Issues in Ethics: Client Abandonment
- About This Document
- Issues in Ethics Statements: Definition
- Introduction
- Discussion
- Guidance
- Summary
About This Document
Published 2025. This Issues in Ethics statement was originally published in 2007 and was last revised in 2020. It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2023) (hereinafter, "Code of Ethics"). The Board of Ethics (hereinafter, the "BOE") reviews Issues in Ethics statements periodically to ensure that they reflect current practices and the current Code of Ethics.
Issues in Ethics Statements: Definition
From time to time, the BOE determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided, ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.
Introduction
For a variety of reasons, such as leaving a practice to pursue other career opportunities or relocating for family reasons, clinicians may decide to end their relationships with clients/patients. There are also times when, for safety or health reasons, an individual can no longer provide services to a client/patient. There is nothing unethical about terminating services for these reasons. (Although, given the shortage of professionals in this field, it may be necessary to caution managers of care-giving facilities that it is unethical to try to exert moral pressure on clinicians to continue once they have indicated their plans to leave.) However, professionals must be mindful of the fact that such departures may result in former clients/patients being left without appropriate care. It is therefore imperative that audiologists and speech-language pathologists (SLPs) in such transitional situations maintain their focus on the welfare of the client/patient. They should be careful to uphold the Code of Ethics so that clients/patients are not harmed by the clinician’s departure.
When a clinician stops providing services without arranging for alternative care by an appropriately qualified professional, it is called client abandonment. A professional who abandons their clients/patients without making effective efforts to provide for the clients’/patients' continuing care violates the following provisions of the Code of Ethics:
- Principle I: "Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally or who are participants in research and scholarly activities."
- Principle I, Rule B: "Individuals shall use every resource, including referral and/or interprofessional collaboration when appropriate, to ensure that quality service is provided."
- Principle I, Rule T: "Individuals shall give reasonable notice to ensure continuity of care and shall provide information about alternatives for care in the event that they can no longer provide professional services."
Additionally, when leaving a position, individuals who fail to properly transition clients/patients can find themselves in violation of other, related Code of Ethics provisions related to recordkeeping and professional practice.
Discussion
When there is employment transition or any other change in the relationship with clients/patients, audiologists and SLPs should hold paramount their obligations to those being served. They should make every effort to ensure continuity of care and to accommodate the needs of clients. When good-faith efforts are not sufficient to guarantee that continuity, acceptable alternative plans should be pursued. Such plans might involve (a) developing home programs that clients/patients could use during an interim period without professional services, (b) referring clients/patients to appropriately qualified professionals in the surrounding area, and (c) providing clients/patients and their families with troubleshooting techniques and maintenance activities.
Audiologists and SLPs who leave an organization or facility should attempt to amicably sever ties with their employer. Employers should cooperate in every way with departing clinicians in order to safeguard the well-being of clients/patients. Such behavior is consistent with Principle IV: “Individuals shall uphold the dignity and autonomy of the professions, maintain collaborative and harmonious interprofessional and intraprofessional relationships, and accept the professions' self-imposed standards.”
When the practitioner’s departure has been precipitated by difficulties in workplace relationships or perceived deficiencies in working conditions, there may be increased potential for conduct that violates the Code of Ethics. Professionals in such situations should avoid engaging in behaviors that might be viewed as retaliatory or slanderous. Employers who are ASHA members are likewise expected to behave in ways that place the highest priority on the needs of the clients/patients. Angry and spiteful words, obstructive actions, and uncooperative or aggressive behavior are potentially harmful to clients/patients and could reflect adversely on the professions. It is also a violation of the Code of Ethics if such behaviors lead to filing a frivolous complaint, as stated in Principle IV, Rule P: “Individuals shall not file or encourage others to file complaints that disregard or ignore facts that would disprove the allegation; the Code of Ethics shall not be used for personal reprisal, as a means of addressing personal animosity, or as a vehicle for retaliation.”
Guidance
The ASHA Ethics Office receives many questions related to client abandonment each year. The following questions are the Office's most common inquiries.
What should I do to help transition my clients/patients when I terminate services?
In all settings, the transition of care must be done properly and in a timely manner so as not to negatively impact those we serve. Whatever your particular circumstances, there are several steps you can take to help transition your clients/patients:
- Promptly inform your clients/patients and employer that you are ending services or employment. This is an essential part of Principle I, Rule T. Failing to inform clients/patients in a timely manner of plans to terminate treatment can be detrimental to the client/patient. The issue sometimes arises in private practice, where individuals know they will be retiring or moving but do not want to inform clients/patients of these plans because they do not want clients/patients to leave before they close their practice. Ultimately, the professional’s duty is to their client/patient, even though such action might not be in the professional’s best interest. Clients/patients should be given reasonable notice, and the professional should take the time needed to properly transition them to a new provider.
- Provide an interim plan or alternative care options for each client/patient. When changes in employment occur, failing to (a) provide an interim plan for each client/patient or (b) provide alternative care options may violate Principle I, Rules B and T.
