ethics speech language sdqsdpathology and audiology

7/23/2019 Ethics Speech Language sdqsdPathology and Audiology

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Ethics – Speech Language Pathology & Audiology

INNOVATIVE EDUCATIONAL SERVICES

To take the post-test for CE credit, go to: WWW.CHEAPCEUS.COM

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Course Information

Course Sponsor - Innovative Educational Services

Provider Approval - ASHA Approved Provider of Continuing Education. Provider Code: AAVE

Course Description“Ethics – Speech Language Pathology & Audiology” is a web-based continuing education program that focuses ondefining ethical behavior for speech and audiolgy professionals. Information presented includes sections on thetheoretical basis for ethical decision-making, conflict of interest, confidentiality, informed consent, the ASHA Code ofEthics, legal standards of behavior, and hypothetical case scenarios.

Course Rationale This course was developed to explain, promote, and facilitate ethical behavior among speech-language and audiologyprofessionals.

Learner OutcomesAt the end of this course, the participants will be able to:

1. define the meaning of Ethics and explain the various theories that promote ethical behavior.2. identify the theoretical basis for ethical decision-making3. define the parameters of informed consent4. identify components of effective provider-patient communication

5. differentiate between appropriate and inappropriate relationships6. define conflict of interest and identify situations that demonstrate it7. identify the principles of confidentiality as defined under HIPAA guidelines8. identify and apply the principles of the ASHA Code of Ethics9. analyze and interpret clinical situations to determine appropriate professional legal and ethical behavior.

Course Instructor - Michael Niss DPT, President, Innovative Educational Services

Instructor Conflict of Interest Disclosure – Dr. Niss receives compensation as an employee of InnovativeEducational Services

Course Instructor - Niva Kilman MS, CCC-SLP, ASHA CE Administrator, Innovative Educational Services

Instructor Conflict of Interest Disclosure – Ms. Kilman receives compensation as an employee of InnovativeEducational Services

Methods of Instruction – Asynchronous text-based online course

Target Audience – Speech-Language Pathologists, SLP Assts, Audiologists, Audiology Assts

Course Educational Level - This course is applicable for introductory learners.

Course Prerequisites - None

Criteria for Issuance of Continuing Education Credits - score of 70% or greater on the written post-test

Continuing Education Credits - Two (2) hours of continuing education credit

Course Price - $19.95

Refund Policy – 100% unrestricted refund upon request

This program is offered for .2 CEUs (introductory level; related area).






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Outline

page

Course Information 1 start hour 1

Course Outline 2Ethics 3

Why Ethics are Important 3Ethics vs Morals 3Ethical Questions 3

Ethics Theories 4-6Utilitarianism 4Social Contract Theory 4Deontological/Duty Theory 4Ethical Intuitionism 4Ethical Egoism 4Natural Law Theory 4Virtue Ethics 5

How to Make Right Decisions 5-7Informed Consent 7-10Consent for Multiple Treatments 7Blanket Consent 7-8Notification vs. Consent 8Refusing Treatment 8-9Resisting Treatment 9-10

Provider – Patient Communication 10-11Relationships 11-14

Professionalism 11-12Boundaries 12Legal Aspects 12-13Other Problematic Relationships 13Recommendations 13-14 end hour 1

Gifts & Conflict of Interest 14-16 start hour 2Confidentiality 16-17ASHA Code of Ethics 17-22

Preamble 17Ethics I 17-19Ethics II 19-20Ethics III 20Ethics IV 21-22

Ethics Case Studies 22-27#1 – Confidentiality 22-23#2 – Qualification of Practice 23#3 – Informed Consent 23-24#4 – Medical Necessity 25

#5 – Conflict of Interest 25-26#6 – Relationships with Referral Sources 26-27

References 28Post-Test 29-30 end hour 2






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Ethics Overview

The word “ethics” is derived from the Greek word ethos (character), and from theLatin word mores (customs). Together, they combine to define how individualschoose to interact with one another. In philosophy, ethics defines what is good

for the individual and for society and establishes the nature of duties that peopleowe themselves and one another. Ethics is also a field of human inquiry thatexamines the bases of human goals and the foundations of “right” and “wrong”human actions that further or hinder these goals.

Why Ethics are ImportantEthics are important on several levels.

• People feel better about themselves and their profession when they workin an ethical manner.

• Professions recognize that their credibility rests not only on technicalcompetence, but also on public trust.

•

At the organizational level, ethics is good business. Several studies haveshown that, over the long run, ethical businesses perform better thanunethical businesses.

Ethics vs. MoralsAlthough the terms “ethics” and “morals” are often used interchangeably, theyare not identical. Morals usually refer to practices; ethics refers to the rationalethat may or may not support such practices. Morals refer to actions, ethics to thereasoning behind such actions. Ethics is an examined and carefully consideredstructure that includes both practice and theory. Morals include ethicallyexamined practices, but may also include practices that have not been ethicallyanalyzed, such as social customs, emotional responses to breaches of sociallyaccepted practices and social prejudices. Ethics is usually at a higher intellectuallevel, more universal, and more dispassionate than morals. Some philosophers,however, use the term “morals” to describe a publicly agreed-upon set of rulesfor responding to ethical problems.

Ethical Questions Ethical questions involve 1) responsibilities to the welfare of others or to thehuman community; or 2) conflicts among loyalties to different persons or groups,among responsibilities associated with one’s role (e.g. as consumer or provider),or among principles. Ethical questions include (or imply) the words “ought” or“should”.






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Ethics Theories

Throughout history, mankind has attempted to determine the philosophical basisfrom which to define right and wrong. Here are some of the more commonlyaccepted theories that have been proposed.

UtilitarianismThis philosophical theory develops from the work of Jeremy Bentham and JohnStewart Mill. Simply put, utilitarianism is the theory that right and wrong isdetermined by the consequences. The basic tool of measurement is pleasure(Bentham) or happiness (Mill). A morally correct rule is one that provides thegreatest good to the greatest number of people.

Social Contract TheorySocial contract theory is attributed to Thomas Hobbes, John Locke, and from thetwentieth century, John Rawls. Social contract theories believe that the moral

code is created by the people who form societies. These people come togetherto create society for the purpose of protection and gaining other benefits of socialcooperation. These persons agree to regulate and restrict their conduct toachieve this end.

Deontological or Duty TheoryUnder this theory you determine if an act or rule is morally right or wrong if itmeets a moral standard. The morally important thing is not consequences but theway choosers think while they make choices. One famous philosopher whodeveloped such a theory was Immanuel Kant.

Ethical IntuitionismUnder this view an act or rule is determined to be right or wrong by appeal to thecommon intuition of a person. This intuition is sometimes referred to as yourconscience. Anyone with a normal conscience will know that it is wrong to kill aninnocent person.

Ethical EgoismThis view is based on the theory that each person should do whatever promotestheir own best interests; this becomes the basis for moral choices.

