You are on page 1of 30

Ethics – Speech Language Pathology & Audiology

Ethics – Speech Language Pathology & Audiology
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 on
defining ethical behavior for speech and audiolgy professionals. Information presented includes sections on the
theoretical basis for ethical decision-making, conflict of interest, confidentiality, informed consent, the ASHA Code of
Ethics, 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 audiology
professionals.
Learner Outcomes
At 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-making
3. define the parameters of informed consent
4. identify components of effective provider-patient communication
5. differentiate between appropriate and inappropriate relationships
6. define conflict of interest and identify situations that demonstrate it
7. identify the principles of confidentiality as defined under HIPAA guidelines
8. identify and apply the principles of the ASHA Code of Ethics
9. 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 Innovative
Educational 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 Innovative
Educational 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).

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

-1-

Ethics – Speech Language Pathology & Audiology
Ethics – Speech Language Pathology & Audiology
Outline
page

Course Information
Course Outline
Ethics
Why Ethics are Important
Ethics vs Morals
Ethical Questions
Ethics Theories
Utilitarianism
Social Contract Theory
Deontological/Duty Theory
Ethical Intuitionism
Ethical Egoism
Natural Law Theory
Virtue Ethics
How to Make Right Decisions
Informed Consent
Consent for Multiple Treatments
Blanket Consent
Notification vs. Consent
Refusing Treatment
Resisting Treatment
Provider – Patient Communication
Relationships
Professionalism
Boundaries
Legal Aspects
Other Problematic Relationships
Recommendations
Gifts & Conflict of Interest
Confidentiality
ASHA Code of Ethics
Preamble
Ethics I
Ethics II
Ethics III
Ethics IV
Ethics Case Studies
#1 – Confidentiality
#2 – Qualification of Practice
#3 – Informed Consent
#4 – Medical Necessity
#5 – Conflict of Interest
#6 – Relationships with Referral Sources
References
Post-Test

1
2
3
3
3
3
4-6
4
4
4
4
4
4
5
5-7
7-10
7
7-8
8
8-9
9-10
10-11
11-14
11-12
12
12-13
13
13-14
14-16
16-17
17-22
17
17-19
19-20
20
21-22
22-27
22-23
23
23-24
25
25-26
26-27
28
29-30

start hour 1

end hour 1
start hour 2

end hour 2

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

-2-

Ethics – Speech Language Pathology & Audiology
Ethics Overview
The word “ethics” is derived from the Greek word ethos (character), and from the
Latin word mores (customs). Together, they combine to define how individuals
choose 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 people
owe themselves and one another. Ethics is also a field of human inquiry that
examines the bases of human goals and the foundations of “right” and “wrong”
human actions that further or hinder these goals.
Why Ethics are Important
Ethics are important on several levels.
• People feel better about themselves and their profession when they work
in an ethical manner.
• Professions recognize that their credibility rests not only on technical
competence, but also on public trust.
• At the organizational level, ethics is good business. Several studies have
shown that, over the long run, ethical businesses perform better than
unethical businesses.
Ethics vs. Morals
Although the terms “ethics” and “morals” are often used interchangeably, they
are not identical. Morals usually refer to practices; ethics refers to the rationale
that may or may not support such practices. Morals refer to actions, ethics to the
reasoning behind such actions. Ethics is an examined and carefully considered
structure that includes both practice and theory. Morals include ethically
examined practices, but may also include practices that have not been ethically
analyzed, such as social customs, emotional responses to breaches of socially
accepted practices and social prejudices. Ethics is usually at a higher intellectual
level, more universal, and more dispassionate than morals. Some philosophers,
however, use the term “morals” to describe a publicly agreed-upon set of rules
for responding to ethical problems.
Ethical Questions
Ethical questions involve 1) responsibilities to the welfare of others or to the
human 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”.

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

-3-

COM -4- . The morally important thing is not consequences but the way choosers think while they make choices. One famous philosopher who developed such a theory was Immanuel Kant. Social contract theories believe that the moral code is created by the people who form societies. Ethical Egoism This view is based on the theory that each person should do whatever promotes their own best interests. go to: WWW. Here are some of the more commonly accepted theories that have been proposed. i. Social Contract Theory Social contract theory is attributed to Thomas Hobbes. Anyone with a normal conscience will know that it is wrong to kill an innocent person. The basic tool of measurement is pleasure (Bentham) or happiness (Mill). Utilitarianism This philosophical theory develops from the work of Jeremy Bentham and John Stewart Mill. Ethical Intuitionism Under this view an act or rule is determined to be right or wrong by appeal to the common intuition of a person. utilitarianism is the theory that right and wrong is determined by the consequences.e. John Locke. These people come together to create society for the purpose of protection and gaining other benefits of social cooperation. Simply put. In the case of human beings. These persons agree to regulate and restrict their conduct to achieve this end. This nature determines what is good or bad for that thing.CHEAPCEUS. This intuition is sometimes referred to as your conscience. John Rawls. who advocated that each thing has its own inherent nature. the moral laws of nature stem from INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. Natural Law Theory This is a moral theory which claims that just as there are physical laws of nature. mankind has attempted to determine the philosophical basis from which to define right and wrong. and from the twentieth century. This theory is largely associated with Thomas Aquinas. A morally correct rule is one that provides the greatest good to the greatest number of people. characteristic ways of behavior that belong to all members of its species and are appropriate to it. this becomes the basis for moral choices. there are moral laws of nature that are discoverable. Deontological or Duty Theory Under this theory you determine if an act or rule is morally right or wrong if it meets a moral standard.Ethics – Speech Language Pathology & Audiology Ethics Theories Throughout history.

distributing the risks and benefits equally. Understanding/Tolerance: the duty to understand and to accept other viewpoints if reason dictates. Autonomy: the duty to maximize the individual’s right to make his or her own decisions. a legitimate argument can be made that sometimes what is legal is not always moral. A person will do what is morally right because they are a virtuous person. go to: WWW. place. Respect for persons: the duty to honor others. Aristotle was a famous exponent of this view. or people involved.COM -5- . How to Make Right Decisions The foundation for making proper ethical decisions is rooted in an individual’s ability to answer several fundamental questions concerning their actions. Finality: the duty to take action that may override the demands of law. and therefore acting immorally. Universality: the duty to take actions that hold for everyone.Ethics – Speech Language Pathology & Audiology our unique capacity for reason. These are some of the commonly accepted virtues. Aristotle felt that virtue ethics was the way to attain true happiness. Veracity: the duty to tell the truth. This code of conduct usually defines clearly which actions are considered acceptable and which actions are unacceptable. Beneficence: the duty to do good. The laws of a geopolitical region are a written code of that region’s accepted rules of conduct. and social customs. Virtue Ethics This ethics theory proposes that ethical behavior is a result of developed or inherent character traits or virtues. we are violating our nature. and their responsibilities. Are my actions legal? Weighing the legality of one’s actions is a prudent way to begin the decision-making process. and that sometimes INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. Confidentiality: the duty to respect privacy of information. their rights. religion. When we act against our own reason. However.CHEAPCEUS. Nonmaleficence: the duty to cause no harm. regardless of time. 1. Justice: the duty to treat all fairly.

