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Drawing the line

As Speech & Language Therapy in Practice draws to a close, editor Avril Nicoll reflects on some of the ethical dimensions of publishing and promotion.
n page 6 Dot Reeves discusses how being involved in marketing a new product felt alien to her. At the same time she realised that the people who might benefit needed to hear about the product, and it could only be improved if it paid its way. In the event she was reassured to find that this kind of activity doesnt have to mean your professional integrity is going to take a battering. The Health Professions Council Standards of conduct, performance and ethics have been constructed to apply to all registrants whatever their professional role. The way the NHS is shifting suggests we may increasingly seek creative ways to put our speech and language therapy skills to good use and attract funding. The detail of the expectations under standard 14 is therefore worth a closer look (HPC, 2008, p.14): If you are involved in advertising or promoting any product or service, you must make sure that you use your knowledge, skills and experience in an accurate and responsible way. You must not make or support unjustifiable statements relating to particular products. Any potential financial reward should not play a part in the advice or recommendations of products and services you give. Although we are discussing products and promotion, Body & McAllister (2009, p.1) observe that Ethics is basically about people and how they relate to each other. In a social world we depend on connection and reciprocity. The ethical boundaries can be messy or confusing, and often we may not even realise they are needed. Publishing and editing Speech & Language Therapy in Practice has raised my awareness of such dimensions, and some of this might strike a chord with clinicians and managers who are having to negotiate an increasingly commercial space. I am not against advertising, marketing and public relations. Indeed, the magazine could not have survived so long if I hadnt used all these methods to promote and sustain it. The challenge, as always, comes in recognising there is a line and deciding where to draw it. In the same way as conference organisers seek sponsorship to mitigate their costs, any additional income from advertising potentially helps keeps down the price of a subscription magazine to the customer. Disclaimers and clear physical separation attempt to distance organisers and publishers from sponsorship and advertising, but I have frequently asked myself where my ethical responsibility as a magazine publisher ends. Is it possible to avoid the consequence of the reader forming an association between the magazine and the product? Should we even care?

BOUNDARY ISSUES EXPLAINED The Health Professions Council Standards of conduct, performance and ethics (2008) require us to behave with honesty and integrity at all times (p.14). We are reminded that poor conduct outside of your professional life may still affect someones confidence in you and your profession (p.9). Arguably, our clinical conversations and research literature do not focus sufficiently on moral principles, but they at least touch on the ethics around issues such as prioritisation and evidence-based practice. In this series we think through everyday events which receive much less attention but also need to be on our ethical radar. To do the best for their clients in line with the bioethical principle of beneficence (Beauchamp & Childress, 2001), therapists need access to tools for continuing professional development. I have happily accepted adverts for communication aids, advanced courses, assessments and therapy programmes. After some soul searching I decided to include adverts from recruitment agencies, on the grounds that individual therapists have the autonomy to decide who they will work for. I declined to deal with a company that I boycott in my personal life as this would produce conflict in what is known in virtue ethics as narrative unity (Hodkinson, 2008). But was I right to use my position as a gatekeeper in this way, especially if the products might benefit clients? In any publication there is huge reliance on trust that articles are original and fair representations, that due acknowledgement is given to contributing parties, that claims and references are accurate and that any service user referred to has been properly consulted and involved for their opinion and informed consent. You dont have to be familiar with philosophical theories and ethical principles to recognise this ultimately comes down to common sense and respect for yourself and others. However, when an author writes about a product in which they have a vested interest, or even one they believe in and wish to promote, it is important to be extra vigilant in balancing the ethical risks and benefits (Long & Johnson, 2007). I ensure the author gives away information that is potentially useful to readers whether or not they buy the product. I also make explicit any links between the author and the product, or the product stakeholders and the references. But are such measures enough?

It is standard practice for publishers to send complimentary books and products for review in publications, as the authoritative recommendation of a peer has more impact on sales than a marketers blurb. There is always a risk that the review will be negative, but on balance it is worth taking the chance. It is important that reviewers are independent of the publisher and author and, if in doubt, that they declare any connection. I usually decide which conferences I want to go to and pay my own fee but occasionally I am offered a press pass with the expectation that I will subsequently write about it. Writing and disseminating a conference article can take 20-30 hours, so is this a fair exchange or a potential conflict of interest? To be on the safe side, I have started adding information about the source of funding so readers can interpret what they are reading with that in mind. On one occasion I didnt write up a conference, in spite of its topicality and impressive list of speakers. Perhaps I just spend too much time reading Private Eye or am too prejudiced against the medical model, but the event was very heavily subsidised by a drug company and involved high profile exposure of its product. I felt this muddied the waters to the extent that I would have been endorsing the product by reporting on the event. This decision wasnt easy, but how much harder would it have been if I had not paid my own fee? Ultimately, conference speakers, reviewers, recognised experts and journalists should all be aware of their position of power (Carne, 2010) and the responsibility to use it wisely and avoid being used. Body & McAllister (2009, p.10) believe the profession currently needs as much in the way of ethics debate as it can get. I hope the boundary issues series has played a part in helping you discuss and reflect on where you SLTP will draw the line. Avril Nicoll is editor of Speech & Language Therapy in Practice, email
References Beauchamp, T.L. & Childress, J.F. (2001) Principles of Biomedical Ethics. 5th edn. Oxford: Oxford University Press. Body, R. & McAllister, L. (2009) Ethics in Speech and Language Therapy. Chichester: Wiley-Blackwell. Carne, V. (2010) Just a harmless perk of the job...?, MIDIRS Essence. Available at: http://www.midirs. org/development/MIDIRSEssence.nsf/articles/70F4 55A280AB4A8D802576D4004B4A2F (Accessed: 23 November 2011). Hodkinson, K. (2008) How should a nurse approach truth telling? A virtue ethics perspective, Nursing Philosophy 9, pp.248-256. HPC (2008) Standards of conduct, performance and ethics. London: Health Professions Council. Long, T. & Johnson, M. (2007) Research Ethics in the Real World. London: Churchill Livingstone Elsevier.