You may have had to memorize the ASHA Code of Ethics (or your country’s equivalent) in school, but how many times have you consulted it since then? In our line of work, ethical quandaries are bound to come up. Leaders from ASHA recently published a series of papers to give you the tools you need when confronted with an ethical dilemma. The full texts (five papers in all) are very readable, with a connecting storyline about “María,” a lead SLP for a school district. But for those of you who enjoy the CliffNotes version, this review is for you. 

What SLP Ethics Resources Should I Know About?

To start, take a gander at the ASHA Code of Ethics and the ASHA Assistants Code of Conduct (VERY relevant if you supervise an SLPA!). These guiding principles and rules dictate the expected ethical behavior of SLPs, audiologists, and SLPAs. It’s also important to know your own state’s laws and licensing requirements. The authors strongly recommend checking out the Ethics Resource Page, especially Issues in Ethics Statements, which covers common ethical issues like client abandonment, ethical use of social media, telepractice, and conflicts of interest.

Although these resources are US-specific, the basic ethical principles are universal. An important distinguisher, however, is that ethical violations are different from legal violations (e.g., being in violation of IDEA or HIPAA) and may differ from moral violations (i.e., doing something that is “wrong”) which are more subjective and may or may not be considered “unethical.” For instance, sending friend requests to clients from your personal Facebook account is definitely unethical, but it’s not illegal, and whether it’s immoral is up for debate. Got that? 
 

What Ethics Violations are Common?

It’s our responsibility to ensure that we are practicing ethically. What should we be on the lookout for? How do we know if we are toeing the line? 

Improper documentation and misrepresentation

Documentation issues are rampant in the healthcare industry these days, especially with the ease of EMRs. Misrepresenting your services, whether by accidentally billing a no-show session or by providing more services than necessary when pressured by your supervisor, can easily turn into cases of fraud. And of course, intentionally misrepresenting or falsifying records would be a major violation. Read this article from ASHA for more on this topic.
 

Unlicensed Practice

This type of violation is almost always the result of a lapsed license. One clinician practiced for 12 years without realizing her license lapsed because she expected her office to notify her, and they didn’t. Maintaining your license is your responsibility! This might seem like a minor violation, but licensing systems are in place to keep clients safe and ensure all clinicians have the appropriate education and qualifications.

Use of Social Media

Oh, social media. It has given our field so many positive things: increased awareness, collaboration, learning opportunities, etc. However,  things can go wrong when SLPs misuse social media when providing client services. Some obvious violations would include posting pictures of clients without their permission or describing a client in enough detail that someone could recognize them. Others could include misrepresenting yourself, your expertise, or your products and services—think: “Cure your child’s language delay with this book!” Moral of the story: be careful what you post, and assume anyone could find it regardless of privacy settings. For more on this topic see here and here.
 

Practitioner Impairment & Mental Health

This one gets… interesting. Historically, practitioner impairment referred specifically to substance abuse. Don’t drink and drive a FEES scope, friends. According to Gleason (a former ASHA Board of Ethics member), however, this category has broadened to include mental health issues like anxiety, depression, PTSD, chronic pain, and… burnout. Just gonna let that one simmer for a second. Yeah. 

The author cites technology and the evolution of telehealth/home health as the reason SLPs have “little ‘down time’ for self care,” leading to burnout and increased risk of ethical violations. Not sure about you, but I can think of a few other reasons many of us feel burnt out. Gleason advises SLPs experiencing burnout to let their supervisors know if they’re unable to carry out their job duties adequately, which feels like a conversation that would rarely end well. As uncomfortable (infuriating?) as it is to think that our individual licenses and CCCs are ultimately on the line when systemic factors create unsustainable work conditions, that’s the reality.

Navigating Ethical Issues

Not every ethical issue is black and white, nor does it require an immediate report to ASHA. Key steps of ethical decision making, according to Weichmann, include collaborating with others, consulting resources and individuals with knowledge about the issue, and brainstorming the most ethical and feasible solutions. There are currently many active ethical debates within our professional community. Let’s discuss.

The rapid rise of telepractice (thanks, COVID) is one area that has raised lots of ethical questions. Are telepractice services equivalent to face-to-face services? (Research can help us here!) Is it ethical to provide virtual services to only some students or schools within one school district? What happens when certain students or clients aren’t good candidates for telepractice? If given the choice, what if SLPs choose (intentionally or not) to offer virtual services (rather than in-person) to schools in lower-income communities or those with more children of color. How can we ensure discrimination and bias are not factors in decisions made around telepractice?

Working with culturally and linguistically diverse clients presents many points of debate as well. The concept of Ethics itself varies from culture to culture. What happens when a clinician and client’s thoughts on an ethical dilemma clash? Is it possible for one to become “competent” in a culture that is not their own? (Many say no, and use the term cultural humility instead). Is it possible for one to deliver truly unbiased services, or is bias always inherent in everything we do? What is the most ethical way to evaluate a client from a different cultural background? 

While these questions might seem philosophical, we encounter them regularly in our profession. Some of TISLP’s reviews on telepractice and multilingual clients may help you make an informed decision about these topics. There are so many more ethical discussions in our community that we can’t possibly cover them all here, but ableism, gender-neutral pronouns, accent services, and end of life considerations all come to mind.

Conclusion

We hope reading this has added more tools to your toolbox for approaching ethical dilemmas that come up throughout your career. (If you’re like me, you just triple-checked that your license and CCC are in good standing). We won’t ever have foolproof answers for every situation; the best we can do is stay informed on current topics, collaborate and discuss, and approach our work with an ethical mindset. 

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