Natural Law TheoryThis is a moral theory which claims that just as there are physical laws of nature,there are moral laws of nature that are discoverable. This theory is largelyassociated with Thomas Aquinas, who advocated that each thing has its owninherent nature, i.e. characteristic ways of behavior that belong to all members ofits species and are appropriate to it. This nature determines what is good or badfor that thing. In the case of human beings, the moral laws of nature stem from






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our unique capacity for reason. When we act against our own reason, we areviolating our nature, and therefore acting immorally.

Virtue EthicsThis ethics theory proposes that ethical behavior is a result of developed or

inherent character traits or virtues. A person will do what is morally right becausethey are a virtuous person. Aristotle was a famous exponent of this view. Aristotlefelt that virtue ethics was the way to attain true happiness. These are some of thecommonly accepted virtues.

Autonomy: the duty to maximize the individual’s right to make his or herown decisions.

Beneficence: the duty to do good.

Confidentiality: the duty to respect privacy of information.

Finality: the duty to take action that may override the demands of law,

religion, and social customs.Justice: the duty to treat all fairly, distributing the risks and benefitsequally.

Nonmaleficence: the duty to cause no harm.

Understanding/Tolerance: the duty to understand and to accept otherviewpoints if reason dictates.

Respect for persons: the duty to honor others, their rights, and theirresponsibilities.

Universality: the duty to take actions that hold for everyone, regardless of

time, place, or people involved.Veracity: the duty to tell the truth.

How to Make Right Decisions

The foundation for making proper ethical decisions is rooted in an individual’sability to answer several fundamental questions concerning their actions.

1. Are my actions legal?Weighing the legality of one’s actions is a prudent way to begin thedecision-making process. The laws of a geopolitical region are a writtencode of that region’s accepted rules of conduct. This code of conductusually defines clearly which actions are considered acceptable and whichactions are unacceptable. However, a legitimate argument can be madethat sometimes what is legal is not always moral, and that sometimes






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what is moral is not always legal. This idea is easily demonstrated by thefollowing situation.

It is illegal for a pedestrian to cross a busy street anywhere other than atthe designated crosswalk (jaywalking). A man is walking down a street

and sees someone fall and injure themselves on the other side of thestreet. He immediately crosses the street outside of the crosswalk toattend to the injured person. Are his actions legal? Are they moral?What if by stepping into the street he causes a car to swerve and to strikeanother vehicle?

Admittedly, with the exception of law enforcement officers and attorneys,most people do not know all of the specific laws that govern their lives.However, it is assumed that most people are familiar with the fundamentalvirtues from which these laws are based, and that they will live their livesin accordance with these virtues.

2. Are my actions ethical?Professional ethical behavior as it is defined in this context relates toactions that are consistent with the normative standards established orpracticed by others in the same profession. For speech and audiologyprofessionals, these ethical standards are documented in the ASHA Codeof Ethics. All SLPs, SLP assistants, audiologists, and audiologyassistants, even those who are not members of ASHA, are bound to theseguidelines. This is because the ASHA Code of Ethics is the accepted andde facto standard of practice throughout the profession.

3. Are my actions fair?I think most people would agree that the concept of fairness is often highlysubjective. However, for these purposes, we will define fairness asmeaning deserved, equitable and unbiased. Fairness requires thedecision-maker to have a complete understanding of benefits andliabilities to all parties affected by the decision. Decisions that result incapricious harm or arbitrary benefit cannot be considered fair. The goal ofevery decision should be an outcome of relative equity that reflectsinsightful thought and soundness of intent.

4. Would my actions be the same if they were transparent to others?This question presents as a true reflection of the other three. Legal,ethical, and fair are defined quite differently by most people when judgedin the comfort of anonymity versus when it is examined before the forumof public opinion. Most often it is the incorrect assumption that “no one willever find out about this” that leads people to commit acts of impropriety.How would your decisions change, if prior to taking any actions, you






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assumed just the opposite; “other people will definitely know what I havedone”. One sure sign of a poor decision is debating the possible exposureof an action instead of examining the appropriateness of it.

Informed Consent

Patients have a fundamental right to direct what happens to their bodies,grounded in the principles of autonomy and respect for persons. In turn, healthcare professionals have an ethical obligation to involve patients in a process ofshared decision making and to seek patients’ informed consent for treatmentsand procedures. Good informed consent practices, thus, are an essentialcomponent of ethics quality in health care. And that means more than getting apatient’s signature on a consent form.

The goal of the informed consent process is to ensure that patients have an

opportunity to be informed participants in decisions about their health care.

Toachieve that goal practitioners must inform the patient (or authorized surrogate)about treatment options and alternatives, including the risks and benefits of each,providing the information that a “reasonable person” in similar circumstanceswould want to know in making the treatment decision. A key element of theprocess is that the practitioner must explain why he or she believesrecommended treatments or procedures will be more beneficial than alternativesin the context of the patient’s diagnosis.

Informed consent must always be specific: to the individual patient, the clinicalsituation, and the recommended plan of care or recommended treatment(s) orprocedure(s).

Consent for Multiple Treatments Although consent is always specific, it is not the same as saying that separateconsent is always required for every episode of repeated treatment. When theplan of care for a given diagnosis involves repeated treatments or procedures—for example, a course of diagnostic tests or ongoing therapy—practitioners donot need to obtain consent for each individual episode.

Blanket Consent Informed consent for a planned course of multiple repeated treatments based ona specific diagnosis is very different from practices sometimes referred to as“routine” or “blanket” consent. Asking a patient to agree at the outset of care to“any treatment your doctors think is necessary,” or “routine procedures asneeded,” is ethically problematic in several ways.






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Such practices fail to meet the requirement that consent be specific. This is thecase even when common procedures are identified. For example, asking apatient entering the ICU to consent to the use of a ventilator, performance ofthoracentesis, or other common critical care interventions, “if needed.” Such indi-vidual procedures are not part of a plan of care because they are not anticipated

to be clinically indicated or recommended for that individual patient at the timeconsent is obtained.

Moreover, seeking consent “in case” a patient should need some future interven-tion that is not related to that patient’s current clinical status violates the funda-mental ethical norm that patients must make decisions about proposed treat-ments or procedures in the context of their present situation. As a “patient-centered action,” informed consent involves the contemporaneous bodilyintegrity, rights, dignity, intelligence, preferences, interests, goals, and welfare.If a patient’s condition changes enough to warrant a change in the plan of care,the practitioner must explain to the patient (or authorized surrogate) how the

situation has changed, establish goals of care in light of the new situation,recommend a new plan of care, and obtain informed consent for the new plan orfor specific treatment(s) or procedure(s) now recommended.

Notification versus Consent Informed consent is also different from “notification,” that is, providing generalinformation relevant to patients’ participation in health care. Notification informspatients not only about their rights, but also about organizational activities andprocesses that shape how care is delivered. Like informed consent, notificationserves the goal of respecting patients as moral agents.

Refusing TreatmentThe right to refuse unwanted treatment, even potentially life-saving treatment, iscentral to health care ethics. Health care professionals are understandablyconcerned when patients refuse recommended treatments. How shouldpractitioners respond when a patient declines an intervention that practitionersbelieve is appropriate and needed? The answer to that question depends on boththe patient’s decision-making capacity and the particular circumstances of thetreatment decision.

