Trends in Ethics Inquiries Received by the ASHA National Office
By David R. Denton, JD, MA, CCC-SLP
December 2008
ASHA's director of ethics is the Association's National Office point person for ethics inquiries. I receive and respond to approximately 2,500 ethics and ethics-related inquiries per year. Questions come from ASHA members, certificate holders, Clinical Fellows, Clinical Fellowship supervisors, employers, students, faculty, state licensure boards, ASHA National Office staff, ASHA leadership, and others. Consequently, I am in the unique position of having a finger on the pulse of the ethical issues and dilemmas that are challenging our members in audiology and speech-language pathology.
Over the past 7 years I have informally tracked ethics inquiries by the themes of those inquiries and the settings in which they arise.
Themes of Ethics Inquiries
By far the most frequent and recurring concerns over the past 7 years have dealt with what I refer to as "employer demands," that is, demands and requests made by employers, supervisors, and directors that would cause our members-as their employees-to potentially violate the Code of Ethics as part of their employment. You can appreciate what a challenging situation this is for ASHA members. For example, if, on the one hand, the member does what is asked and it is unethical, then the member risks being sanctioned by ASHA's Board of Ethics and/or a state licensure board. On the other hand, if the member refuses to do what is demanded, he or she risks being disciplined (or terminated) by the employer. It is a classic dilemma. Fortunately, in my experience, in the majority of cases the employer does not appreciate that what he/she is demanding is problematic and the predicament can be cured by the clinician educating the employer, and advocating for best practices.
The second most recurring theme of ethics inquiries has been in the area of the training, use, and supervision of support personnel and assistants.
The third most recurring theme has shown some variability over the past 7 years. In 2001 and 2002, the issues involved matters involving dysphagia. In 2003 and 2004, it was ethical quandaries associated with reimbursement. From 2005 to the present, the third most recurring themes have been those associated with the Clinical Fellowship and the provision of services to culturally and linguistically diverse populations.
And lastly, the fourth most recurring theme of ethics inquiries has been issues and dilemmas associated with audiology. Because many audiologists have private practices, some come face-to-face with the natural tension between the needs of their business to make a profit to stay in business and the requirement that the audiologist abide by their ethical requirements and hold paramount the welfare of those they serve. If there has been any change in this theme, it has been in the increase in such inquiries associated with speech-language pathology over the past several years. As speech-language pathologists become more entrepreneurial and establish private practices, they are confronted with the same dilemmas and challenges as similarly situated audiologists.
Settings of Ethics Inquiries
If you have a sense of the demographics of the ASHA membership, the settings in which the themes identified above arise are predictable and present no surprises.
The most recurring setting of ethics inquiries received at the National Office is the schools, including early intervention contexts. The second most recurring setting is health care, including long-term care settings. And the third most recurring setting is private practice.
Use of Information About Trends in Ethics Inquiries
Information about the trends in ethics inquiries received at the National Office is important because it provides invaluable assistance to the Board of Ethics and its ethics education efforts. I present trend information to the board on a periodic basis and it helps to direct the board's drafting of ethics articles for The ASHA Leader and in their creation and revision of formal Issues in Ethics statements. Trend information is also helpful in considering which topics to include in the board's annual Convention presentation.