Gain insight into how to successfully navigate the difficult conversations and interactions that our field presents us with. Have you ever had an ethical question or dilemma arise? Or do you work with clients who speak a language other than English and have concerns about how ethical the services are that they receive? Back by popular demand, our original ethics presentation drew a huge crowd and resulted in many invigorating, compassionate discussions. Following that event we were contacted by even more speech pathologists with ethical dilemmas and share their case studies with you here in this course.

2. Outline for Today
• Why study ethics?
• The origins of ethics
• Research on ethical behavior
• Principles of Ethics for TSHA and ASHA
• Case studies

3. Learner objectives
• Participants will:
▫ Review laws and codes of ethics pertaining to speech
language pathologists
▫ Highlight legal issues in serving a bilingual population
▫ Consider case studies of ethical issues related to
working with culturally and linguistically diverse
populations.
▫ Identify sections of the Codes of Ethics that assist in
decision-making for case studies.

4. Ethics defined
• The code of good conduct for an individual or
a group. (Merriam-Webster’s, 2010)
• A discipline dealing with right conduct and
morality. (Webster’s, 2001)
• “moral principles or values that address
whether actions, intentions, and goals are right
or wrong” (Herer, 1989)
• The main ethical category for ancient Greeks
was arete or virtue
• List of Rules

5. How are ethics codes different from laws?
Rules of Ethics are specific statements of
minimally acceptable professional conduct or
of prohibitions and are applicable to all
individuals.
Laws are legal documents setting forth rules
governing a particular kind of activity.
Rules
of
Ethics
Law

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to listen to this course live?
Click here to visit
the online courses.

7. Click for Audio‐over‐Powerpoint Presentation

8. Why study ethics?
“With great power comes great responsibility.”
Responsible practice means adherence to a standard of ethics.
It makes us better people?
Because we have to? State Board of Examiners Requirement
Why have the requirements changed?
What happened?

9. International Environment
2002
Finland
Denmark
New Zealand
United States
(20th)
Haiti
Iran
20012000
Finland
Denmark
New Zealand
United States
(14th)
Haiti
Iran
20112003-2010
United States
(22th)

10. Economic Incentive for being Ethical
• For honest companies, moving from a low
corruption climate to one where corporate and
government misdeeds are more prevalent can
represent as much as a 20% additional tax on
top of the normal costs of doing business.
• For our field, this
equates to:
• Retention of
staff
• Reduction in
errors

11. Most Ethical Countries Least Ethical Countries
1. DENMARK
2. NEW ZEALAND
3. SINGAPORE
4. FINLAND
5. SWEDEN
1. SOMALIA
2. MYANMAR
3. AFGHANISTAN
4. IRAQ
5. UZBEKISTAN
Countries

12. Most Ethical Professions Least Ethical Professions
1. NURSES
2. PHARMACISTS
3. TEACHERS (HIGHSCHOOL)
4. DOCTORS
5. POLICEMEN
1. LOBBYISTS
2. TELEMARKETER
3. CAR SALESMEN
4. CONGRESSMEN
5. STOCK BROKER
Professions

13. Probing the Field of Law
• “Two-thirds of respondents in a survey of California lawyers said
they “compromise their professionalism as a result of economic
pressure.”
• Lawyers in Maryland reported their profession had degenerated so
badly that “they were often irritable, short-tempered,
argumentative, and verbally abusive.”
• Lawyers in Virginia were asked whether the increasing problems in
professionalism were attributable to “a few bad apples” or a
widespread trend. They overwhelmingly said, “a widespread trend.”
• Lawyers in Florida reported that a “substantial minority [were]
money grabbing, too clever, tricky, sneaky, and not trustworthy.”

14. Trying to correct the downward trend.
• “At present, several state bars and professional
organizations are scrambling to shore up their
professional ethics. Some are increasing
courses in college and graduate schools, and
others are requiring brush-up ethics classes.”