Practitioners should take care not to assume that a patient who refusesrecommended treatment lacks decision-making capacity.

A capacity assessmentis appropriate if the practitioner has reason to believe the patient might lack oneor more of the components of decision-making capacity. When decision-makingcapacity is not in question, practitioners must respect the patient’s decision todecline an intervention, even if they believe the decision is not the best one thatcould have been made. However, this does not mean that health careprofessionals should never question the patient’s decision, or never try to






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persuade the patient to accept treatment. For example, by exploring the reasonsfor refusal with the patient, a practitioner might learn that the patient simplyneeds more information before deciding to proceed.

The professional ethical ideal of shared decision making calls for active,

respectful engagement with the patient or surrogate. As a prelude to exploring apatient’s refusal of recommended treatment, practitioners should clarify thepatient’s (and/or surrogate’s) understanding of the clinical situation and elicit hisor her expectations about the course of illness and care.

Practitioners shouldclarify the goals of care with the patient or surrogate, address expectations forcare that may be unrealistic, and work with the patient or surrogate to prioritizeidentified goals as the foundation for a plan of care.

Asking in a nonjudgmental way, “What leads you to this conclusion?”

can thenhelp the practitioner to understand the reasons for the patient’s decision todecline recommended treatment. It can also help to identify concerns or fears the

patient may have about the specific treatment that practitioners can address. Theaim should be to negotiate a plan of care that promotes agreed on goals of care.

Resisting Treatment Health care professionals face different concerns when patients who lackdecision-making capacity resist treatment for which their authorized surrogateshave given consent. When a surrogate consents to treatment on behalf of apatient who lacks decision-making capacity, practitioners are authorized to carryout the treatment or procedure even if the patient actively resists. In such cases,treatment is not being administered over the patient’s refusal because thesurrogate has taken the patient’s place in the process of shared decision makingand exercised the patient’s decision-making rights. However, practitionersshould still be sensitive to patients who resist treatment. They should try tounderstand the patient’s actions and their implications for treatment. Practitionersshould ask themselves why, for example, a patient repeatedly tries to pull out afeeding tube. Is the tube causing physical discomfort? Is the patient distressedbecause he or she does not understand what is happening?

Resistance to treatment should prompt practitioners to reflect on whether thetreatment is truly necessary in light of the established goals of care for thepatient, or whether it could be modified to minimize the discomfort or distress itcauses. For instance, a patient may resist treatment via one route ofadministration but not another.

Practitioners should also be alert to the implications of the patient’s resistance forthe judgment that he or she lacks decision-making capacity. In some cases,resistance to treatment may be an expression of the patient’s authentic wishes.Decision-making capacity is not an “all or nothing” proposition. Rather, decision-






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making capacity is task specific. It rests on being able to receive, evaluate,deliberate about and manipulate information, and communicate a decision, whichcan vary considerably with the decision to be made. A patient may have capacityto make a simple decision but not a more complex one.

When a patient resists, surrogates, family members, or friends may be able toshed light on the patient’s actions and help practitioners identify ways to providetreatment that are less upsetting for the patient. For patients with fluctuatingcapacity, it may be possible to explore concerns directly with the patient duringlucid moments.

Patients who resist treatment present unique challenges for health care practitio-ners. The root cause of the resistance should be explored, as well as otherclinically acceptable alternatives to the proposed treatment.

Provider-Patient Communication

Health care practitioners have an ethical responsibility to work with patients (ortheir surrogates) to negotiate treatment plans that respect the patient’s values,preferences, and goals for care. To meet that obligation, practitioners mustensure that they communicate effectively with patients and surrogates.

Communicating effectively is an important aspect of showing respect to patients.And it has practical benefits: Effective communication promotes greatersatisfaction and helps ensure better adherence to treatment plans, with betterhealth outcomes for patients. Good communication also reduces the likelihood

of lawsuits even when patients don’t have good outcomes.

Yet poor communication remains a significant problem in health care. Manypractitioners are not well trained in basic communication skills, such as askingopen-ended questions to elicit information (“What brings you to the clinic thismorning?”), reflecting patients’ comments back to them (“I hear you saying yournew medication makes you sleepy”), or using other active listening techniques. And formal training rarely focuses on the communication tasks that must becompleted in patient-provider encounters.

Moreover, practitioners tend to underestimate patients’ needs for information,and overestimate their own effectiveness in conveying information. Manypatients aren’t comfortable disclosing that they don’t understand whatpractitioners are saying—asking point blank, “Do you understand?” puts them onthe spot. And a nod in response doesn’t guarantee they’ve actually heard andunderstood what’s been said.






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To make it easier for patients to understand health information, practitioners mustestablish conditions for effective communication. Among other things, theyshould provide a safe environment, in which patients feel comfortable askingquestions. Practitioners should use plain language—e.g., “sore” or ”wound”instead of “lesion”; “bad” instead of “adverse” reaction. And they should use the

technique of “teach back,” asking the patient to recount what he or she has beentold, to help gauge the level of understanding.

Practitioners can use this technique to identify patient-specific barriers to com-munication, for example, low health literacy, which includes more than justdifficulty reading. Cognitive impairments, such as early stage dementia, and,especially, limited proficiency in English (possibly indicating the need for amedical interpreter), also contribute. There can be other barriers to effectivecommunication as well, for example, when patients have hearing problems.

Asking patients to recount instructions or to describe a proposed procedure can

alert practitioners to individuals’ particular needs and challenges and helpclinicians tailor communication more effectively.

Relationships

Boundaries define the limits of appropriate behavior by a professional toward hisor her clients. By establishing boundaries, a health care professional creates asafe space for the therapeutic relationship to occur. Health care professionalsneed guidance if they are to avoid engaging in interactions with their patients thatmay prove ethically problematic.

ProfessionalismThe notion of boundaries in the health care setting is rooted in the concept of a“profession”. While this concept is understood in several different ways in themedical and sociological literature, there is consensus regarding one of thedefining characteristics of professions and professionals: commitment to servethe profession’s clients. That is, professionals are expected to make a fiduciarycommitment to place their clients’ interests ahead of their own. In exchange forfaithfully applying their unique knowledge and skills on behalf of their clients,members of a profession are granted the freedom to practice and to regulatethemselves.

Patients who come to health care professionals when they are ill and vulnerablebring with them expectations about this interaction and how clinicians shouldbehave toward them as health care professionals, though patients are not alwaysable to articulate those expectations clearly. Patients should be able to trust thattheir interests and welfare will be placed above those of the health care






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professional, just as they should be confident they will be treated with respect,and be informed so that they can make their own health care decisions to thegreatest extent possible. Professionals, as such, are held to different standardsof conduct from other persons. Relationships and interactions that may beethically unproblematic among nonprofessionals may be unacceptable when one

of the parties is a professional. An individual may have a personal interest that isperfectly acceptable in itself, but conflicts with an obligation the same individualhas as a health care professional.

For example, under circumstances in which it would normally be acceptable forone person to ask another individual for a date, it may not be acceptable for ahealth care professional to ask a patient for a date, because doing so mightcompromise the professional’s fiduciary commitment to the patient’s welfare. Thenature of professions is such that the human needs the professions address andthe human relationships peculiar to them are sufficiently distinct to warrant,indeed to demand, expectations of a higher morality and a greater commitment

to the good of others than in most other human activities.

