by Luke Damiani, Salus University
I find the idea of a “living document” to be a beautiful one. It is paradoxical and poetic. After all, a document, by definition an inanimate thing, is not alive, so what does this term mean? The concept arises often in legal scholarship, scriptural interpretation, and other forms of textual criticism. In Canadian constitutional law, this philosophy has become a fundamental means of interpreting foundational legal documents and is known as the “living tree doctrine,” referring back to the writing of Canadian justice John Sankey, who referred to the constitution of Canada as “a living tree capable of growth and expansion within its natural limits” (Centre for Constitutional Studies, 2019).
I think Sankey’s metaphor of a tree perfectly captures both the obligatory and aspirational elements of what it means for the ASHA Code of Ethics to be a living document. A tree is in fact aspirational, growing from a seed, spreading out in many unexpected directions, growing larger every day, always putting out new growth. A tree is also a wonder of stability. It exists through seasons and decades, growing, but not beyond its limits. It has a definite structure and foundation upon which future growth relies. In the same way, the ASHA Code of Ethics is meant to serve as a foundational document. In one sense it is a list of statements that prescribe ethical duties for speech-language pathologists (SLP) and audiologists to adhere to. The ethical principles are definite, not just suggestions, and should be thought of as duties of practice. At the same time, a list of ethics cannot possibly address specifically the many ethical dilemmas and scenarios an SLP or audiologist will encounter over the course of a career, or the dilemmas that will arise with advancement of clinical research, technology, and social change. This requires ongoing revisitation of the Code of Ethics and a mindful exploration of how to apply the principles and rules to new situations.
Take for example ASHA’s Principle II, Rule A: “Individuals who hold the Certificate of Clinical Competence shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience” (2016). The obligatory interpretation of this rule is what clinicians must not do. Clinicians must not take on clinical responsibilities or cases that they are not adequately prepared to manage. For instance, if a certain therapy protocol or technique requires specific training or mentorship, a clinician should not go forward with using that technique with a client until they receive the necessary training. This obligation requires clinicians to be mindful in considering their competency level, because competency is not always a straightforward calculation, nor is it limited to certification, but also includes education, training, and experience. This is so important because speech-language pathology and audiology are broad professions. There are many settings where clinicians practice, and areas of specialization, and the professions are only growing. Clinicians must be mindful to pursue competency before venturing into new areas of practice or specialization.
The aspirational, or positive, interpretation of Principle II, Rule A would answer the question, “what is it that an audiologist or speech-language pathologist does?” What we do is that we continue to learn and grow professionally. This is true for all clinicians, not just clinicians who are just starting out, and not just clinicians who are venturing into a new area of practice. One nugget of wisdom that I heard more than once during my graduate education is that a lot of what I would learn in my program would be outdated within a decade or two. I remember when I heard that I felt taken aback. I thought, “how could that be, and why am I learning this, then?” Throughout my studies, though, I learned how important it is to keep up with current research in the field, about the process of sifting through research to find studies of quality and import, and about how to apply the principles of evidence-based practice to each individual client that I see. To follow Principle II, Rule A in an aspirational way would mean to avoid viewing competency as something that can be obtained and held, but instead as something to continually pursue, something that is alive and growing. To look ahead into my career, if in ten years of clinical practice, my practice hasn’t significantly evolved and changed, I think it would be appropriate to question whether I am demonstrating competence anymore, because what it means to be competent at that time will likely have shifted or grown.
This aspirational view of the Code of Ethics can be applied to any of the principles or rules, and involves mindfully exploring not only what a clinician or researcher should avoid doing, but also who we are, and what we can and must do. It means to explore what our responsibilities are more broadly, and how those responsibilities may change and evolve over time. In that sense, the Code of Ethics is less something to look at and more something to look through, at ourselves and at the professions as a whole. It’s not just a rule book but also a foundation and guide, and something that is just as valuable to the seasoned SLP or audiologist as to a soon-to-be clinical fellow like myself.
American Speech-Language-Hearing Association (2016). Code of Ethics [Ethics]. https://www.asha.org/Code-of-Ethics/
Centre for Constitutional Studies. (2019, July 4). Living tree doctrine. https://www.constitutionalstudies.ca/2019/07/living-tree-doctrine/