15. Can we change behavior?
A study by MIT
So what can we do? How do we
change a profession’s ethical
behavior?

16. Ethical Studies by MIT
Study 1
50 math
questions
Study 2
15 math
questions +
Book Lists
Study 3
20 math
questions
+ Ethics Code
Group 1
Control
32.1/50
Group 2
Test
Group 3
Test
36.2/50
36.2/50
3.1/15
4.1/15
3.0/15
3.0/20
5.5/20
3.o/20

17. All of the documents and charts in this presentation
can be downloaded from our Free Resource Library.
Click here to visit the Resource Library

18. Principles of Ethics
ASHA’s and TSHA’s Codes
Personal Responsibility
Professional Competence
Responsibility to the Public
Responsibility to the Profession

19. The origins of ethics
Influence of Greek Philosophers TSHA/ASHA Code of Ethics
• Personal Happiness (Aristotle)
• Professional Influence (Epicurus)
• Social Interaction (Socrates)
• Promoting Peace of Mind
(Epectetus)
• Personal Responsibility
• Professional Competence
• Responsibility to the Public
• Responsibility to the
Profession

20. Origins of Ethics
• Actions that Allow Social
Interaction
Socrates
• “The truly wise man will know
what is right, do what is good,
and therefore be happy.”
• Ethics is a conversation that
enables people to interact
communally within a society

21. Origins of Ethics
• Actions that Promote Personal
Happiness
Aristotle
• In Aristotle's view, when a
person acts in accordance with
his nature and realizes his full
potential, he will do good and
be content.

22. Origins of Ethics
• Actions that Promote Peace of Mind
Epictetus
• “the greatest good was
contentment and serenity”
• We get to go to work each day
knowing we will be respected and
valued

23. Origins of Ethics
Epicurus
• Hedonism, responding to one’s
own desire without consideration
for the greater of society
Joe Wilson Serena Williams Shoe guy
• Guidance of actions that do not reflect
poorly on society (a professional’s
field)

24. Principles of Ethics I
• Personal Responsibility
“Individuals shall honor their responsibility to hold
paramount the welfare of persons they serve
professionally or participants in research and
scholarly activities and shall treat animals
involved in research in a humane manner.”

25. Principles of Ethics II
• Professional Competence
“Individuals shall honor their responsibility to
achieve and maintain the highest level of
professional competence.”

26. Principles of Ethics III
• Responsibility to the Public
“Individuals shall honor their responsibility to the
public by promoting public understanding of the
professions, by supporting the development of
services designed to fulfill the unmet needs to the
public.”

27. Principles of Ethics IV
• Responsibility to the Profession
“Individuals shall honor their responsibilities to
professionals and colleagues, and students.
Individuals shall uphold and accept the professions’
self-imposed standards.”

28. Our discussion today
• The original intent of Ethics, it was meant as a way of creating
dialogue.
• This dialogue is created by:
1) naming or bringing to attention
a goal or value
2) putting it to the test with
rigorous discussion about real
life circumstances.

29. Five Ethical Philosophies
• The Categorical Imperative
• Utilitarianism
• The Golden Mean
• The Veil of Ignorance
• The Golden Rule

30. Ethics through Case Study
Which Principles are violated?
Which Ethic Rule is in Violation?
How you will respond to the situation?

31. Case Study
To whom it may concern,
I am looking for guidance toward best practice on an inpatient
rehabilitation unit. The details about the case are as follows:
The SLP only speaks English and does not understand Spanish. There
is a Spanish speaking patient who suffered a CHI while at work. This
individual spoke several languages prior to the accident and as of this
time, only his primary language of Spanish has returned. The company
will provide a translator during OT, PT, and ST treatments. The SLP
does not feel competent to treat this individual due to the language
barrier. She stated it is “unethical” for her to provide ST services
because she cannot verify the validity of the translation. I am looking
for guidance on how to provide the best skilled ST services for this
individual. The other resources available at our hospital include
certified translators as well as a “blue phone” translator service. (I
have searched the ASHA website and have contacted the only bilingual
SLP in our area and she is not available for hospital coverage.)

32. 3
2
Selecting Personnel to Conduct the
Evaluation
• Level 1: trained (in CLD issues) bilingual speech-
language pathologist fluent in the native language
• Level 2: trained (in CLD issues) monolingual speech-
language pathologist assisted by trained bilingual
ancillary examiner.
• Level 3: trained (in CLD issues) monolingual speech-
language pathologist assisted by trained interpreter
Source: ASHA

33. • You do a Child Find evaluation. The mother brings a
copy of a report from a private practice that was done a
few months earlier. The SLP used the PLS-3-English
with an interpreter and reported the norms from the
English version. The results indicated a severe
expressive and receptive language delay.