Boundaries Boundaries define the professional relationship as fundamentally respectful andprotective of the patient and as dedicated to the patient’s well-being and bestinterests. A boundary violation occurs when a health care professional’sbehavior goes beyond appropriate professional limits. Boundary violationsgenerally arise when the interaction between parties blurs their roles vis-à-visone another. This creates what is known as a “double bind situation”. That is acircumstance in which a personal interest displaces the professional’s primarycommitment to the patient’s welfare in ways that harm—or appear to harm—thepatient or the patient-clinician relationship, or might reasonably be expected to doso.

Legal AspectsVarious legal and regulatory requirements address boundaries in patient-professional interactions. Clinicians are subject to guidelines for professionalconduct in health care promulgated by state licensing boards. Most stateprofessional licensing boards have addressed specific boundary issues. Forexample, “engaging in any conduct with a patient that is sexual or may bereasonably interpreted as sexual ... [or] behavior, gestures, or expressions thatare seductive, sexually suggestive, or sexually demeaning to a patient.”

Some state board guidelines offer specific guidance to help clinicians avoidinappropriate conduct, such as recommending that professionals restrict contactwith patients to appropriate times and places for the therapy to be given.Violations of these guidelines could result in probation, limitation of practice, andsuspension or revocation of licensure. Clinicians should be aware; moreover, that






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inappropriate sexual or physical contact can result in patients suing clinicians forbattery and malpractice, and in several states sexual exploitation of a patient isconsidered a felony.

Other Problematic Relationships

Many kinds of interaction potentially interfere with the primary clinical relationshipbetween practitioner and patient and pose concerns about acceptable conductfor health care professionals. Becoming socially involved or entering into abusiness relationship with a patient, for example, can impair, or appear to impair,the professional’s objectivity. Accepting a gift is sometimes an appropriate way toallow a patient to express his or her gratitude, and at other times is problematic.Showing favoritism—by giving a particular patient extra attention, time, or priorityin scheduling appointments, for example—can cross the boundary betweenaction that is appropriate advocacy on behalf of a particular patient and actionthat is unfair to others.

Such interactions or activities are ethically problematic when they can reasonablybe expected to affect the care received by the individual or by other patients orthe practitioner’s relationships with his or her colleagues, or when they give theappearance of doing so. Yet not all behavior that might be consideredinappropriate necessarily violates professional obligations.

Health care professionals should be alert to situations in which they may be likelyto be motivated to behave in ways that violate accepted ethical standards.Ambiguous interactions and relationships, for example, have the potential both toimpair the professional’s objectivity and compromise his or her judgment, and togive rise to conflicting expectations on the patient’s part, which can contaminatethe therapeutic relationship and potentially undermine the patient’s trust.

RecommendationsHealth care professionals should beware of interacting with any patient in waysthat could reasonably be expected to create awkward situations for either party,compromise the professional’s primary commitment to patient welfare, or call theprofessional’s objectivity into question. While not every business or socialinteraction or relationship between a health care professional and a patientnecessarily violates ethical professional boundaries, professionals shouldcritically examine their own actions by considering the following:

• Is this activity a normal, expected part of practice for members of myprofession? Might engaging in this activity compromise my relationshipwith this patient, other patients, colleagues, my employer, or with thepublic?

• Could this activity cause others to question my professional objectivity?






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• Would I want my other patients, other professionals, or the public to knowthat I engage in such activities?

If the answers to these questions indicate that an activity may violateprofessional ethical boundaries, the health care professional should:

• Determine if there are applicable standards.• Consult a trusted and objective peer for a second opinion about the

activity.• Seek assistance from a supervisor or ethics committee.

• Communicate his or her concern to the individual involved.

• Transfer the patient to another clinician’s care if the professionalrelationship has been compromised, or if avoiding the violation willdamage the relationship.

As well, it is imperative that health care professionals be familiar with:

• Relevant professional codes of ethics, standards of practice, guidelines,and position statements

• Applicable policies in their facilities; and

• Laws pertaining to relationships between patients and health careprofessionals.

Understanding and respecting professional boundaries is part of professionalcompetence. Maintaining those boundaries is an essential part ofcompassionate, effective, and ethical health care practice.

Gifts and Conflict of Interest

Because gifts create relationships, health care professionals’ acceptance of giftsfrom commercial vendors can be ethically problematic in several ways. Acceptinggifts risks undermining trust. It may bias clinicians’ judgments about the relativemerits of different treatments. And it may affect treatment patterns in ways thatincrease costs and adversely affect access to care.

Health care professionals’ fiduciary, or trust-based, relationship with patientsrequires that practitioners explain the reasons for treatment decisions and

disclose any potential conflicts of interest, including the influence of gifts.

Given the ways in which gift giving differs from entering into a contractualrelationship, gifts to health care professionals can blur the distinction betweenformal business exchanges and informal, interpersonal exchanges.






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Industry gifts to health care professionals create potential conflicts of interest thatcan affect practitioners’ judgment—without their knowledge and even contrary totheir intent—thereby placing professional objectivity at risk and possiblycompromising patient care.

If accepting gifts is ethically problematic in these ways, why do health careprofessional continue to take the gifts they are offered? One explanation is thataccepting a gift is a natural, socially expected reaction motivated by acombination of self-interest and politeness. But it is also argued that health careprofessionals have come to expect gifts as part of a “culture of entitlement” thathas evolved over many years. Gifts have become a familiar part of many healthcare workplace cultures and established patterns of behavior often resist change.Other rationales are that inducements such as free lunches are needed to induceattendance at educational sessions (and may help offset the costs of suchprograms), and that they help boost employee morale. Some even claim thataccepting gifts results in economic savings for health care institutions, because

the industry provides for free items that the institutions would otherwise have tobuy. Finally, apathy on the part of professional bodies allows the “tradition” ofaccepting gifts to continue.

Failure to enforce ethical standards consistently has made it easier simply not tonotice, or not to be concerned about, the fact that accepting gifts creates ethicalrisks. None of these arguments, however, is compelling enough to allow anethically problematic practice to continue. While habit and self-interest can bepowerful motivators, ethical standards explicitly require health care professionalsto place patient interests above their own.

In recent years, many prominent organizations and associations haveestablished ethical guidelines for health care professionals about accepting giftsfrom industry representatives. These guidelines do not prohibit all gifts fromindustry, but there is general agreement that gifts from companies to health careprofessionals are acceptable only when the primary purpose is the enhancementof patient care and medical knowledge. The acceptance of individual gifts,hospitality, trips, and subsidies of all types from industry by an individual isstrongly discouraged. Practitioners should not accept gifts, hospitality, services,and subsidies from industry if acceptance might diminish, or appear to others todiminish, the objectivity of professional judgment.

Professional guidelines seek to establish thresholds for what kinds of gifts andgift relationships are acceptable. In general, gifts to individual practitioners arediscouraged unless they are of minimal value and related to the practitioner’swork—such as pads, pens, or calendars for office use.