these ethical standards are documented in the ASHA Code of Ethics. Most often it is the incorrect assumption that “no one will ever find out about this” that leads people to commit acts of impropriety. SLP assistants. most people do not know all of the specific laws that govern their lives. The goal of every decision should be an outcome of relative equity that reflects insightful thought and soundness of intent. Are his actions legal? Are they moral? What if by stepping into the street he causes a car to swerve and to strike another vehicle? Admittedly. and audiology assistants. audiologists. 3. Are my actions fair? I think most people would agree that the concept of fairness is often highly subjective.Ethics – Speech Language Pathology & Audiology what is moral is not always legal. ethical. 2. He immediately crosses the street outside of the crosswalk to attend to the injured person. How would your decisions change. It is illegal for a pedestrian to cross a busy street anywhere other than at the designated crosswalk (jaywalking). if prior to taking any actions. All SLPs. However. are bound to these guidelines. This is because the ASHA Code of Ethics is the accepted and de facto standard of practice throughout the profession. with the exception of law enforcement officers and attorneys. This idea is easily demonstrated by the following situation.COM -6- . For speech and audiology professionals. and that they will live their lives in accordance with these virtues. it is assumed that most people are familiar with the fundamental virtues from which these laws are based.CHEAPCEUS. we will define fairness as meaning deserved. Decisions that result in capricious harm or arbitrary benefit cannot be considered fair. for these purposes. Are my actions ethical? Professional ethical behavior as it is defined in this context relates to actions that are consistent with the normative standards established or practiced by others in the same profession. you INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. A man is walking down a street and sees someone fall and injure themselves on the other side of the street. go to: WWW. However. equitable and unbiased. Fairness requires the decision-maker to have a complete understanding of benefits and liabilities to all parties affected by the decision. Would my actions be the same if they were transparent to others? This question presents as a true reflection of the other three. even those who are not members of ASHA. 4. and fair are defined quite differently by most people when judged in the comfort of anonymity versus when it is examined before the forum of public opinion. Legal.

including the risks and benefits of each. it is not the same as saying that separate consent is always required for every episode of repeated treatment. grounded in the principles of autonomy and respect for persons. In turn.Ethics – Speech Language Pathology & Audiology assumed just the opposite.COM -7- . are an essential component of ethics quality in health care. and the recommended plan of care or recommended treatment(s) or procedure(s). providing the information that a “reasonable person” in similar circumstances would want to know in making the treatment decision. Asking a patient to agree at the outset of care to “any treatment your doctors think is necessary. thus. Informed consent must always be specific: to the individual patient. And that means more than getting a patient’s signature on a consent form. Blanket Consent Informed consent for a planned course of multiple repeated treatments based on a specific diagnosis is very different from practices sometimes referred to as “routine” or “blanket” consent. health care professionals have an ethical obligation to involve patients in a process of shared decision making and to seek patients’ informed consent for treatments and procedures. go to: WWW. Consent for Multiple Treatments Although consent is always specific. a course of diagnostic tests or ongoing therapy—practitioners do not need to obtain consent for each individual episode. When the plan of care for a given diagnosis involves repeated treatments or procedures— for example. Good informed consent practices.” or “routine procedures as needed. Informed Consent Patients have a fundamental right to direct what happens to their bodies. One sure sign of a poor decision is debating the possible exposure of an action instead of examining the appropriateness of it. the clinical situation. “other people will definitely know what I have done”. INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. To achieve that goal practitioners must inform the patient (or authorized surrogate) about treatment options and alternatives. A key element of the process is that the practitioner must explain why he or she believes recommended treatments or procedures will be more beneficial than alternatives in the context of the patient’s diagnosis. 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.” is ethically problematic in several ways.CHEAPCEUS.

the practitioner must explain to the patient (or authorized surrogate) how the situation has changed. or other common critical care interventions. Refusing Treatment The right to refuse unwanted treatment.” that is. even potentially life-saving treatment.COM -8- . is central to health care ethics. and welfare. notification serves the goal of respecting patients as moral agents. interests. A capacity assessment is appropriate if the practitioner has reason to believe the patient might lack one or more of the components of decision-making capacity. Notification versus Consent Informed consent is also different from “notification. Practitioners should take care not to assume that a patient who refuses recommended treatment lacks decision-making capacity. Notification informs patients not only about their rights. performance of thoracentesis.” informed consent involves the contemporaneous bodily integrity. intelligence. go to: WWW. When decision-making capacity is not in question. providing general information relevant to patients’ participation in health care. recommend a new plan of care. For example. Health care professionals are understandably concerned when patients refuse recommended treatments.” Such individual 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 time consent is obtained. However.CHEAPCEUS. rights. practitioners must respect the patient’s decision to decline an intervention. As a “patientcentered action. asking a patient entering the ICU to consent to the use of a ventilator. even if they believe the decision is not the best one that could have been made. seeking consent “in case” a patient should need some future intervention that is not related to that patient’s current clinical status violates the fundamental ethical norm that patients must make decisions about proposed treatments or procedures in the context of their present situation. How should practitioners respond when a patient declines an intervention that practitioners believe is appropriate and needed? The answer to that question depends on both the patient’s decision-making capacity and the particular circumstances of the treatment decision. and obtain informed consent for the new plan or for specific treatment(s) or procedure(s) now recommended. Like informed consent. dignity.Ethics – Speech Language Pathology & Audiology Such practices fail to meet the requirement that consent be specific. this does not mean that health care professionals should never question the patient’s decision. establish goals of care in light of the new situation. If a patient’s condition changes enough to warrant a change in the plan of care. goals. but also about organizational activities and processes that shape how care is delivered. or never try to INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. preferences. Moreover. “if needed. This is the case even when common procedures are identified.