- Refer clients to other qualified professionals, if needed. When managing one’s caseload during changes in employment, such as closing a practice or moving to a new employment setting, practitioners are obligated to refer clients/patients to other qualified professionals when appropriate. To not do so violates Principle I, Rule B.
- Complete all remaining reports, billing, and other required documentation. When leaving an employment setting, failing to complete all remaining reports, billing, and other required documentation is a violation of Principle I, Rule Q, which states, “Individuals shall maintain timely records; shall accurately record and bill for services provided and products dispensed; and shall not misrepresent services provided, products dispensed, or research and scholarly activities conducted.” Practitioners are obligated to complete all clinical/administrative responsibilities when leaving a position.
- Do not remove client records or withhold paperwork. Upon transitioning from employment, withholding paperwork so that the clinician’s successor does not have access to the client’s entire record is harmful to clients/patients. Such misconduct could be a violation of Principle I, Rule Q (see above) and Principle IV, Rule A, which states, “Individuals shall work collaboratively with members of their own profession and/or members of other professions, when appropriate, to deliver the highest quality of care.” Similarly, removing materials, records, protocols, and other administrative materials without the consent of the administrator of the facility or organization—even if intended by the clinician to ensure the care of a client/patient—negatively impacts those we serve. This is a violation of Principle I, Rule O: Individuals shall protect the confidentiality and security of records of professional services provided, research and scholarly activities conducted, and products dispensed. Access to these records shall be allowed only when doing so is legally authorized or required by law.
I’m quitting my job and giving 2 weeks’ notice. Is that enough time to ensure that I’m not committing client abandonment?
Maybe. There is no set amount of time that is deemed to constitute sufficient notice. Notice can range from as short as 2 weeks to several months. Many factors influence how much notification should be given—including but not limited to job responsibilities, number of clients, state laws, and actions needed to ensure continuity of services. The decision of whether an individual has committed client abandonment is not dependent solely on the notice given; it is also dependent on the efforts made by the practitioner to ensure continuity of care.
- they show up for work and then do not actually “work” or
- give 3 weeks’ notice but take 2 weeks of vacation during that period.
Am I obligated to stay in my position until my replacement is found?
No. You should adhere to the transition guidelines described in question 1. You are not required to stay in your job if a replacement has not been found by the end of your notice period.
My new job is closer to home and pays better, but my new employer wants me to start working in 3 days. Is this an exception to the client abandonment rule?
No. Abandoning clients/patients for personal gain or convenience is a detriment to those you serve. A practitioner who is motivated to leave one job for another job that is perceived as more prestigious, better paying, or closer to home must still provide sufficient notice and make efforts to transition clients/patients prior to making that choice. Failure to do so could constitute client abandonment.
Is it considered client abandonment if I’m fired from my job?
No. Some disruptions of clinician–client relationships are involuntary. If a clinician is dismissed for cause, then the employee’s responsibility to clients/patients terminates with the dismissal, and the facility assumes all responsibility for ensuring that no clients/patients suffer harm as a result of the departure. Clinical relationships may also be interrupted if an organization decides to close a program or when emergency situations occur (e.g., natural disasters or public health emergencies). It is expected that, even in these types of situations, practitioners would hold paramount the welfare of the clients/patients they serve; however, no clinician is ever ethically required to work without pay.
Is it considered client abandonment if I leave because I’m being threatened or because I fear for my safety?
No. Clinicians are never ethically obligated to place themselves in danger to deliver client/patient care. On rare occasions, clinicians may be threatened with physical danger and/or extreme emotional distress (e.g., sexual harassment, physical assault, specific threat of harm, or other serious misconduct). When clients/patients and/or their families exhibit this behavior, it seriously interferes with their treatment and jeopardizes clinician safety. In these circumstances, the provider may immediately elect to (a) inform the client/patient that treatment will be discontinued (this does not constitute client abandonment) and (b) notify their supervisor/director.
Is it considered client abandonment if I can’t see students due to a school strike?
No. Potential disruptions in clinician–client relationships may also occur as the result of a school strike. If a district makes the decision to close schools because of a strike, then this temporary lack of services would not be construed as client/patient/student abandonment by the audiologist or SLP. If schools remain open during a strike, the audiologist or SLP should ensure that parents are notified that their children may not receive services as scheduled. (Whether free appropriate public education [FAPE] has been denied as the result of a missed session is to be decided on a case-by-case basis. The school district is responsible for addressing parent concerns. For additional guidance, refer to Missed Speech-Language Sessions in Schools and ASHA Guidance on School Walkouts or Strikes on the ASHA website.)
Summary
It should be clear from this discussion that whenever it is necessary to terminate a clinical relationship, for whatever reason, there is an unavoidable impact on those we serve. As the welfare of our clients/patients is paramount, practitioners need to effectively eliminate the possibility of client abandonment.
Resources
Legal Disclaimer:
The information and materials available through ASHA’s website are for informational and educational purposes only. Nothing in this document should be construed as legal advice, and your use of the legal information provided on ASHA’s website is not a substitute for legal advice. ASHA has no knowledge of the specific or unique circumstances under which such information may be used by you. Your use of ASHA’s website does not create an attorney–client relationship between you and ASHA or between you and any of ASHA’s employees or representatives.
