2006 Student Ethics Essay Award - 1st Place

Doing Well by Others: Thoughts on Idealism and the ASHA Code of Ethics in Practice

By Victoria L. Carlson-Casaregola
Saint Louis University
St. Louis, Missouri
NSSLHA Chapter Advisor: Carol L. Ackerson

The professions in Communication Disorders exist to help people with problems. Individuals seek speech, language, hearing, and swallowing intervention because they have difficulties with some of the most basic functions of life and social interaction. For some, these problems are disruptive or debilitating. Such problems may even represent significant permanent losses that become crises of identity and dysfunction for those we serve and for those who care about them. For others, problems may be issues of unknown origins and implications, causing frustration and anxiety. For all, these problems create situations requiring trust in the professionals whose expertise and integrity clients must depend upon in seeking diagnostics and therapy. The ASHA Code of Ethics makes clear that professionals are to honor that trust and "to hold paramount the welfare of persons they serve professionally."
 
As a student preparing to undertake this professional obligation, I regard the "Principle of Ethics I" as the central purpose of all efforts required to achieve clinical competency: we become skilled, knowledgeable, committed to research and continuing education, and ethically conscious in order to serve people in need as well as we can. While we may not be able to solve all of our clients' problems (and should not promise them otherwise), we owe those we serve our competency, respect, and dedication to serving their best interests within our scope of practice. Moreover, the "welfare of persons" is a far-reaching, complex concern that necessitates our respecting clients/patients as persons with lives larger than the problems that put them on our caseloads or in our research studies. I also believe that upholding the "welfare of persons" challenges us to take an active advocacy role in society, in order to make our services available to people in need. We are ethically and professionally called to respect the cultural and linguistic diversity of those we serve, to honor their priorities and values as we pursue responsible innovation and evidence-based practice, and to advocate for access to services for all who require them.

The "welfare of persons" includes regard for the cultural and linguistic identity of all people, and it demands an informed professional sensitivity to diversity. As a future speech-language pathologist, I envision an increasingly diverse caseload that will require my undertaking additional research and consultation in order to distinguish cultural or linguistic difference from indications of speech or language disorders. Cultural competency and genuine respect for diversity are essential if we are to understand, affirm, and serve clients appropriately, while countering discrimination.

In addition, the people we serve need to know that we are prepared to consider a larger view of intervention that includes evidence-based practice and respect for their individual needs and priorities. According to the "ASHA Position Statement on Evidence-Based Practice in Communication Disorders," evidence-based practice is defined as "an approach in which current, high-quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions." The implications of this statement are profound, not only for research but in regard for clients as individuals and as members of communities. In adding a client to my caseload, I will be encountering and working closely with a person who is more than a file of data and a diagnosis, and who is someone deserving more than a standard treatment plan of prefabricated approaches that may be obsolete in light of current research. I hope that no matter how large and daunting that caseload might be, I will endeavor to treat each client as a unique person whose strengths, needs, personality, and life objectives call for creative solutions and responsive adaptations of sound intervention methods. Such approaches need to be informed by solid research to support the efficacy of clinical methods. The objectives and methods, in turn, need to have the support of the client for therapy to happen. In seeking "to hold paramount the welfare of persons" served, I aspire to become an adaptable, resourceful, and research-oriented clinician who serves clients by gaining their active involvement in partnership for therapy.

Finally, I believe that the ethical call to "hold paramount the welfare of persons [we] serve" challenges our professions to go beyond our caseloads and to advocate for the people we cannot serve because of limited resources. As professionals, we need to communicate to the public, to policymakers, and to the private sector regarding the importance of speech, language, hearing, and swallowing services. We have increasing cause to challenge systems that shortchange patients, students, and clients by imposing limitations that keep us from helping those in need. We must support innovative non-profit organizations that provide services in under-resourced areas. In our education and our professional development, we need to address the concerns of poor, underserved, and other vulnerable and marginalized groups. We need to do as a profession what my Clinical Methods professor challenged us to do in class: to look at the statistics of demographic change, including levels of poverty, and to begin to see in those figures the complex needs of people who will someday be on our caseloads. We also need to make sure that these people will indeed have our services.

In the practice a service profession, "doing well" is a matter of doing Good. We do well in many ways, when we have the courage, integrity, and vision to establish and uphold a Code of Ethics as rigorous and as comprehensive as the one governing ASHA. We do well as we do Good when we set high standards for ourselves and our colleagues and when we provide services in ways that truly address people's needs within the larger context of their lives and communities. Our services are not simply commodities to be sold; rather, our ethos of service is a commitment to be honored through competency, dedication to people and principles, and the best practices that result from idealism put into practice.

ASHA Announces 2007 Student Ethics Essay Award (SEEA) Competition
See the 2007 essay topic and submission information.