practitioners should clarify the patient’s (and/or surrogate’s) understanding of the clinical situation and elicit his or her expectations about the course of illness and care. In such cases. However. a patient may resist treatment via one route of administration but not another. go to: WWW. When a surrogate consents to treatment on behalf of a patient who lacks decision-making capacity. and work with the patient or surrogate to prioritize identified goals as the foundation for a plan of care. respectful engagement with the patient or surrogate. For example. The aim should be to negotiate a plan of care that promotes agreed on goals of care. The professional ethical ideal of shared decision making calls for active.COM -9- . Is the tube causing physical discomfort? Is the patient distressed because he or she does not understand what is happening? Resistance to treatment should prompt practitioners to reflect on whether the treatment is truly necessary in light of the established goals of care for the patient. Practitioners should ask themselves why. practitioners are authorized to carry out the treatment or procedure even if the patient actively resists. “What leads you to this conclusion?” can then help the practitioner to understand the reasons for the patient’s decision to decline recommended treatment. practitioners should still be sensitive to patients who resist treatment. It can also help to identify concerns or fears the patient may have about the specific treatment that practitioners can address. Resisting Treatment Health care professionals face different concerns when patients who lack decision-making capacity resist treatment for which their authorized surrogates have given consent. Rather. Decision-making capacity is not an “all or nothing” proposition. decisionINNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. Asking in a nonjudgmental way. As a prelude to exploring a patient’s refusal of recommended treatment. for example. resistance to treatment may be an expression of the patient’s authentic wishes. Practitioners should also be alert to the implications of the patient’s resistance for the judgment that he or she lacks decision-making capacity. address expectations for care that may be unrealistic.CHEAPCEUS. by exploring the reasons for refusal with the patient. or whether it could be modified to minimize the discomfort or distress it causes. Practitioners should clarify the goals of care with the patient or surrogate.Ethics – Speech Language Pathology & Audiology persuade the patient to accept treatment. a practitioner might learn that the patient simply needs more information before deciding to proceed. In some cases. For instance. They should try to understand the patient’s actions and their implications for treatment. a patient repeatedly tries to pull out a feeding tube. treatment is not being administered over the patient’s refusal because the surrogate has taken the patient’s place in the process of shared decision making and exercised the patient’s decision-making rights.

reflecting patients’ comments back to them (“I hear you saying your new medication makes you sleepy”). Many practitioners are not well trained in basic communication skills. Moreover. go to: WWW. A patient may have capacity to make a simple decision but not a more complex one.10 - . Many patients aren’t comfortable disclosing that they don’t understand what practitioners are saying—asking point blank. and goals for care. which can vary considerably with the decision to be made. preferences. Communicating effectively is an important aspect of showing respect to patients. For patients with fluctuating capacity. When a patient resists. family members. “Do you understand?” puts them on the spot. And a nod in response doesn’t guarantee they’ve actually heard and understood what’s been said. surrogates. To meet that obligation. INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. deliberate about and manipulate information. practitioners tend to underestimate patients’ needs for information. such as asking open-ended questions to elicit information (“What brings you to the clinic this morning?”). The root cause of the resistance should be explored. Provider-Patient Communication Health care practitioners have an ethical responsibility to work with patients (or their surrogates) to negotiate treatment plans that respect the patient’s values. And it has practical benefits: Effective communication promotes greater satisfaction and helps ensure better adherence to treatment plans. with better health outcomes for patients. or using other active listening techniques. evaluate. as well as other clinically acceptable alternatives to the proposed treatment. and communicate a decision. and overestimate their own effectiveness in conveying information. Patients who resist treatment present unique challenges for health care practitioners. And formal training rarely focuses on the communication tasks that must be completed in patient-provider encounters. or friends may be able to shed light on the patient’s actions and help practitioners identify ways to provide treatment that are less upsetting for the patient.Ethics – Speech Language Pathology & Audiology making capacity is task specific. practitioners must ensure that they communicate effectively with patients and surrogates. it may be possible to explore concerns directly with the patient during lucid moments.COM . Good communication also reduces the likelihood of lawsuits even when patients don’t have good outcomes.CHEAPCEUS. Yet poor communication remains a significant problem in health care. It rests on being able to receive.

Ethics – Speech Language Pathology & Audiology To make it easier for patients to understand health information. Relationships Boundaries define the limits of appropriate behavior by a professional toward his or her clients. Practitioners can use this technique to identify patient-specific barriers to communication. And they should use the technique of “teach back. when patients have hearing problems.CHEAPCEUS. and. practitioners must establish conditions for effective communication. for example. Patients should be able to trust that their interests and welfare will be placed above those of the health care INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. There can be other barriers to effective communication as well. low health literacy. That is.11 - . Cognitive impairments. Among other things. Asking patients to recount instructions or to describe a proposed procedure can alert practitioners to individuals’ particular needs and challenges and help clinicians tailor communication more effectively.g. which includes more than just difficulty reading.. a health care professional creates a safe space for the therapeutic relationship to occur.COM . Practitioners should use plain language—e. for example. professionals are expected to make a fiduciary commitment to place their clients’ interests ahead of their own. especially. to help gauge the level of understanding. there is consensus regarding one of the defining characteristics of professions and professionals: commitment to serve the profession’s clients. Professionalism The notion of boundaries in the health care setting is rooted in the concept of a “profession”. By establishing boundaries. Health care professionals need guidance if they are to avoid engaging in interactions with their patients that may prove ethically problematic. In exchange for faithfully applying their unique knowledge and skills on behalf of their clients. members of a profession are granted the freedom to practice and to regulate themselves. “bad” instead of “adverse” reaction. “sore” or ”wound” instead of “lesion”. they should provide a safe environment. though patients are not always able to articulate those expectations clearly. go to: WWW. While this concept is understood in several different ways in the medical and sociological literature.” asking the patient to recount what he or she has been told. Patients who come to health care professionals when they are ill and vulnerable bring with them expectations about this interaction and how clinicians should behave toward them as health care professionals. also contribute. in which patients feel comfortable asking questions. such as early stage dementia. limited proficiency in English (possibly indicating the need for a medical interpreter).

[or] behavior. Relationships and interactions that may be ethically unproblematic among nonprofessionals may be unacceptable when one of the parties is a professional. such as recommending that professionals restrict contact with patients to appropriate times and places for the therapy to be given.. An individual may have a personal interest that is perfectly acceptable in itself. For example. This creates what is known as a “double bind situation”. because doing so might compromise the professional’s fiduciary commitment to the patient’s welfare.12 - . moreover. Professionals.. Violations of these guidelines could result in probation. For example. expectations of a higher morality and a greater commitment to the good of others than in most other human activities. it may not be acceptable for a health care professional to ask a patient for a date. go to: WWW. Boundaries Boundaries define the professional relationship as fundamentally respectful and protective of the patient and as dedicated to the patient’s well-being and best interests. as such. are held to different standards of conduct from other persons. Clinicians are subject to guidelines for professional conduct in health care promulgated by state licensing boards. sexually suggestive. or expressions that are seductive.CHEAPCEUS. Legal Aspects Various legal and regulatory requirements address boundaries in patientprofessional interactions. indeed to demand.Ethics – Speech Language Pathology & Audiology professional. but conflicts with an obligation the same individual has as a health care professional. just as they should be confident they will be treated with respect.COM . Most state professional licensing boards have addressed specific boundary issues. or might reasonably be expected to do so. and suspension or revocation of licensure. That is a circumstance in which a personal interest displaces the professional’s primary commitment to the patient’s welfare in ways that harm—or appear to harm—the patient or the patient-clinician relationship. Clinicians should be aware. Boundary violations generally arise when the interaction between parties blurs their roles vis-à-vis one another.” Some state board guidelines offer specific guidance to help clinicians avoid inappropriate conduct. A boundary violation occurs when a health care professional’s behavior goes beyond appropriate professional limits. “engaging in any conduct with a patient that is sexual or may be reasonably interpreted as sexual . limitation of practice. and be informed so that they can make their own health care decisions to the greatest extent possible. that INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. under circumstances in which it would normally be acceptable for one person to ask another individual for a date. or sexually demeaning to a patient. The nature of professions is such that the human needs the professions address and the human relationships peculiar to them are sufficiently distinct to warrant. gestures.

