2018 Student Ethics Essay Award—Third Place Essay
Sound Advice: Conflict of Interest in Audiological Practice
by Rivka Moller, Nova Southeastern University
ASHA's Issues in Ethics statement defines the term "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" (2011). Speech-language pathologists and audiologists who conduct research must be aware that both individuals and the public are depending on reliable, valid, and unbiased results. Audiologists, in particular, according to Margolis (2007, p. 32) must know that "professions that recommend or dispense (sell) products to consumers are susceptible to conflict of interest (COI) because they may benefit from recommending or selling a product that may not be in the best interest of the consumer."
Consider the case of an audiologist, Dr. Jones, who is employed as a clinician in a large audiology clinic. This practice, in addition to providing treatment, sells a variety of hearing aids. Dr. Jones has been involved in selling these devices for quite a while, and has the programming and function of these devices down to a science. Dr. Jones is contacted by one of the partners of one of the above-mentioned hearing aid companies to help lead a research study on the efficacy of hearing aids, and treatment implications for patients.
Dr. Jones gives a tentative consent to the plan. When asking for time off to lead the research study, he shares with his employer the details of the proposed investigation. The employer, Dr. Smith, immediately detects a potential issue with this course of action. Dr. Smith decides to have a candid conversation with his employee, regarding the possible violations of ASHA's Code of Ethics that Dr. Jones now faces.
Dr. Smith points out Principle of Ethics I (ASHA, 2016), that "Individuals shall honor their responsibility to hold paramount the welfare of 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." Corresponding Rule J states "Individuals shall accurately represent the intended purpose of a service, product, or research endeavor and shall abide by established guidelines for clinical practice and the responsible conduct of research." Dr. Smith explains to Dr. Jones that the research study may not actually be researching treatment efficacy of a specific hearing aid, but rather a means to promoting it through a clinician who already sells that product.
The next Principle of ASHA's Code of Ethics (2016) to be discussed by Dr. Smith is Principle of Ethics III (ASHA, 2016), which states that "Individuals shall honor their responsibility to the public when advocating for the unmet communication and swallowing needs of the public and shall provide accurate information involving any aspect of the professions." Accordingly, Rule B of Principle III states "Individuals shall avoid engaging in conflicts of interest whereby personal, financial, or other considerations have the potential to influence or compromise professional judgment and objectivity." Dr. Smith reminds Dr. Jones that the latter's objectivity may be compromised while conducting the research study. The fact that Dr. Jones is closely involved in selling the hearing aids may affect his professional judgment, as he may be interested in promoting the sale of one hearing aid over another.
Dr. Smith also references Rule F of the same principle (ASHA, 2016), which requires that "Individuals' statements to the public shall adhere to prevailing professional norms and shall not contain misrepresentations when advertising, announcing, and promoting their professional services and products and when reporting research results." Should Dr. Jones lead the research study regarding a specific hearing aid, while simultaneously making financial gain from sales of that hearing aid, he will be misrepresenting his objectivity in the research process.
Dr. Jones, relieved to have been spared from participating in a conflict of interest, takes immediate restorative steps after the conversation with his employer. He contacts the company partner to withdraw from the study, explaining his rationale behind the decision. Dr. Jones is also advised by Dr. Smith to create an in-service presentation for his co-workers regarding potential similar situations and ways to avoid them.
The Department of Health and Human Services (DHHS) Office of the Inspector General, as cited by Margolis (2007), has published several guidelines related to the Federal Anti-kickback Statute. The guidelines of this law pertain to receiving gifts from a company in return for promotion of its product. While Dr. Jones did not receive a gift in exchange for participating in the research study, he would likely have been influenced by his dual role as a researcher and vendor of the same product. "Does the arrangement have a potential to interfere or skew clinical decision making?" (Margolis, 2007, p. 34) is a question that all clinicians faced with a situation such as Dr. Jones faced should determine. This question is also a pivotal consideration in the clinical judgment necessary when evaluating, treating, and creating recommendations for our clients.
American Speech-Language-Hearing Association (2016). Code of Ethics. Retrieved from
American Speech-Language-Hearing Association (2011). Issues in Ethics: Conflicts of Professional Interest. Retrieved from
Margolis, R. (2007). Viewpoint. Conflict of interest in audiology. Audiology Today, 19(4), 32–34.