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The social dynamics of the gift relationship, the potential for gifts subtly to biashealth care professionals’ prescribing practices and clinical decisions, and theobligation of health care professionals to avoid acting in ways that mightundermine public trust all argue for the adoption of clear, robust policiesregarding the acceptance of gifts from companies. Creating a workplace in which

professionals no longer routinely expect or accept gifts from industry is achallenging task that calls for professional role modeling and sustained,coordinated efforts on the part of clinical and administrative leaders, as well asdevelopment and careful implementation of clear, well-considered policy.

Confidentiality

The obligation to ensure patient privacy is rooted in the ethical principle ofrespect for persons. Health care providers convey that respect in a few ways withregard to privacy. They respect patient’s informational privacy by limiting access

to patient information to those authorized health care providers who need it toperform their duties. The obligation to ensure patient privacy is also justified bythe obligation of harm prevention. Sometimes maintaining patient privacy is away of keeping the patient safe, for example, by minimizing the risk of identitytheft.

Confidentiality is mandated by HIPAA laws, specifically the Privacy Rule. ThePrivacy Rule protects all individually identifiable health information held ortransmitted by a covered entity or its business associate, in any form or media,whether electronic, paper, or oral.

“Individually identifiable health information” is information, including demographicdata, that relates to:

• the individual’s past, present or future physical or mental health orcondition,

• the provision of health care to the individual, or

• the past, present, or future payment for the provision of health care to theindividual, and that identifies the individual or for which there is areasonable basis to believe it can be used to identify the individual.

Individually identifiable health information includes many common identifiers(e.g., name, address, birth date, Social Security Number).

Health care providers must make reasonable efforts to use, disclose, and requestonly the minimum amount of protected health information needed to accomplishthe intended purpose of the use, disclosure, or request. They must also developand implement policies and procedures to reasonably limit uses and disclosures






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to the minimum necessary. When the minimum necessary standard applies to ause or disclosure, a covered entity may not use, disclose, or request the entiremedical record for a particular purpose, unless it can specifically justify the wholerecord as the amount reasonably needed for the purpose.

ASHA Code of Ethics

Preamble

The preservation of the highest standards of integrity and ethical principles isvital to the responsible discharge of obligations by speech-language pathologists,audiologists, and speech, language, and hearing scientists. This Code of Ethicssets forth the fundamental principles and rules considered essential to thispurpose.

Every individual who is (a) a member of the American Speech-Language-HearingAssociation, whether certified or not, (b) a nonmember holding the Certificate ofClinical Competence from the Association, (c) an applicant for membership orcertification, or (d) a Clinical Fellow seeking to fulfill standards for certificationshall abide by this Code of Ethics.

Any violation of the spirit and purpose of this Code shall be considered unethical.Failure to specify any particular responsibility or practice in this Code of Ethicsshall not be construed as denial of the existence of such responsibilities orpractices.

The fundamentals of ethical conduct are described by Principles of Ethics and byRules of Ethics as they relate to the responsibility to persons served, the public,speech-language pathologists, audiologists, and speech, language, and hearingscientists, and to the conduct of research and scholarly activities.

Principles of Ethics, aspirational and inspirational in nature, form the underlyingmoral basis for the Code of Ethics. Individuals shall observe these principles asaffirmative obligations under all conditions of professional activity.Rules of Ethics are specific statements of minimally acceptable professionalconduct or of prohibitions and are applicable to all individuals.

Principle of Ethics I

Individuals shall honor their responsibility to hold paramount the welfare ofpersons they serve professionally or who are participants in research andscholarly activities, and they shall treat animals involved in research in a humanemanner.






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Rules of Ethics I

1. Individuals shall provide all services competently.

2. Individuals shall use every resource, including referral when appropriate,to ensure that high-quality service is provided.

3. Individuals shall not discriminate in the delivery of professional services orthe conduct of research and scholarly activities on the basis of race orethnicity, gender, gender identity/gender expression, age, religion,national origin, sexual orientation, or disability.

4. Individuals shall not misrepresent the credentials of assistants,technicians, support personnel, students, Clinical Fellows, or any othersunder their supervision, and they shall inform those they serveprofessionally of the name and professional credentials of personsproviding services.

5. Individuals who hold the Certificate of Clinical Competence shall not

delegate tasks that require the unique skills, knowledge, and judgmentthat are within the scope of their profession to assistants, technicians,support personnel, or any nonprofessionals over whom they havesupervisory responsibility.

6. Individuals who hold the Certificate of Clinical Competence may delegatetasks related to provision of clinical services to assistants, technicians,support personnel, or any other persons only if those services areappropriately supervised, realizing that the responsibility for client welfareremains with the certified individual.

7. Individuals who hold the Certificate of Clinical Competence may delegate

tasks related to provision of clinical services that require the unique skills,knowledge, and judgment that are within the scope of practice of theirprofession to students only if those services are appropriately supervised.The responsibility for client welfare remains with the certified individual.

8. Individuals shall fully inform the persons they serve of the nature andpossible effects of services rendered and products dispensed, and theyshall inform participants in research about the possible effects of theirparticipation in research conducted.

9. Individuals shall evaluate the effectiveness of services rendered and ofproducts dispensed, and they shall provide services or dispense productsonly when benefit can reasonably be expected.

10. Individuals shall not guarantee the results of any treatment or procedure,directly or by implication; however, they may make a reasonablestatement of prognosis.

11. Individuals shall not provide clinical services solely by correspondence.






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12. Individuals may practice by telecommunication (e.g., telehealth/e-health),where not prohibited by law.

13. Individuals shall adequately maintain and appropriately secure records ofprofessional services rendered, research and scholarly activitiesconducted, and products dispensed, and they shall allow access to these

records only when authorized or when required by law.

14. Individuals shall not reveal, without authorization, any professional orpersonal information about identified persons served professionally oridentified participants involved in research and scholarly activities unlessdoing so is necessary to protect the welfare of the person or of thecommunity or is otherwise required by law.

15. Individuals shall not charge for services not rendered, nor shall theymisrepresent services rendered, products dispensed, or research andscholarly activities conducted.

16. Individuals shall enroll and include persons as participants in research orteaching demonstrations only if their participation is voluntary, withoutcoercion, and with their informed consent.

17. Individuals whose professional services are adversely affected bysubstance abuse or other health-related conditions shall seek professionalassistance and, where appropriate, withdraw from the affected areas ofpractice.

18. Individuals shall not discontinue service to those they are serving withoutproviding reasonable notice.

Principle of Ethics II

Individuals shall honor their responsibility to achieve and maintain the highestlevel of professional competence and performance.

Rules of Ethics II

1. Individuals shall engage in the provision of clinical services only when theyhold the appropriate Certificate of Clinical Competence or when they arein the certification process and are supervised by an individual who holdsthe appropriate Certificate of Clinical Competence.

2. Individuals shall engage in only those aspects of the professions that are

within the scope of their professional practice and competence,considering their level of education, training, and experience.

3. Individuals shall engage in lifelong learning to maintain and enhanceprofessional competence and performance.






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4. Individuals shall not require or permit their professional staff to provideservices or conduct research activities that exceed the staff member'scompetence, level of education, training, and experience.