and in several states sexual exploitation of a patient is considered a felony. or with the public? Could this activity cause others to question my professional objectivity? INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. go to: WWW. professionals should critically examine their own actions by considering the following: • • Is this activity a normal. can impair. and to give rise to conflicting expectations on the patient’s part.COM . expected part of practice for members of my profession? Might engaging in this activity compromise my relationship with this patient. or priority in scheduling appointments. or call the professional’s objectivity into question. Recommendations Health care professionals should beware of interacting with any patient in ways that could reasonably be expected to create awkward situations for either party. compromise the professional’s primary commitment to patient welfare. time.13 - . Ambiguous interactions and relationships. Showing favoritism—by giving a particular patient extra attention. for example—can cross the boundary between action that is appropriate advocacy on behalf of a particular patient and action that is unfair to others. Yet not all behavior that might be considered inappropriate necessarily violates professional obligations. or when they give the appearance of doing so. for example.Ethics – Speech Language Pathology & Audiology inappropriate sexual or physical contact can result in patients suing clinicians for battery and malpractice. While not every business or social interaction or relationship between a health care professional and a patient necessarily violates ethical professional boundaries. Such interactions or activities are ethically problematic when they can reasonably be expected to affect the care received by the individual or by other patients or the practitioner’s relationships with his or her colleagues. or appear to impair. and at other times is problematic. the professional’s objectivity. Health care professionals should be alert to situations in which they may be likely to be motivated to behave in ways that violate accepted ethical standards. Accepting a gift is sometimes an appropriate way to allow a patient to express his or her gratitude.CHEAPCEUS. my employer. for example. have the potential both to impair the professional’s objectivity and compromise his or her judgment. Other Problematic Relationships Many kinds of interaction potentially interfere with the primary clinical relationship between practitioner and patient and pose concerns about acceptable conduct for health care professionals. other patients. colleagues. which can contaminate the therapeutic relationship and potentially undermine the patient’s trust. Becoming socially involved or entering into a business relationship with a patient.

guidelines. gifts to health care professionals can blur the distinction between formal business exchanges and informal. relationship with patients requires that practitioners explain the reasons for treatment decisions and disclose any potential conflicts of interest.CHEAPCEUS. Gifts and Conflict of Interest Because gifts create relationships. Understanding and respecting professional boundaries is part of professional competence. and ethical health care practice. other professionals.COM . or trust-based. go to: WWW. interpersonal exchanges. As well. and Laws pertaining to relationships between patients and health care professionals.14 - . Consult a trusted and objective peer for a second opinion about the activity. It may bias clinicians’ judgments about the relative merits of different treatments. including the influence of gifts. Maintaining those boundaries is an essential part of compassionate.Ethics – Speech Language Pathology & Audiology • Would I want my other patients. it is imperative that health care professionals be familiar with: • • • Relevant professional codes of ethics. the health care professional should: • • • • • Determine if there are applicable standards. Health care professionals’ fiduciary. And it may affect treatment patterns in ways that increase costs and adversely affect access to care. effective. and position statements Applicable policies in their facilities. Transfer the patient to another clinician’s care if the professional relationship has been compromised. or the public to know that I engage in such activities? If the answers to these questions indicate that an activity may violate professional ethical boundaries. or if avoiding the violation will damage the relationship. Communicate his or her concern to the individual involved. health care professionals’ acceptance of gifts from commercial vendors can be ethically problematic in several ways. Seek assistance from a supervisor or ethics committee. Given the ways in which gift giving differs from entering into a contractual relationship. Accepting gifts risks undermining trust. standards of practice. INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit.

pens. Some even claim that accepting gifts results in economic savings for health care institutions.15 - . INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. Practitioners should not accept gifts. hospitality. If accepting gifts is ethically problematic in these ways. ethical standards explicitly require health care professionals to place patient interests above their own.COM . is compelling enough to allow an ethically problematic practice to continue. The acceptance of individual gifts.CHEAPCEUS. go to: WWW. trips. Other rationales are that inducements such as free lunches are needed to induce attendance at educational sessions (and may help offset the costs of such programs). These guidelines do not prohibit all gifts from industry. socially expected reaction motivated by a combination of self-interest and politeness. the objectivity of professional judgment.Ethics – Speech Language Pathology & Audiology Industry gifts to health care professionals create potential conflicts of interest that can affect practitioners’ judgment—without their knowledge and even contrary to their intent—thereby placing professional objectivity at risk and possibly compromising patient care. While habit and self-interest can be powerful motivators. Finally. Failure to enforce ethical standards consistently has made it easier simply not to notice. and that they help boost employee morale. many prominent organizations and associations have established ethical guidelines for health care professionals about accepting gifts from industry representatives. None of these arguments. hospitality. In recent years. Gifts have become a familiar part of many health care workplace cultures and established patterns of behavior often resist change. or appear to others to diminish. or not to be concerned about. Professional guidelines seek to establish thresholds for what kinds of gifts and gift relationships are acceptable. services. But it is also argued that health care professionals have come to expect gifts as part of a “culture of entitlement” that has evolved over many years. and subsidies from industry if acceptance might diminish. apathy on the part of professional bodies allows the “tradition” of accepting gifts to continue. because the industry provides for free items that the institutions would otherwise have to buy. however. but there is general agreement that gifts from companies to health care professionals are acceptable only when the primary purpose is the enhancement of patient care and medical knowledge. why do health care professional continue to take the gifts they are offered? One explanation is that accepting a gift is a natural. and subsidies of all types from industry by an individual is strongly discouraged. the fact that accepting gifts creates ethical risks. gifts to individual practitioners are discouraged unless they are of minimal value and related to the practitioner’s work—such as pads. or calendars for office use. In general.

Ethics – Speech Language Pathology & Audiology The social dynamics of the gift relationship. specifically the Privacy Rule.. Sometimes maintaining patient privacy is a way of keeping the patient safe. coordinated efforts on the part of clinical and administrative leaders. • the provision of health care to the individual. or • the past.CHEAPCEUS. name. the potential for gifts subtly to bias health care professionals’ prescribing practices and clinical decisions. go to: WWW. and the obligation of health care professionals to avoid acting in ways that might undermine public trust all argue for the adoption of clear. disclosure. and request only the minimum amount of protected health information needed to accomplish the intended purpose of the use. Creating a workplace in which professionals no longer routinely expect or accept gifts from industry is a challenging task that calls for professional role modeling and sustained. birth date. or future payment for the provision of health care to the individual. address. Health care providers convey that respect in a few ways with regard to privacy. present or future physical or mental health or condition. robust policies regarding the acceptance of gifts from companies. well-considered policy.COM . The obligation to ensure patient privacy is also justified by the obligation of harm prevention. Confidentiality The obligation to ensure patient privacy is rooted in the ethical principle of respect for persons.g. for example. or oral.16 - . paper. “Individually identifiable health information” is information. present. and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. Confidentiality is mandated by HIPAA laws. Social Security Number). They must also develop and implement policies and procedures to reasonably limit uses and disclosures INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. They respect patient’s informational privacy by limiting access to patient information to those authorized health care providers who need it to perform their duties. as well as development and careful implementation of clear. The Privacy Rule protects all individually identifiable health information held or transmitted by a covered entity or its business associate. disclose. in any form or media. Health care providers must make reasonable efforts to use. or request. by minimizing the risk of identity theft. that relates to: • the individual’s past. whether electronic. including demographic data. Individually identifiable health information includes many common identifiers (e.