34. The Relativity of Ethics
• Ethical standards evolve over time.
• Consider the practices of Lionel Logue in the
King’s speech

35. Case Study
• Bilingual SLP goes to daycare to serve student.
Next to her is an English-speaking SLP serving a
Spanish-speaking child and intervening on the
unvoiced “th” sound that does not exist in
Spanish.

36. Case Study
• A monolingual SLP is pushed to evaluate and
provide therapy for children who don’t speak
English. When he told his employer that this
was an ethically uncomfortable situation, the
response was, “Any service is better than no
service. What is unethical is not serving the
clients.”

37. Case Study
• A graduate student’s supervisor tells her to
implement speech/articulation exercises for
students with only a diagnosis of language
impairment.

38. Case Study
• You do an initial school evaluation for a 6-year-old
student, Maria, who is predominantly Spanish speaking.
There is an evaluation report in her folder from a private
practice two months prior. The only information
provided is a list of the items the child got correct and
those that the child missed on a standardized test.
Receptive and expressive language skills are reported as
severely disordered.
• Your evaluation indicates typical receptive language
skills and moderately delayed expressive language skills.

39. Case Study
• A parent denies bilingual services. You believe that the
student will benefit from speech services in Spanish and
that if services are done in English you will be teaching
English rather than addressing underlying language
deficits. Your supervisor tells you that you need to do
services in English.

40. Case Study
• A teacher reports to you that she has a bilingual student
in her class who she is concerned about. She went to her
principal to find out how to refer her for speech-
language testing and the principal told her they already
had too many Hispanic students in special education so
she should not make the referral.

41. • Your supervisor asks you to complete 45-minute sessions
with your students in a 40-minute period, stating that
they are students receiving Medicaid and the Medicaid
regulations state that if you complete at least 7 minutes
of your last 15-minute unit, you can report it as a
complete 15-minute unit.

42. • You are one of the few bilingual SLPs in the Grande ISD
and your caseload reaches 60 students across 6
campuses. You do not feel you are able to provide
effective services to that many children.
• What do you do?

43. Case Study
• You do an initial school evaluation for a 4-year-old
student, Jose, whose family uses only Spanish in the
home. He has very limited English exposure. He was
diagnosed 9 months prior with severe expressive and
receptive language disorder at a private practice. They
provided speech therapy in English for 6 months until
the mother decided she was wasting her money because
services were in English. The mother asks you your
opinion.

44. Case Study
• A parent of one of your students goes to a local
clinic to get additional services. The clinic tells
the parent that they will put the family on their
waiting list of 150 people and that they can
expect to wait 8-10 months before they will
receive services. When the family asks the clinic
where else they might go, the clinic provides no
suggestions.

45. Case Study
• You work in the Po-Dunk ISD. You took 4 semesters of
Spanish in high school and are able to greet people in
Spanish and understand some frequent vocabulary.
Your boss asks you to evaluate a child whose
predominant language is Spanish.

46. • Your supervisor lays out a schedule for you, the bilingual
SLP, that looks like this:
▫ 8-8:30 Billy at Stromville Elementary
▫ 8:30-8:45 travel 12 miles to to Batesville Elementary
▫ 8:45-9:45 therapy with a group of 4 students
▫ 9:45-10:00 travel 15 miles to Brook Elementary
▫ 10:00-11:00 Group of 5 students
▫ 11:00-12:00 Group of 5 students
▫ 12:00-1:00 Lunch and travel 45 miles to Cramville
▫ 1:00-3:00 Two groups of 4 students each.

47. Case Study
• You are a bilingual student completing a clinical
rotation. You observe an evaluation in which an
English-dominant SLP administers a receptive
vocabulary task in Spanish. She mispronounces the
words. You know what she is saying but the student
does not appear to understand so you say the word
correctly and the student get the item correct. The
supervising SLP asks you not to interrupt her testing
session again. She diagnoses the student with a
moderate receptive language impairment.

48. • Near the end of the school year you run out of CELF-4
protocols but still have many more evaluations to
complete. You tell your supervisor you need more
protocols and she informs you that there is no budget for
that and you will have to make photocopies of the
protocols for the rest of the school year.
Case Study

49. Bilingual vs. CLD Caseloads
• Distinction
▫ Bilingual – one with native or near-native
proficiency in two languages
▫ CLD-Competent – one with knowledge of cultural
and linguistic differences, including language
influences in bilingual development
• No one can be bilingual enough
▫ Proficiency
▫ Languages
• In Texas, multicultural caseloads are the norm.

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