Client Abandonment

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.

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Introduction

For a variety of reasons, such as leaving a practice to pursue other career opportunities or relocating for family reasons, clinicians may decide to end their relationships with clients. There is nothing unethical about such departures. (Although, given the shortage of professionals in this field, it may be necessary to caution managers of care-giving facilities that it is unethical to try to exert moral pressure on clinicians to continue once they have indicated their plans to leave.) However, professionals must be mindful of the fact that such departures may result in former clients being left without appropriate care. It is therefore imperative that speech-language pathologists and audiologists in such transitional situations maintain their focus on the welfare of the client. They should be careful to uphold the ASHA Code of Ethics so that clients are not harmed by the clinician's departure.

When clinicians leave a caseload without coverage by an appropriately qualified professional, it is called client abandonment. A professional who abandons her or his clients without making effective efforts to provide for their continuing care violates the first principle of the ASHA Code of Ethics: “Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally….”

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Guidance

Examples of misconduct may include the following:

• failing to give sufficient notice to employers when leaving a position

• in private practice, failing to inform clients in a timely manner of plans to terminate treatment; in employment settings, failing to work out with the employer clear plans concerning who will notify the clients of the changes and when they will be notified

• failing to provide an interim plan for each client

• attempting to provide continuing services by correspondence alone; any such attempt violates Principle of Ethics I, Rule K, “Individuals shall not provide clinical services solely by correspondence.”

• failing to refer clients to other appropriately qualified professionals for coverage when referral is appropriate; failure violates Principle I, Rule B, “Individuals shall use every resource, including referral when appropriate, to ensure that high-quality service is provided.”

• failing to complete all remaining reports, billing slips, and other required paperwork; completing such materials is required by Principle I, Rule A, “Individuals shall provide all services competently,” and Principle I, Rule M, “Individuals shall adequately maintain and appropriately secure records of professional services rendered, research and scholarly activities conducted, and products dispensed….”

• withholding paperwork so that the clinician's successor does not have access to the client's entire record; such behavior is manifestly harmful to clients.

• removing materials, records, protocols, and other administrative materials without the consent of the administrator of the facility or organization; such removal, even if intended by the clinician to ensure the care of a client, violates Principle IV: “Individuals shall honor their responsibilities to the professions and their relationships with colleagues, students, and members of other professions and disciplines; and Principle IV, Rule A: ”Individuals shall uphold the dignity and autonomy of the professions, maintain harmonious interprofessional and intraprofessional relationships, and accept the professions' self-imposed standards.” It is likely that such removal will also violate Principle IV, Rule C, which prohibits “dishonesty, fraud, deceit.”

• maligning, in the presence of clients, the facility or organization the professional is leaving; this behavior, too, would violate Principle IV, Rule A, which requires that professionals “uphold the dignity and autonomy of the professions” and “maintain harmonious interprofessional and intraprofessional relationships.”

• recruiting clients for the new employment setting; too often such behavior would involve a violation of Principle III, Rule C, “Individuals shall refer those served professionally solely on the basis of the interest of those being referred and not on any personal interest, financial or otherwise.”

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Discussion

Speech-language pathologists and audiologists should hold paramount their obligations to clients whom they have been serving. Every effort should be made to ensure continuity of care and, in the event that vigorous good-faith efforts are not sufficient to guarantee continuity, to accommodate the needs of clients who will be left, even for a short period, without an appropriately qualified clinician. Such needs might be accommodated by developing home programs that could be used during an interim period without professional services, referring clients to appropriately qualified professionals in the surrounding area, and providing clients and their families with troubleshooting techniques and maintenance exercises and activities.

A professional who is leaving a facility should, if requested, assist the organization with recruitment of a replacement and should offer to participate in the orientation of replacement personnel as necessary.

Speech-language pathologists and audiologists who leave an organization or facility should attempt to sever ties with the employer amicably. Employers should cooperate in every way with departing clinicians in order to safeguard the well-being of clients. When the speech-language pathologist's or audiologist's departure has been precipitated by difficulties in workplace relationships or what the clinician regards as deficiencies in working conditions, there may be increased potential for behavior that violates the principles and rules of the Code of Ethics. Professionals in such situations should avoid engaging in behaviors that might be viewed as retaliatory or slanderous. Employers who are ASHA members likewise are expected to behave in ways that place the highest priority on the needs of the clients. Angry and spiteful words, obstructive actions, and uncooperative or aggressive behavior are potentially very harmful to clients and reflect badly on the profession. If a practitioner believes that a facility is not meeting professional standards, the practitioner should report the facility to the appropriate oversight organization. If an employer believes that a clinician is unqualified or has behaved unethically, that problem should be reported to the appropriate oversight body. It is a violation of the ASHA Code of Ethics for such problems or suspicions to become matters of slander, public disputes or personal attacks, or gossip.

Some disruptions of clinician-client relationships are involuntary. If a clinician is dismissed for cause, the employee's responsibility to clients terminates with the dismissal, and the facility assumes all responsibility for seeing that no clients suffer harm as a result of the departure. Clinical relationships may also be interrupted if an organization decides to close a program for financial reasons or when natural disasters occur. It would be expected that even in these types of situations, speech-language pathologists and audiologists would hold paramount the welfare of the clients they have served, but no clinician is ever morally required to work without pay or to place herself or himself in physical danger in order to offer client care.