framed that will specifically identify all of the forms such conflicts can take. This Issues in Ethics statement attempts to do two things in a fairly general way: (1) give some guidance in identifying conflicts of interest and (2) suggest what should be done when a conflict is identified. Individuals may also wish to access the websites of other professional organizations that have adopted guidelines concerning conflict of interest.
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Since many conflicts of interest involve commercial interests or financial arrangements, all business practices, even commonly occurring business practices, should be evaluated to be sure that they will not introduce biases or preferences into the professional's clinical judgments or research interests. Generally, if a professional enjoys any unearned financial benefit, even a benefit as minor as a free box lunch, conflict of interest may be suspected.
Personal and family relationships always arrange themselves along a continuum from the very close and intimate to the distant and detached, so it can be particularly difficult to recognize conflicts of interest that arise from personal friendships. Any time a pattern of preference emerges that cannot be explained on the basis of shared assessments, proven competence, or empirical facts, a conflict of interest may exist. Such patterns may occur in referrals, in the evaluation of employees, or in the assessments of students and fellow faculty members.
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The proper responses fall into three categories: avoid, disclose, and recuse.
Obviously, the best thing to do is avoid situations that give rise to conflicts of interest or that even appear to give rise to such conflicts. In commercial and financial matters, avoidance is by far the best strategy. This does not mean that absolutely no non-wage benefits may be accepted, but it does mean that some are prohibited and that all should be carefully scrutinized. Speech-language pathologists and audiologists should not accept gifts or benefits unless it can be clearly demonstrated that such gifts or benefits
primarily 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.
Disclosure is often associated with recusal. When one sits on a committee or a board that makes decisions about the advancement of others or about the distribution of resources and benefits to others, a conflict of interest may require that the professional withdraw or recuse herself or himself from a particular consideration or decision. This may occur because of the professional's financial interests in or personal ties to one or more of the parties being considered. By disclosing the nature of the association and by stepping out of the decision-making process, the professional ensures that any personal preferences or biases she or he may have will not unfairly influence the deliberations in favor one candidate and against others.
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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. Individuals must also be constantly aware of ways in which their personal and family relationships, and other close personal associations, may potentially bias their judgments. 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 to the dignity of the professions. Conflicts of professional interest, and even just perceptions of conflicts of interest, erode the public's trust in both the professional and the professions. For these reasons, situations of conflict of interest must be avoided whenever possible, and where they cannot be avoided, they must be managed in an open and cooperative way.