5. Individuals shall ensure that all equipment used to provide services or toconduct research and scholarly activities is in proper working order and is

properly calibrated.

Principle of Ethics III

Individuals shall honor their responsibility to the public by promoting publicunderstanding of the professions, by supporting the development of servicesdesigned to fulfill the unmet needs of the public, and by providing accurateinformation in all communications involving any aspect of the professions,including the dissemination of research findings and scholarly activities, and thepromotion, marketing, and advertising of products and services.

Rules of Ethics III

1. Individuals shall not misrepresent their credentials, competence,education, training, experience, or scholarly or research contributions.

2. Individuals shall not participate in professional activities that constitute aconflict of interest.

3. Individuals shall refer those served professionally solely on the basis ofthe interest of those being referred and not on any personal interest,financial or otherwise.

4. Individuals shall not misrepresent research, diagnostic information,

services rendered, results of services rendered, products dispensed, orthe effects of products dispensed.

5. Individuals shall not defraud or engage in any scheme to defraud inconnection with obtaining payment, reimbursement, or grants for servicesrendered, research conducted, or products dispensed.

6. Individuals' statements to the public shall provide accurate informationabout the nature and management of communication disorders, about theprofessions, about professional services, about products for sale, andabout research and scholarly activities.

7. Individuals' statements to the public when advertising, announcing, and

marketing their professional services; reporting research results; andpromoting products shall adhere to professional standards and shall notcontain misrepresentations.






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Principle of Ethics IV

Individuals shall honor their responsibilities to the professions and theirrelationships with colleagues, students, and members of other professions anddisciplines.

Rules of Ethics IV

1. Individuals shall uphold the dignity and autonomy of the professions,maintain harmonious interprofessional and intraprofessional relationships,and accept the professions' self-imposed standards.

2. Individuals shall prohibit anyone under their supervision from engaging inany practice that violates the Code of Ethics.

3. Individuals shall not engage in dishonesty, fraud, deceit, ormisrepresentation.

4. Individuals shall not engage in any form of unlawful harassment, includingsexual harassment or power abuse.

5. Individuals shall not engage in any other form of conduct that adverselyreflects on the professions or on the individual's fitness to serve personsprofessionally.

6. Individuals shall not engage in sexual activities with clients, students, orresearch participants over whom they exercise professional authority orpower.

7. Individuals shall assign credit only to those who have contributed to apublication, presentation, or product. Credit shall be assigned in proportion

to the contribution and only with the contributor's consent.8. Individuals shall reference the source when using other persons' ideas,

research, presentations, or products in written, oral, or any other mediapresentation or summary.

9. Individuals' statements to colleagues about professional services,research results, and products shall adhere to prevailing professionalstandards and shall contain no misrepresentations.

10. Individuals shall not provide professional services without exercisingindependent professional judgment, regardless of referral source orprescription.

11. Individuals shall not discriminate in their relationships with colleagues,students, and members of other professions and disciplines on the basisof race or ethnicity, gender, gender identity/gender expression, age,religion, national origin, sexual orientation, or disability.






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12. Individuals shall not file or encourage others to file complaints thatdisregard or ignore facts that would disprove the allegation, nor should theCode of Ethics be used for personal reprisal, as a means of addressingpersonal animosity, or as a vehicle for retaliation.

13. Individuals who have reason to believe that the Code of Ethics has been

violated shall inform the Board of Ethics.

14. Individuals shall comply fully with the policies of the Board of Ethics in itsconsideration and adjudication of complaints of violations of the Code ofEthics.

© Copyright 2011 American Speech-Language-Hearing Association. All rights reserved.

Ethics Case Studies

Case Study #1 - Confidentiality

John Jones, CCC- SLP, Sue Brown (receptionist), and Mary Smith (Director ofManaged Care Contracting), are in a private office discussing the fact that theyare treating a celebrity following a stroke.. John says, “I can’t believe that I’mactually treating actress Jennifer Morrison.” Mary asks, “Do you think that shewill fully recover and be able to act again?” John replies, “I’m not sure. I saw herMRI report, and it shows that she has a significant left side lesion on her brain.”

Is this a breach in confidentiality?

The information contained in each patient’s medical record must be safeguarded

against disclosure or exposure to nonproprietary individuals. The right to knowany medical information about another is always predicated on a sounddemonstration of need. Frequently, many individuals require access toinformation contained in a patient’s medical record. Their right to access thisinformation is limited to only that information which is deemed necessary forthem perform their job in a safe, effective, and responsible manner.

The first questions we must ask are “What information is being disclosed and dothe three individuals engaged in the conversation have a need to know thisinformation?”

John’s first statement discloses the name of person receiving care, and hissecond statement reveals private patient medical information. Certainly, as theprovider of speech therapy services, John would need to know the patient’sname and diagnosis in order to provide care. Sue, the receptionist, may alsoneed this information to schedule appointments and perform other essential






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clerical tasks. Mary, whose job it is to contract with managed care organizations,most likely has no compelling reason to know either the patient’s identity or anyof her medical information. Therefore, the disclosure to Mary of the patient’sidentity and medical information is a breach of patient confidentiality.(ASHA Code of Ethics: I-13, I-14)

Case Study #2 – Qualifications of Practice

Mary is a speech-language pathology assistant who has practiced for more than20 years. Frequently, she is called upon to perform treatments that should bedone by an SLP. The patients always give her compliments, and frequentlyrequest her to treat them. She demonstrates exceptional skills and achievesoutstanding outcomes.

Is the clinic providing ethical care to its patients?

The practice of speech therapy is closely regulated throughout the United States.Each state, through legislation, establishes minimal licensure and practicestandards. This is done to protect the general public against fraud andsubstandard care by under-qualified practitioners. It is each professional’sresponsibility to adhere to the standards of care and licensure requirementsspecific to the state in which they practice. The licensee must also ensure that allcare provided not directly by them, but under their supervision, also meets thesestandards.

In this situation, the assistant’s abilities and outcomes are considered irrelevant.The key sentence in the paragraph is: “perform treatments that should be doneby an SLP ”. The “should” in this case must not be interpreted as merely acasual suggestion but rather a legal definition regulated by the state’s PracticeAct. Any treatment or procedure that should be performed by a licensedprofessional, must be performed only by a qualified licensed professional.(ASHA Code of Ethics: I-5, II-1, II-2, II-4)

Case Study #3 – Informed Consent

Sam is a SLP who works in a rehabilitation hospital. He has just received areferral to begin speech therapy with a 45-year-old woman who has had radicalmandible reconstruction following cancer resection. He goes to her hospitalroom to evaluate her and begin therapy. She indicates to him that she does notwant therapy today because she is in too much pain. Sam explains to her thatthe doctor has left orders for her to begin speech therapy. The patient refuses.Sam leaves and returns the next day to try again. Again, she declines treatmentand he leaves.






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Under the guidelines of informed consent, were Sam’s actions adequate?

Informed consent is the process by which a fully informed patient can participatein choices about their health care. It originates from the legal and ethical right thepatient has to direct what happens to their body and from the ethical duty of the

therapist to involve the patient in her health care.

