by Connor Mahon, Cleveland State University
Jennifer is a speech-language pathologist in a public middle school. Among her students are four 7th graders diagnosed with Autism Spectrum Disorder who meet as a group to practice social skills. One student in the group, Alex, expresses to the others that they have chosen to go by gender neutral pronouns (they, them, themselves) rather than gendered masculine (he, him, his) or feminine (she, her, hers) pronouns. Jennifer has never met someone who uses gender neutral pronouns, and is taken aback. She pushes back against this, insisting that the pronouns they and them are plural, and to use them for one individual is incorrect. She feels strongly about this, as she believes she would be teaching the children “improper English” if she were to encourage the others to use gender neutral pronouns with Alex.
Alex reports this to their parents, who are supportive of their gender identity and expression. Their parents set up a conference with Jennifer and the school principal. Jennifer maintains that teaching gender neutral pronouns is detrimental to Alex and the other students in the group. She cites her education and certification as a speech-language pathologist, asserting that it makes her “an expert on language.” Alex’s parents share that Alex feels uncomfortable continuing to work with Jennifer. They express their disappointment about this, as they saw Alex make progress from the group sessions, and it is uncertain if there is an alternative available. Wanting to ensure Alex continues to receive therapy, the situation escalates to the school board.
At the school board meeting, the community is divided on the issue. Jennifer publicly advocates against teaching they and them as singular pronouns, and again cites her education and certification as a speech-language pathologist. To the audience of parents, largely unfamiliar with the scope of practice and depth of knowledge a speech-language pathologist has, Jennifer refers to herself as an “expert on language” and says that her position is “the standard for all speech-language pathologists.”
Several violations of the Code of Ethics occurred in these events. As noted in ASHA’s guidance on supporting transgender individuals, “using correct pronouns is a way of respecting [a client’s] dignity and falls in line with ASHA’s Principle of Ethics I” (American Speech-Language-Hearing Association [ASHA], n.d.b). This relates to Principle 1, Rule C, which states that “individuals shall not discriminate in the delivery of professional services or in the conduct of research and scholarly activities on the basis of race, ethnicity, sex, gender identity/gender expression, sexual orientation, age, religion, national origin, disability, culture, language, or dialect” (ASHA, 2016). The refusal to use gender-neutral pronouns, a component of Alex’s gender expression, created a negative therapy experience by invalidating their identity and was a cause for additional stress.
Jennifer’s public comments also constituted an ethical violation. ASHA Code of Ethics Principle IV, Rule D states that “individuals shall not engage in any form of conduct that adversely reflects on the professions or on the individual's fitness to serve persons professionally” (ASHA, 2016). While public comments primarily fall under the governance of Principle III, Jennifer’s public comments misrepresented the profession by claiming it supported a discriminatory position, reflecting poorly on the profession’s ability to serve LGBTQ+ clients competently. Even without her larger claims about the beliefs of all speech-language pathologists, the statement would be damaging to the whole profession, as “discrimination in any professional arena and against any individual for any reason, whether subtle or overt, ultimately dishonors the professions and harms all those within the practice” (ASHA, 2017).
Jennifer could have turned to the three components of evidence-based practice (EBP) to prevent this ethical violation (ASHA, n.d.a.). Jennifer relied solely on her own clinical expertise. She neglected to incorporate the two other components of EBP, evidence and client perspectives. If she had researched the issue, Jennifer would have found a robust body of evidence in favor of gender-affirming support for children (Olson et al., 2016). She also would have found that gender neutral pronouns may be used as singular according to several language style guides and common usage (ASHA, n.d.b).
Additionally, Jennifer failed to respect client perspectives, which include the “unique set of personal and cultural circumstances” for each individual (ASHA, n.d.a.). ASHA specifically recommends that “if the family and/or individual requests, a service provider should work on nonbinary pronouns…as part of their therapy language targets” (ASHA, n.d.b). By following the guidance of Alex and their parents, as well as available evidence, Jennifer could have avoided ethical issues.
Jennifer could have also prevented an ethical violation by understanding her responsibility to the public. This is outlined in Principle III of the Code of Ethics, which requires statements to the public “provide accurate and complete information” and “adhere to prevailing professional norms,” neither of which can be said for Jennifer’s school board comments (ASHA, 2016, 2018).
In conclusion, it is critical that professionals understand the ways in which discrimination and personal bias affect their clients, and work to increase their knowledge of cultural competency to prevent this. To discriminate in service delivery is always unethical, and in order to “hold paramount the welfare of persons they serve professionally” (ASHA, 2016), speech-language pathologists must maintain a current and accurate knowledge of the relevant topics, as well as the ethical guidelines that govern them.
American Speech-Language-Hearing Association. (n.d.a). Evidence-Based Practice (EBP). ASHA Research Resources. https://www.asha.org/research/ebp/
American Speech-Language-Hearing Association. (n.d.b). Supporting and working with transgender and gender-diverse individuals. ASHA Multicultural Affairs and Resources. https://www.asha.org/practice/multicultural/supporting-and-working-with-transgender-and-gender-diverse-individuals/
American Speech-Language-Hearing Association. (2017). Issues in ethics: Cultural and linguistic competence. ASHA Ethics Resources. https://www.asha.org/practice/ethics/cultural-and-linguistic-competence/
American Speech-Language-Hearing Association. (2018). Issues in ethics: Public announcements and public statements. ASHA Ethics Resources. https://www.asha.org/practice/ethics/public-announcements-and-public-statements/
Olson, K. R., Durwood, L., DeMeules, M., McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3). https://doi.org/10.1542/peds.2015-3223