The fundamentals of ethical conduct are described by Principles of Ethics and by Rules of Ethics as they relate to the responsibility to persons served. (c) an applicant for membership or certification. audiologists. INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. aspirational and inspirational in nature.17 - .COM .CHEAPCEUS. and they shall treat animals involved in research in a humane manner. language. disclose. language. a covered entity may not use. ASHA Code of Ethics Preamble The preservation of the highest standards of integrity and ethical principles is vital to the responsible discharge of obligations by speech-language pathologists. Individuals shall observe these principles as affirmative obligations under all conditions of professional activity. When the minimum necessary standard applies to a use or disclosure. (b) a nonmember holding the Certificate of Clinical Competence from the Association. and speech. Rules of Ethics are specific statements of minimally acceptable professional conduct or of prohibitions and are applicable to all individuals. Any violation of the spirit and purpose of this Code shall be considered unethical. or request the entire medical record for a particular purpose. This Code of Ethics sets forth the fundamental principles and rules considered essential to this purpose. audiologists. the public. go to: WWW. and hearing scientists. and speech. form the underlying moral basis for the Code of Ethics.Ethics – Speech Language Pathology & Audiology to the minimum necessary. and to the conduct of research and scholarly activities. or (d) a Clinical Fellow seeking to fulfill standards for certification shall abide by this Code of Ethics. Every individual who is (a) a member of the American Speech-Language-Hearing Association. speech-language pathologists. whether certified or not. unless it can specifically justify the whole record as the amount reasonably needed for the purpose. Failure to specify any particular responsibility or practice in this Code of Ethics shall not be construed as denial of the existence of such responsibilities or practices. Principles of Ethics. Principle of Ethics 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. and hearing scientists.

and they shall provide services or dispense products only when benefit can reasonably be expected. and they shall inform participants in research about the possible effects of their participation in research conducted. 10. gender. they may make a reasonable statement of prognosis. support personnel.18 - . Clinical Fellows. Individuals shall not discriminate in the delivery of professional services or the conduct of research and scholarly activities on the basis of race or ethnicity. 3. to ensure that high-quality service is provided.CHEAPCEUS. 11. however. Individuals shall provide all services competently. 7. religion. Individuals shall use every resource. 6. and judgment that are within the scope of practice of their profession to students only if those services are appropriately supervised. or any other persons only if those services are appropriately supervised. Individuals shall evaluate the effectiveness of services rendered and of products dispensed.Ethics – Speech Language Pathology & Audiology Rules of Ethics I 1. national origin. 4. technicians. Individuals who hold the Certificate of Clinical Competence may delegate tasks related to provision of clinical services that require the unique skills. go to: WWW. sexual orientation. INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. Individuals shall not provide clinical services solely by correspondence. and judgment that are within the scope of their profession to assistants. directly or by implication. technicians. technicians. or any nonprofessionals over whom they have supervisory responsibility. realizing that the responsibility for client welfare remains with the certified individual. Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed. and they shall inform those they serve professionally of the name and professional credentials of persons providing services. 8. or disability. support personnel. 5. Individuals who hold the Certificate of Clinical Competence may delegate tasks related to provision of clinical services to assistants. age. 9. knowledge. or any others under their supervision. Individuals shall not misrepresent the credentials of assistants. 2.COM . gender identity/gender expression. Individuals shall not guarantee the results of any treatment or procedure. students. The responsibility for client welfare remains with the certified individual. Individuals who hold the Certificate of Clinical Competence shall not delegate tasks that require the unique skills. including referral when appropriate. knowledge. support personnel.

Individuals shall not reveal.CHEAPCEUS. 18. Individuals shall engage in lifelong learning to maintain and enhance professional competence and performance. 13. Individuals shall not discontinue service to those they are serving without providing reasonable notice. without coercion.COM . withdraw from the affected areas of practice. any professional or personal information about identified persons served professionally or identified participants involved in research and scholarly activities unless doing so is necessary to protect the welfare of the person or of the community or is otherwise required by law. considering their level of education. without authorization. where appropriate. where not prohibited by law. training. Individuals shall enroll and include persons as participants in research or teaching demonstrations only if their participation is voluntary. or research and scholarly activities conducted. nor shall they misrepresent services rendered. 2. Principle of Ethics II Individuals shall honor their responsibility to achieve and maintain the highest level of professional competence and performance. Rules of Ethics II 1. and they shall allow access to these records only when authorized or when required by law. Individuals shall engage in only those aspects of the professions that are within the scope of their professional practice and competence. products dispensed. 16. research and scholarly activities conducted. Individuals shall engage in the provision of clinical services only when they hold the appropriate Certificate of Clinical Competence or when they are in the certification process and are supervised by an individual who holds the appropriate Certificate of Clinical Competence. 17. Individuals whose professional services are adversely affected by substance abuse or other health-related conditions shall seek professional assistance and. Individuals may practice by telecommunication (e. 15.. and with their informed consent.19 - . INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. Individuals shall adequately maintain and appropriately secure records of professional services rendered. 3. and products dispensed.g.Ethics – Speech Language Pathology & Audiology 12. 14. telehealth/e-health). go to: WWW. and experience. Individuals shall not charge for services not rendered.

level of education. about products for sale. Rules of Ethics III 1. or grants for services rendered.20 - . by supporting the development of services designed to fulfill the unmet needs of the public. go to: WWW. 4. marketing. about professional services. 5. training. and marketing their professional services. training. or the effects of products dispensed. research conducted. including the dissemination of research findings and scholarly activities. Individuals' statements to the public when advertising. announcing. services rendered. financial or otherwise. competence. and the promotion. experience. Individuals shall not misrepresent research. reimbursement. about the professions.COM . Individuals shall not defraud or engage in any scheme to defraud in connection with obtaining payment. products dispensed. 7. 5. diagnostic information. results of services rendered. or products dispensed. and promoting products shall adhere to professional standards and shall not contain misrepresentations. and advertising of products and services. 2. 3. Individuals shall not participate in professional activities that constitute a conflict of interest. education. and about research and scholarly activities. Individuals shall not require or permit their professional staff to provide services or conduct research activities that exceed the staff member's competence. Individuals' statements to the public shall provide accurate information about the nature and management of communication disorders. and by providing accurate information in all communications involving any aspect of the professions. INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. Principle of Ethics III Individuals shall honor their responsibility to the public by promoting public understanding of the professions.Ethics – Speech Language Pathology & Audiology 4. 6.CHEAPCEUS. reporting research results. Individuals shall not misrepresent their credentials. Individuals shall ensure that all equipment used to provide services or to conduct research and scholarly activities is in proper working order and is properly calibrated. and experience. Individuals shall refer those served professionally solely on the basis of the interest of those being referred and not on any personal interest. or scholarly or research contributions.

INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. 3. 9. Individuals shall uphold the dignity and autonomy of the professions. 10. 5. Individuals shall not engage in sexual activities with clients. and members of other professions and disciplines on the basis of race or ethnicity. 2. Individuals shall prohibit anyone under their supervision from engaging in any practice that violates the Code of Ethics. and accept the professions' self-imposed standards.COM . maintain harmonious interprofessional and intraprofessional relationships. presentations. or product. sexual orientation. students. regardless of referral source or prescription. presentation.CHEAPCEUS. research results. Individuals shall not engage in dishonesty. national origin. or products in written. age. gender. go to: WWW. oral. fraud. students. gender identity/gender expression. 7. or any other media presentation or summary. Individuals shall not provide professional services without exercising independent professional judgment. or disability. Individuals shall not engage in any other form of conduct that adversely reflects on the professions or on the individual's fitness to serve persons professionally. and members of other professions and disciplines. or misrepresentation. including sexual harassment or power abuse. Individuals' statements to colleagues about professional services. research. or research participants over whom they exercise professional authority or power. and products shall adhere to prevailing professional standards and shall contain no misrepresentations. 6. religion. students. Individuals shall reference the source when using other persons' ideas.21 - . Individuals shall not discriminate in their relationships with colleagues. Rules of Ethics IV 1. Individuals shall not engage in any form of unlawful harassment. 11. 4. deceit. 8. Credit shall be assigned in proportion to the contribution and only with the contributor's consent.Ethics – Speech Language Pathology & Audiology Principle of Ethics IV Individuals shall honor their responsibilities to the professions and their relationships with colleagues. Individuals shall assign credit only to those who have contributed to a publication.

CCC. John would need to know the patient’s name and diagnosis in order to provide care.CHEAPCEUS. nor should the Code of Ethics be used for personal reprisal. “Do you think that she will fully recover and be able to act again?” John replies. Sue Brown (receptionist). All rights reserved. may also need this information to schedule appointments and perform other essential INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit.” 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.Confidentiality John Jones. The right to know any medical information about another is always predicated on a sound demonstration of need.Ethics – Speech Language Pathology & Audiology 12. and Mary Smith (Director of Managed Care Contracting). Frequently. and his second statement reveals private patient medical information. 14. “I’m not sure. © Copyright 2011 American Speech-Language-Hearing Association. Individuals shall comply fully with the policies of the Board of Ethics in its consideration and adjudication of complaints of violations of the Code of Ethics. and it shows that she has a significant left side lesion on her brain. Their right to access this information is limited to only that information which is deemed necessary for them perform their job in a safe. 13. Individuals shall not file or encourage others to file complaints that disregard or ignore facts that would disprove the allegation. Individuals who have reason to believe that the Code of Ethics has been violated shall inform the Board of Ethics. or as a vehicle for retaliation. as the provider of speech therapy services. Ethics Case Studies Case Study #1 .22 - . Sue.. The first questions we must ask are “What information is being disclosed and do the three individuals engaged in the conversation have a need to know this information?” John’s first statement discloses the name of person receiving care. “I can’t believe that I’m actually treating actress Jennifer Morrison. I saw her MRI report.SLP. many individuals require access to information contained in a patient’s medical record. Certainly.COM . effective. go to: WWW. as a means of addressing personal animosity. the receptionist. John says. and responsible manner. are in a private office discussing the fact that they are treating a celebrity following a stroke.” Mary asks.

COM . II-1. It is each professional’s responsibility to adhere to the standards of care and licensure requirements specific to the state in which they practice. INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. The “should” in this case must not be interpreted as merely a casual suggestion but rather a legal definition regulated by the state’s Practice Act. she is called upon to perform treatments that should be done by an SLP. She demonstrates exceptional skills and achieves outstanding outcomes. The licensee must also ensure that all care provided not directly by them. and frequently request her to treat them. Therefore.Ethics – Speech Language Pathology & Audiology clerical tasks. Sam leaves and returns the next day to try again. Mary. (ASHA Code of Ethics: I-5. (ASHA Code of Ethics: I-13. She indicates to him that she does not want therapy today because she is in too much pain. In this situation. most likely has no compelling reason to know either the patient’s identity or any of her medical information. must be performed only by a qualified licensed professional. through legislation. He has just received a referral to begin speech therapy with a 45-year-old woman who has had radical mandible reconstruction following cancer resection. Again. whose job it is to contract with managed care organizations. Frequently.CHEAPCEUS. but under their supervision. This is done to protect the general public against fraud and substandard care by under-qualified practitioners. The patients always give her compliments. Any treatment or procedure that should be performed by a licensed professional. the disclosure to Mary of the patient’s identity and medical information is a breach of patient confidentiality. II-4) Case Study #3 – Informed Consent Sam is a SLP who works in a rehabilitation hospital. she declines treatment and he leaves. I-14) Case Study #2 – Qualifications of Practice Mary is a speech-language pathology assistant who has practiced for more than 20 years. He goes to her hospital room to evaluate her and begin therapy. the assistant’s abilities and outcomes are considered irrelevant. The key sentence in the paragraph is: “perform treatments that should be done by an SLP ”. establishes minimal licensure and practice standards. II-2. go to: WWW. also meets these standards.23 - . Each state. The patient refuses. Sam explains to her that the doctor has left orders for her to begin speech therapy. Is the clinic providing ethical care to its patients? The practice of speech therapy is closely regulated throughout the United States.

benefits. (ASHA Code of Ethics: I-8) INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit.CHEAPCEUS. increased risk of morbidity or mortality). It is generally accepted that complete informed consent includes a discussion of the following elements: • • • • • • • • the nature of the decision/procedure reasonable alternatives to the proposed intervention the relevant risks.COM . (i. 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. The provider is also generally obligated to provide a recommendation and share their reasoning process with the patient. Sam’s actions in this case were not sufficient. not merely signing a form. Consequently. they must be considered competent to make the decision at hand and their consent must be voluntary. were Sam’s actions adequate? Informed consent is the process by which a fully informed patient can participate in choices about their health care. the discussion should be carried on in layperson’s terms and the patient’s understanding should be assessed along the way. Health care professionals should make clear to the patient that they are participating in a decision. The patient cannot make an informed decision regarding therapy without this information.e.Ethics – Speech Language Pathology & Audiology Under the guidelines of informed consent. None of the required information was offered to the patient. With this understanding. It could be argued that her decision to refuse therapy may have changed had she known that one of the consequences of this decision could be the development of secondary complications.24 - . go to: WWW. The most important thing he failed to explain to the patient was the consequences of non-treatment. The most important goal of informed consent is that the patient has an opportunity to be an informed participant in their health care decisions. Comprehension on the part of the patient is equally as important as the information provided. It is easy for coercive situations to arise in medicine. Patients often feel powerless and vulnerable. It originates from the legal and ethical right the patient 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 informed consent process should be seen as an invitation for them to participate in their health care decisions.