The most important goal of informed consent is that the patient has anopportunity to be an informed participant in their health care decisions. It isgenerally accepted that complete informed consent includes a discussion of thefollowing elements:

• the nature of the decision/procedure• reasonable alternatives to the proposed intervention• the relevant risks, benefits, and uncertainties related to each

alternative

• the consequences on non-treatment• the goals of treatment• the prognosis for achieving the goals• assessment of patient understanding• the acceptance of the intervention by the patient

In order for the patient’s consent to be valid, they must be considered competentto make the decision at hand and their consent must be voluntary. It is easy forcoercive situations to arise in medicine. Patients often feel powerless andvulnerable. Health care professionals should make clear to the patient that theyare participating in a decision, not merely signing a form. With this

understanding, the informed consent process should be seen as an invitation forthem to participate in their health care decisions. The provider is also generallyobligated to provide a recommendation and share their reasoning process withthe patient. Comprehension on the part of the patient is equally as important asthe information provided. Consequently, the discussion should be carried on inlayperson’s terms and the patient’s understanding should be assessed along theway.

Sam’s actions in this case were not sufficient. None of the required informationwas offered to the patient. The most important thing he failed to explain to thepatient was the consequences of non-treatment. The patient cannot make an

informed decision regarding therapy without this information. It could be arguedthat her decision to refuse therapy may have changed had she known that one ofthe consequences of this decision could be the development of secondarycomplications. (i.e. increased risk of morbidity or mortality).(ASHA Code of Ethics: I-8)






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Case Study #4- Medical Necessity

Steve is a speech-language pathologist who owns his own practice. He recentlysigned a contract with an HMO to provide speech therapy services. The contractstipulates that Steve will be compensated on a case rate basis. (A fixed amount

of money per patient, based on diagnosis) Steve has performed a thorough costanalysis on this contract and has determined that the financial “breakeven” point(revenue equals expenses) on each of these patients is 5 visits. He informs hisstaff that all patients covered by this insurance must be discharged by their fourthvisit.

Is limiting care in this manner ethical?

Health care professionals are obligated to propose and provide care that isbased on sound medical rationale, patient medical necessity, and treatmentefficacy and efficiency. It is unethical to either alter or withhold care based on

other extraneous factors without the patient’s knowledge and consent.

In this instance, the decision to limit care is not ethical. The quantity of care isnot being determined by the medical necessity of the patient. A therapist mustbe able to justify all of their professional decisions (such as the discharging of apatient from clinical care) based on sound clinical rationale and practices.(ASHA Code of Ethics: I-8, I-18)

Case Study #5 – Conflicts of Interest

Debi Jones, Au.D., CCC-A is employed at an audiology clinic. She is meetingwith a vendor whose company is introducing a new hearing aid onto the market.He offers her 3 free samples to “try out” on patients. The vendor states that ifDebi continues to order more of these specific hearing aids, she will qualify toreceive compensation from his company by automatically becoming a member ofits National Clinical Assessment Panel.

Does this represent a conflict of interest?

Yes, there exists a conflict of interest in this situation. Debi has two primaryobligations to fulfill. The first is to her patient. It is her professional duty torecommend devices to her patient that, in her judgment, will benefit them themost. The second obligation is to her employer, the clinic. As an employee ofthe clinic, it is her responsibility to manage expenses by thoroughly andobjectively seeking effective products that also demonstrate economic efficiency.The conflict of interest occurs when she begins to accept compensation from thevendor in direct or indirect response for her orders. Even if she truly believes it isthe best device for her patient, and it is the most cost effective device the clinic






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could purchase, by accepting the money she has established at least anapparent conflict of interest. Under this situation she is obligated to disclose toall parties her financial interest in ordering the appliance. This disclosure isnecessitated because the potential for personal gain would make others rightfullyquestion whether her objectivity was being influenced.

A conflict of interest is a situation in which a person has a private or personalinterest that influences the objective exercise of his or her professional duties. Asa professional you take on certain responsibilities and obligations to patients,employers, and others. These obligations must take precedence over atherapist’s private or personal interests.

In addition to avoiding all real instances of conflict of interest, professionals mustalso avoid any apparent or potential conflicts as well. An apparent conflict ofinterest is one in which a reasonable person would think that the professional’s

judgment is likely to be compromised, and a potential conflict of interest involves

a situation that may develop into an actual conflict of interest.

How do you determine if you are in a conflict of interest, whether actual,apparent, or potential? The key is to determine whether the situation you are ininterferes or is likely to interfere with your independent judgment. A good test isthe ‘trust test’: Would relevant others (my employer, my patients, professionalcolleagues, or the general public) trust my judgment if they knew I was in thissituation. Trust is at the ethical heart or core of this issue. Conflicts of interestinvolve the abuse, actual or potential, of the trust people have placed inprofessionals. This is why conflicts of interest not only injure particular patientsand employers, but they also damage the whole profession by reducing the trustpeople generally have in audiology professionals.(ASHA Code of Ethics: III-2, III-3, IV-10)

Case Study #6 – Relationships with Referral Sources

Larry Jones, CCC-SLP owns a private practice. Business has been poor. Hedecides to sublease half of his space to a maxillofacial surgeon. Larry’s currentlease is at $20/sq ft. The doctor wants to pay $15/sq ft. They come to acompromise of $17/sq ft. Larry also agrees that if the doctor is his top referralsource after 3 months, he’ll make him the Medical Director of the facility and payhim a salary of $500/month.

Is this an ethical arrangement?

No, this agreement is not ethical. The most notable infraction involves offering todesignate (and compensate) the physician as the Medical Director contingentupon the number of referrals he sends. This is undeniably a direct offer of cash






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for patients. Another area of concern is the rent. At first glance, the rent amountof $17/sq ft seems fair because it was a compromise between the two parties.However, closer scrutiny reveals this to be unethical. The fair market value forrent has been established as $20/sqft. (Larry’s current rental agreement with hislandlord) By discounting the doctor $3/sq ft on his rent, Larry is giving a referral

source something of value.

It is unethical to offer anything of value to physicians or any other referral sourcein direct response for the referral of patients or services. This includes cash,rebates, gifts, discounts, reduced rent, services, equipment, employees, ormarketing. Many mistakenly believe that it is a normal acceptable businesspractice to offer these things to referral sources. It is not. In most states, thepractice is not only unethical, but it is also illegal. Exchanges of valued items orservices between health care professionals and referral sources must never haveany relationship to the referral of patients. Goodwill gifts of nominal value areacceptable provided that no correlation can be made between the magnitude or

frequency of the gift giving and referral patterns. All business agreements andtransactions should always be well documented and most importantly, reflect fairmarket value.(ASHA Code of Ethics: IV-1))






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References

American Speech-Language-Hearing Association. Code of Ethics. 2010 Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2011). Conflicts of professional interest [Issues in Ethics]. Available fromwww.asha.org/policy.

American Speech-Language-Hearing Association. (2010). Client Abandonment [Issues in Ethics]. Available from

www.asha.org/policy.

