1. There is no right way to do the wrong the thing, or is there?
Ethics 2016
There is no right way to do the wrong the thing, or is there?

2. Principles of Ethics
Aspirational and inspirational in nature, from the underlying moral basis of the Code of Ethics. Individuals shall observe these principles as affirmative obligations under all conditions of professional activity.

3. Ethical decision-making involves a commitment to applying the ethics code to construct rather than simply to discover solutions to ethical quandaries.

4. A model that considers professional norms and ethical principles, as well as clients’ and clinicians’ cultural heritages and the influence of diverse values, can provide a framework to address ethical questions and lead to confident resolutions and good professional practices.

5. Most codes are broadly written
Most codes are broadly written. It is sometimes difficult to apply general rules to specific cases.
Ethical questions are complex and may not be completely addressed by a code of ethics.
An ethical code may conflict with institutional policies and practices.
We may be required to practice within a framework of numerous codes of conduct.

6. Obligatory – Must always be done regardless of the circumstances
Impermissible - Must never be done under any circumstance
Permissible – Can either be done or, not done – it is good either way

7. The decision making process begins with the question,
“Am I facing an
ethical dilemma?”
If the situation is one in which personal and professional integrity are being challenged, the answer will likely be
Yes!

8. Where do I go to look for help?
ASHA
Licensing Board
Colleagues
Employers
Mentors

9. Ethical Decision Making Model
Identify the problem as you see it.
Get the story straight – gather relevant data
(federal, state and local regulations
professional and practice Documents,
ASHA Code of Ethics, Licensing board code
and rules)
Ask yourself if the problem is a regulatory issue or a process issue related to regulatory requirements.

10. Compare the issue to a specific rule in ASHA’s Code of Ethics
Compare the issue to a specific rule in ASHA’s Code of Ethics. Determine if the rules apply to our problem and can help you develop a course of action.
Identify who has the power and control in the situation.
Identify what is in your control and what is not.

11. Identify your resources
Identify your resources. These can be your supervisor, administrator or colleague. Ask yourself if you need more information, clarification, or ideas from others who have had a similar problem.
Make a list of possible actions and their positive and negative consequences.
Make a plan that you can defend professionally and ethically and that meets the requirements of the regulations.

12. Take action and evaluate your plan as you proceed. Determine next steps.
In the publication Ethics and IDEA , A Guide for Speech-Language-Pathologists and Audiologists Who Provide Services Under IDEA (ASHA 2003).

13. Why are professional codes and guidelines important?
Provide helpful guidance to members
Establish and embrace the common, core values reflecting consensus among members
Promote public trust by stating what is to be expected of professionals
Promote high standards of practice
Define acceptable/unacceptable conduct within the profession

14. What are the most frequently recurring themes of ethics for you?

15. ASHA Reports these most frequently recurring themes of Ethics inquiries
Employer demands
Use and supervision of support personnel
Impaired practitioner/professional
Reimbursement for services
Professional (vs.) business ethics
Clinical fellowship supervision
Documentation lapses
Client abandonment
Disclosures (past misconduct and conviction)

16. How can I avoid ethical difficulties?
Advocate for best practices.
Use evidenced-based practices as the basis for decision making.
Know and understand the ASHA Code of Ethics and your employer’s handbook and guidelines.
Connect the Code of Ethics with your program’s mission statement, policies and procedures and performance evaluations.

17. Strategies Advocate for best practices
Acquaint your supervisors, administrators, etc. with the Code of Ethics, Issues in Ethics Statements and potential for ethical conflicts.
Review federal, state and local regulations and requirements
Create an ethics committee or forum for discussing ethical issues.

18. Present in-services on the importance of ethics in your work setting
Develop a library of ethics resources
Connect the Code of Ethics with your program’s mission statement, policies and procedures and performance evaluations
Familiarize yourself with the Code of Ethics

19. Acquaint supervisors, administrators, and colleagues with the Code of Ethics, Issues in Ethics Statements, and potential for ethical conflicts.
Discuss potential ethical issues before they become a problem.
Review federal, state and local regulations
and requirements.

20. Scenario #1
Your private practice has more empty slots than you’d like. A potential client wants to come to you for treatment, but you haven’t had experience with this type of client, the client’s disorder or the treatment technique the condition requires. This client will bring in much needed revenue from the evaluation and treatment. Is it OK to schedule the client and then figure it out as you go along?

21. Scenario #2
Your client’s insurance covers therapy services, but reimbursement for the procedural code that corresponds to the client’s disorder is substantially less than your hourly rate. Your practice is “in network” and must accept the contracted rate. But, if you use different procedural and diagnostic codes, reimbursement is higher. Should you bill the other codes, collect higher fees and keep this client?

22. Scenario #3
You are working with a child who is 16 years old and has been receiving speech and language therapy for 12 years in the school system with no progress observed in the past 6 years. You decide to dismiss the student but the teacher and parents disagree. Do you cave in to the parents’ demands to preserve good will or do you hold fast to your carefully documented and thought out plan to dismiss?

23. Scenario #4
I have an offer for a great new job. Because my new employer needs me right away, I will have to resign from my current setting with only two days notice. My current employer is complaining that she needs more time in order to hire a new SLP or my clients will go without services. She is threatening to file a complaint against me for “client abandonment”. I think she is holding me hostage. Those clients are her responsibility, aren’t they?

24. Willful Blindness Margaret Hefferman
A situation in which a person seeks to avoid civil or criminal liability for a wrongful act by intentionally keeping himself/herself unaware of the facts that would render him/her liable.
Examples: Catholic church, Nazi Germany,
Bernie Madoff’s investors, run up to Iraq War

25. https://youtu.be/PCetmZUzB5w

26. Are there issues at work that people are afraid to raise
Are there issues at work that people are afraid to raise? 85% know there is a problem but don’t report it. That’s a lot of silence and a lot of blindness.
Some people are blind out of fear and others blind because they believe seeing it will not change anything
We often think that people who do see are whistleblowers –No true. Whistleblowers have been found to care deeply about the health of the organization.

27. Ponder examples of willful blindness that may have occurred in our professions. How may this influence ethical decision-making by SLPs and Auds?

28. Mitigating Willful Blindness
Recognize the homogeneity of our live
Put more effort into heterogeneity
Avoid groupthink by encouraging questions, dissent, minority opinions
Realize that silence can be dangerous
Have confidence that uncertainty facilitates independent judgment
Be comfortable changing your opinion

29. Remember that essential issues are not resolved quickly
Develop the courage to intervene when worried about what you see
Be wary if there is only one available option
Understand the limits of our cognitive capacity
Minimize reliance on technology for communication

30. “As all wisdom does, seeing starts with simple questions: what could I know, should I know, that I don’t know? Just what am I missing here?”
(Hefferman, 2012)

31. Bibliography
All material for this presentation was taken from the ASHA website and from the most recent webinar, “The Many Gray Areas of Ethical Decision Making”.
For more information regarding ethics, go to
Willful Blindness: Why We Ignore the Obvious at Our Peril by Margaret Hefferman,
July 3, 2012.