it is her responsibility to manage expenses by thoroughly and objectively seeking effective products that also demonstrate economic efficiency. the clinic. I-18) Case Study #5 – Conflicts of Interest Debi Jones. Au. will benefit them the most. The vendor states that if Debi continues to order more of these specific hearing aids. The contract stipulates that Steve will be compensated on a case rate basis.25 - .Ethics – Speech Language Pathology & Audiology Case Study #4. go to: WWW. Even if she truly believes it is the best device for her patient. Is limiting care in this manner ethical? Health care professionals are obligated to propose and provide care that is based on sound medical rationale. patient medical necessity.CHEAPCEUS. CCC-A is employed at an audiology clinic. Does this represent a conflict of interest? Yes. The first is to her patient. It is her professional duty to recommend devices to her patient that. there exists a conflict of interest in this situation.Medical Necessity Steve is a speech-language pathologist who owns his own practice. and it is the most cost effective device the clinic INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. (A fixed amount of money per patient. In this instance. and treatment efficacy and efficiency. As an employee of the clinic. He recently signed a contract with an HMO to provide speech therapy services.. A therapist must be able to justify all of their professional decisions (such as the discharging of a patient from clinical care) based on sound clinical rationale and practices. He offers her 3 free samples to “try out” on patients. in her judgment. The second obligation is to her employer. He informs his staff that all patients covered by this insurance must be discharged by their fourth visit.COM .D. based on diagnosis) Steve has performed a thorough cost analysis on this contract and has determined that the financial “breakeven” point (revenue equals expenses) on each of these patients is 5 visits. (ASHA Code of Ethics: I-8. It is unethical to either alter or withhold care based on other extraneous factors without the patient’s knowledge and consent. Debi has two primary obligations to fulfill. The quantity of care is not being determined by the medical necessity of the patient. She is meeting with a vendor whose company is introducing a new hearing aid onto the market. she will qualify to receive compensation from his company by automatically becoming a member of its National Clinical Assessment Panel. the decision to limit care is not ethical. The conflict of interest occurs when she begins to accept compensation from the vendor in direct or indirect response for her orders.

and a potential conflict of interest involves a situation that may develop into an actual conflict of interest. go to: WWW. He decides to sublease half of his space to a maxillofacial surgeon. but they also damage the whole profession by reducing the trust people generally have in audiology professionals. employers. of the trust people have placed in professionals. Business has been poor. Conflicts of interest involve the abuse. Is this an ethical arrangement? No. Trust is at the ethical heart or core of this issue. A conflict of interest is a situation in which a person has a private or personal interest that influences the objective exercise of his or her professional duties. III-3. my patients. CCC-SLP owns a private practice.COM . this agreement is not ethical. Larry’s current lease is at $20/sq ft. As a professional you take on certain responsibilities and obligations to patients. he’ll make him the Medical Director of the facility and pay him a salary of $500/month. actual or potential. An apparent conflict of interest is one in which a reasonable person would think that the professional’s judgment is likely to be compromised. They come to a compromise of $17/sq ft. professionals must also avoid any apparent or potential conflicts as well. and others. professional colleagues. This is why conflicts of interest not only injure particular patients and employers. The most notable infraction involves offering to designate (and compensate) the physician as the Medical Director contingent upon the number of referrals he sends. whether actual. by accepting the money she has established at least an apparent conflict of interest. or potential? The key is to determine whether the situation you are in interferes or is likely to interfere with your independent judgment. A good test is the ‘trust test’: Would relevant others (my employer. apparent. (ASHA Code of Ethics: III-2. This disclosure is necessitated because the potential for personal gain would make others rightfully question whether her objectivity was being influenced. The doctor wants to pay $15/sq ft. These obligations must take precedence over a therapist’s private or personal interests.26 - . Under this situation she is obligated to disclose to all parties her financial interest in ordering the appliance. In addition to avoiding all real instances of conflict of interest. IV-10) Case Study #6 – Relationships with Referral Sources Larry Jones.Ethics – Speech Language Pathology & Audiology could purchase. This is undeniably a direct offer of cash INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. How do you determine if you are in a conflict of interest. Larry also agrees that if the doctor is his top referral source after 3 months. or the general public) trust my judgment if they knew I was in this situation.CHEAPCEUS.

reflect fair market value. It is not. The fair market value for rent has been established as $20/sqft. This includes cash. or marketing. services. closer scrutiny reveals this to be unethical. All business agreements and transactions should always be well documented and most importantly. rebates. gifts. reduced rent. equipment. the practice is not only unethical. employees.COM . go to: WWW. Goodwill gifts of nominal value are acceptable provided that no correlation can be made between the magnitude or frequency of the gift giving and referral patterns. It is unethical to offer anything of value to physicians or any other referral source in direct response for the referral of patients or services. Many mistakenly believe that it is a normal acceptable business practice to offer these things to referral sources. but it is also illegal. the rent amount of $17/sq ft seems fair because it was a compromise between the two parties. In most states. However. At first glance. Another area of concern is the rent.CHEAPCEUS.27 - . (ASHA Code of Ethics: IV-1)) INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. Larry is giving a referral source something of value. Exchanges of valued items or services between health care professionals and referral sources must never have any relationship to the referral of patients. discounts.Ethics – Speech Language Pathology & Audiology for patients. (Larry’s current rental agreement with his landlord) By discounting the doctor $3/sq ft on his rent.