American Speech-Language-Hearing Association. (2004). Confidentiality [Issues in Ethics]. Available from www.asha.org/policy.

Carpenter, C. Moral distress in physical therapy practice. Physiotherapy Theory & Practice. 26(2):69-78, 2010 Feb.

Delany CM. Edwards I. Jensen GM. Skinner E. Closing the gap between ethics knowledge and practice through active engagement:an applied model of physical therapy ethics. Physical Therapy. 90(7):1068-78, 2010 Jul.

Drummond-Dye R. Matters of Integrity PT in Motion. Alexandria: May 2011. Vol. 3, Iss. 4; p. 37

Edwards I. Braunack-Mayer A. Jones M. Ethical reasoning as a clinical-reasoning strategy in physiotherapy. Physiotherapy. 2005Dec; 91(4): 229-36. (45 ref)

Geddes, Lynne E. BScPT MRE. Salvatori, Penny MHSc(OT). Eva, Kevin W. PhD. Does moral judgement improve in occupational

therapy and physiotherapy students over the course of their pre-licensure training?. Learning in Health & Social Care. 8(2):92-102,2009 June.

Kenny, B., Lincoln,M., Balandin.S. Experienced Speech-Language Pathologists' Responses to Ethical Dilemmas: An Integrated

Approach to Ethical Reasoning; American Journal of Speech - Language Pathology (Online). Rockville: May 1, 2010. Vol. 19, Iss. 2;

p. 121

Kenny, B., Lincoln,M., Balandin.S. A dynamic model of ethical reasoning in speech pathology; Journal of Medical Ethics. London:

Sep 2007. Vol. 33, Iss. 9; p. 508

Kirsch NR. Ethics in action. Improper conduct: case two. PT--Magazine of Physical Therapy. 2007 Jun; 15(6): 34-7

Kirsch NR. Ethics in action. Issues of professional integrity: analysis. PT--Magazine of Physical Therapy. 2006 Jul; 14(7): 38-42.

Kirsch NR.. Matter of Vitals Concern. PT in Motion. Alexandria: Jul 2010. Vol. 2, Iss. 6; p. 44

Kirsch.NR. Unsatisfying Satisfaction. PT in Motion. Alexandria: Sep 2010. Vol. 2, Iss. 8; p. 44

Kuczewski MG. Fiedler I. Ethical issues in physical medicine and rehabilitation: treatment decision making with adult patients.Critical Reviews in Physical and Rehabilitation Medicine. 2005; 17(1): 31-52.

Marietta C. McGuire AL. Currents in contemporary ethics. Journal of Law, Medicine & Ethics. 37(2):369-74, 2009.

Nalette.E. Constrained Physical Therapist Practice: An Ethical Case Analysis of Recommending Discharge Placement From the Acute

Care Setting. Physical Therapy. Washington: Jun 2010. Vol. 90, Iss. 6; p. 939

Nalette E. Physical therapy: ethics and the geriatric patient. Journal of Geriatric Physical Therapy. 2001; 24(3): 3-7.

National Center for Ethics in Health Care. Informed Consent Dos & Don’t for Best Practice. In Focus, Aug 2006

National Center for Ethics in Health Care. "Teach Back": A Tool for Improving Provider-Patient Communication. In Focus, April

2006

National Center for Ethics in Health Care. When Patients Refuse Treatment. In Focus, Dec 2005

National Center for Ethics in Health Care. Gifts to Health Care Professionals from the Pharmaceutical Industry. October 2003

National Center for Ethics in Health Care. Ethical Boundaries in the Patient-Clinician Relationship. July 2003

Swisher LL. Moral reasoning among physical therapists: results of the Defining Issues Test. Physiotherapy Research International.15(2):69-79, 2010 Jun.

Swisher LL, Hiller P. The Revised APTA Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical

Therapist Assistant: Theory, Purpose, Process, and Significance. Physical Therapy. Washington: May 2010. Vol. 90, Iss. 5; p. 803

US Department of Health & Human Services. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and

Security Rules. http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/privacysummary.pdf. Accessed 10/1/2011

Veterans Health Administration. VHA Handbook 1004.01: Informed Consent for Clinical Treatments and Procedures. August 2009






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Post-Test

1. Which statement regarding ethics theories is INCORRECT?

A. Utilitarianism is the theory that right and wrong is determined byconsequence.B. Social Contract Theory proposes that moral code is created by the

people who form societies.C. Ethical Egoism is based on the theory that each person should do

whatever promotes their own best interests.D. Natural Law Theory proposes that ethical behavior is a result of

inherent character traits.

2. Which of the following statements is TRUE?A. All actions that are legal are also morally right.B. All actions that are morally right are also legal.

C. Speech / Audiology ethics vary state by state.D. The ASHA Code of Ethics establishes ethical behavior for all speech

and audiology professionals; including those who are not members ofASHA .

3. Which of the following statements regarding informed consent is FALSE?A. Informed consent must always be specific to the individual patient.B. Blanket consent should be obtained from the patient if the care plan

includes multiple treatments.C. Notification informs patients of their rights and how care is delivered.D. Patients have a right to refuse treatment; even those that could save

their life.

4. Speech and audiology professionals can communicate more effectively withtheir patients by __________________________.

A. asking primarily closed-end questions to elicit informationB. reflecting patient’s comments back to themC. practicing passive listening techniquesD. utilizing the teach forward method

5. A circumstance in which a personal interest displaces the professional’sprimary commitment to the patient’s welfare is known as ________.

A. fiduciary displacement

B. blind egoismC. a double bind situationD. boundary neglect






6. Gifts from companies to health care professionals are acceptable only when ___________.

A. the primary purpose is the enhancement of patient care and medicalknowledge

B. each professional in the field receives the same gift without regard toprevious product usage

C. the company is introducing a new product or service to the market.D. permission is received from the professional’s employer

7. Information relating to _____ is individually identifiable health information thatis covered under the Privacy Rule of HIPAA

A. an individual’s past, present or future physical or mental health orcondition

B. the provision of health care to the individualC. the past, present, or future payment for the provision of health care to

the individualD. All of the above

8. Which of the following is NOT included in the ASHA Code of Ethics?A. Individuals shall not discriminate in the delivery of professional

services based on gender identity/gender expression.B. Individuals shall provide services or dispense products only when

benefit to the patient can be guaranteed.C. Individuals shall engage in lifelong learning to maintain and enhance

professional competence and performance.D. Individuals shall not provide professional services without exercising

independent professional judgment, regardless of referral source orprescription.

9. A speech-language or audiology professional who has reason to believe thatthe Code of Ethics has been violated by a colleague shall __________.

A. inform the ASHA Board of EthicsB. give the colleague the benefit of the doubt, and continue to monitor the

situation.C. immediately report the colleague to the local policeD. write an anonymous letter to the state licensing board

10. It is unethical for a speech-language professional to ________________.A. have a physician as a medical directorB. sublease office space to a potential referral source

C. waive the insurance co-pay for the spouse of a referring physicianD. meet with a physician to educate them about new speech therapytechniques and interventions

11/7/2011

ethics speech language sdqsdpathology and audiology

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