Physical Therapy. 2010 Feb. Dec 2005 National Center for Ethics in Health Care.S. "Teach Back": A Tool for Improving Provider-Patient Communication.. Moral reasoning among physical therapists: results of the Defining Issues Test.Language Pathology (Online). Conflicts of professional interest [Issues in Ethics]. (2011). 2005. Iss. Nalette. Swisher LL. Ethics in action. Journal of Law. Washington: Jun 2010. In Focus. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. 90(7):1068-78. 2010 Available from www. Constrained Physical Therapist Practice: An Ethical Case Analysis of Recommending Discharge Placement From the Acute Care Setting. Physical therapy: ethics and the geriatric patient. Vol. go to: WWW. 2007 Jun. When Patients Refuse Treatment. Jensen GM. Lynne E. Physiotherapy.asha. American Speech-Language-Hearing Association. Hiller P. Lincoln. 19. p. 33. p. Code of Ethics. PT--Magazine of Physical Therapy. p. Currents in contemporary ethics. (45 ref) Geddes. Physical Therapy. 2005 Dec. Alexandria: Sep 2010. Kevin W. Physiotherapy Theory & Practice. 2. 14(7): 38-42. http://www. Informed Consent Dos & Don’t for Best Practice. Accessed 10/1/2011 Veterans Health Administration. Aug 2006 National Center for Ethics in Health Care. PT in Motion.S. Vol. Ethical reasoning as a clinical-reasoning strategy in physiotherapy. PT in Motion. Iss. p. The Revised APTA Code of Ethics for the Physical Therapist and Standards of Ethical Conduct for the Physical Therapist Assistant: Theory. Kirsch NR. Experienced Speech-Language Pathologists' Responses to Ethical Dilemmas: An Integrated Approach to Ethical Reasoning. Balandin. 17(1): 31-52.org/policy. 2. Journal of Medical Ethics.asha.. Carpenter.hhs.01: Informed Consent for Clinical Treatments and Procedures. (2004). Vol.asha..28 - . 91(4): 229-36. Balandin. Closing the gap between ethics knowledge and practice through active engagement: an applied model of physical therapy ethics. Alexandria: May 2011. Fiedler I. London: Sep 2007. Delany CM. In Focus. Eva.org/policy. 44 Kirsch. (2010). 2009 June. American Speech-Language-Hearing Association.pdf. 37(2):369-74. Iss. 37 Edwards I. 6.CHEAPCEUS. BScPT MRE.org/policy. Rockville: May 1. 26(2):69-78. and Significance. B. Does moral judgement improve in occupational therapy and physiotherapy students over the course of their pre-licensure training?. August 2009 INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. 803 US Department of Health & Human Services.M. Braunack-Mayer A. Iss. 2001. A dynamic model of ethical reasoning in speech pathology. Edwards I. Iss. Available from www. Jones M.M. PhD. Ethics in action. Journal of Geriatric Physical Therapy. 9. Penny MHSc(OT). October 2003 National Center for Ethics in Health Care. Learning in Health & Social Care. Gifts to Health Care Professionals from the Pharmaceutical Industry.asha. 8(2):92-102. Physical Therapy. 44 Kuczewski MG. 15(2):69-79. 508 Kirsch NR. Matters of Integrity PT in Motion. B. National Center for Ethics in Health Care... Critical Reviews in Physical and Rehabilitation Medicine. Available from www.COM . Improper conduct: case two. 8. Vol. American Speech-Language-Hearing Association. 24(3): 3-7.org/policy. Salvatori. Physiotherapy Research International. 2. April 2006 National Center for Ethics in Health Care. Unsatisfying Satisfaction. Drummond-Dye R. Medicine & Ethics. Available from www. 2010. 121 Kenny. p. Issues of professional integrity: analysis. C. 2009. 3. Moral distress in physical therapy practice. Vol.gov/ocr/privacy/hipaa/understanding/summary/privacysummary. In Focus. Process. American Journal of Speech . 15(6): 34-7 Kirsch NR. 2010 Jul. Confidentiality [Issues in Ethics]. Marietta C. 90. 4. 5. VHA Handbook 1004. Alexandria: Jul 2010.E. McGuire AL. Matter of Vitals Concern. 2006 Jul. 939 Nalette E. 90. Kenny. July 2003 Swisher LL. p.Ethics – Speech Language Pathology & Audiology References American Speech-Language-Hearing Association. Purpose. Vol. 2010 Jun.NR. Washington: May 2010. Iss. Lincoln. Skinner E. PT--Magazine of Physical Therapy. Client Abandonment [Issues in Ethics]. Ethical Boundaries in the Patient-Clinician Relationship. Vol. p. Iss. Ethical issues in physical medicine and rehabilitation: treatment decision making with adult patients. 6.

go to: WWW. Which statement regarding ethics theories is INCORRECT? A. D. C. A. fiduciary displacement B. The ASHA Code of Ethics establishes ethical behavior for all speech and audiology professionals. Blanket consent should be obtained from the patient if the care plan includes multiple treatments. asking primarily closed-end questions to elicit information B. utilizing the teach forward method 5. boundary neglect INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. C. Social Contract Theory proposes that moral code is created by the people who form societies. Patients have a right to refuse treatment. All actions that are legal are also morally right. All actions that are morally right are also legal. B. even those that could save their life. Notification informs patients of their rights and how care is delivered. 3. 2. Informed consent must always be specific to the individual patient. Utilitarianism is the theory that right and wrong is determined by consequence. D.29 - . a double bind situation D.COM . practicing passive listening techniques D. A circumstance in which a personal interest displaces the professional’s primary commitment to the patient’s welfare is known as ________. Speech / Audiology ethics vary state by state. including those who are not members of ASHA .Ethics – Speech Language Pathology & Audiology Ethics – Speech Language Pathology & Audiology Post-Test 1. C. B. Which of the following statements regarding informed consent is FALSE? A. B. 4. reflecting patient’s comments back to them C. Ethical Egoism is based on the theory that each person should do whatever promotes their own best interests. Natural Law Theory proposes that ethical behavior is a result of inherent character traits. Which of the following statements is TRUE? A. A. D.CHEAPCEUS. blind egoism C. Speech and audiology professionals can communicate more effectively with their patients by __________________________.

write an anonymous letter to the state licensing board 10. immediately report the colleague to the local police D. meet with a physician to educate them about new speech therapy techniques and interventions 11/7/2011 INNOVATIVE EDUCATIONAL SERVICES To take the post-test for CE credit. permission is received from the professional’s employer 7. Information relating to _____ is individually identifiable health information that is covered under the Privacy Rule of HIPAA A. 9. A.Ethics – Speech Language Pathology & Audiology 6. Individuals shall provide services or dispense products only when benefit to the patient can be guaranteed. Individuals shall not discriminate in the delivery of professional services based on gender identity/gender expression. D. A speech-language or audiology professional who has reason to believe that the Code of Ethics has been violated by a colleague shall __________. Gifts from companies to health care professionals are acceptable only when ___________. inform the ASHA Board of Ethics B. the company is introducing a new product or service to the market. each professional in the field receives the same gift without regard to previous product usage C. and continue to monitor the situation. C. Which of the following is NOT included in the ASHA Code of Ethics? A. Individuals shall not provide professional services without exercising independent professional judgment. go to: WWW. waive the insurance co-pay for the spouse of a referring physician D. present. D. Individuals shall engage in lifelong learning to maintain and enhance professional competence and performance.CHEAPCEUS. or future payment for the provision of health care to the individual D. B. A. It is unethical for a speech-language professional to ________________. have a physician as a medical director B. the primary purpose is the enhancement of patient care and medical knowledge B. give the colleague the benefit of the doubt. an individual’s past.30 - . the provision of health care to the individual C. All of the above 8. sublease office space to a potential referral source C.COM . regardless of referral source or prescription. A. the past. C. present or future physical or mental health or condition B.