Download Ethical Decisions: A Foundation for Appropriate Problem

Ethical Decisions: A Foundation for
Appropriate Problem Solving
Shelly Chabon
Ellen Estomin
Theresa H. Rodgers
November 2011
Organizer
• Principles for School-Based SLPs
• Definition/Concepts of Ethics
• Relationship/Distinction of Ethics
and Law
• Ethical Inquiries
• Consequences
• Principles of Ethics
Organizer
• Principles of Ethics
• Ethical/Legal Decision
Model
• Scenarios
Making
Disclosure Statement
We have no financial or nonfinancial interest
in any organization whose products or
services are described , reviewed, evaluated
or compared in the presentation.
Principles for School-Based SLPs
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SLPS, like all school personnel, have a responsibility to
prepare students for the world of work (appropriate to the
ability of the student).
The twenty-first century demands that students know how to
think (to reason, analyze, weigh evidence, problem-solve)
and communicate effectively.
SLPs need to recognize the increasing impact of media and
technology on how young people learn, relate to the world,
and relate to each other.
SLPs need to advocate for children at risk and children with
disabilities.
SLPs need to demonstrate leadership roles in school
environments.
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SLPs need to operate within the parameters of federal and
state legislation and regulation. ( If you know one state, you
know one state)
SLPs need to operate within the parameters of local
procedures and policies.
SLPs need to be fiscally responsible.
SLPs need to collaborate with school personnel, the
community, parents and families, and universities.
SLPs need to operate with the ASHA Scope of Practice and
Code of Ethics.
Personal
Experiences
• So, is this an example of a(n)
• ethical dilemma?
• legal issue?
• interpersonal/communication
problem?
• just one of those things that
happens all the time?
•As speech –language
pathologists and audiologists
we are frequently confronted
by ethical and legal questions,
often at the same time.
Basic Ethical and Legal Concepts
Ethics
Law
Ethics
• Ethics is the branch of philosophy
which involves the study of our
actions, values, and the rules of
conduct by which we live
•  Describes actions, not people
Ethics involves not only facts, but also
personal and cultural values
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“Ethics is NOT primarily concerned with getting
people to do what they believe to be right, but
rather with helping them to decide what is
right.”
Law
Established rules for social
conduct
Generally are mandatory
Relationship of Ethics and Law
Ethics is the identification of values
 what we ought to do
 Law is the expression of values in social rules
 what we have to
Why Ethics and Law Overlap
•  Beliefs and values unique to
the individual clinician - client
encounter must be:
 Understood
 Protected
•  Respected
How Ethics and Law Overlap
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Access to treatment
Confidentiality/privileged communications
Reporting obligations
Conflict of interest
Misrepresentation/fraud
• Different sources
Distinctions Between Law and Ethics
• Different enforcement
• Different consequences for breach
Ethics and the Law
Actions may be:
Legal and moral
Illegal and moral (Stealing food following a natural
disaster)
Legal and immoral (e.g. some feel DNR’s are not
moral)
Illegal and immoral (e.g. murder)
Four-Quadrant Clinical Practice Grid
+ Legal -Legal
+Ethical +Ethical
+
+Legal -Legal
-Ethical
Ethical
Examples
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+L/+E
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-L/-E
Practice within ASHA Code of Ethics and state licensure law.
Commission of intentional misrepresentation to a client.
(ASHA Code of Ethics, Principle I, Rule M; Principle III, Rules A and
D)
Examples
Advertise lower price to steal clients from competitor
(ASHA Code of Ethics, Principle IV) +L/-E
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Unknowingly practice SLP or AUD after license has expired
(ASHA Code of Ethics, Principle III, Rule A) -L/+E
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Trends of Ethics Inquiries to ASHA
National Office 2001-2006
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Approximately 2,500 ethics inquiries per year
Approximately
2500 ethics
inquires per
year
Most frequently recurring themes of ethics inquires are dilemmas associated
with:
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“Employer demands”
Use and supervision of support personnel
Cultural competence
Reimbursement for services
Professional (vs.) business ethics
Clinical fellowship supervision
“Employer Demands”
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Pressure to
provide services without adequate training
increase caseload
adhere to treatment eligibility criteria or program placement
recommendations which may be in conflict with the SLP’s clinical
judgment
old or poorly maintained equipment/technology
an IEP without participation of required school staff or parent
summer services
Denton, Ethics Education, 2007)
Clinical Fellowship Challenges
Clinical
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Inadequate or inappropriate supervision of clinical fellows
Inadequate time to meet supervisory responsibilities
Inadequate documentation of supervision and CF’s performance
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Failure to maintain one’s own competence
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Misuse of power over the CF
• Summary
• Ethics is at the heart of
• professionalism as it motivates
• guides and gives meaning to ou
work
-Gabard and Martin (2003)
The HIPDB
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Nowhere to Run
Nowhere to Hide
Martha and the Vandellas
National Practitioner Data Bank (NPDB) and the Healthcare Integrity
and Protection Data Bank
•NPDB - Title IV of Public Law 99-660, the Health Care Quality
Improvement Act of 1986, as amended; National Practitioner
Data Bank opened in September 1990 (45 CFR Part 60)
HIPDB - Established under Section 1128E of the Social
Security Act as Added by Section 221(a) of the Health
Insurance Portability and Accountability Act (HIPAA) of 1996;
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•Campbell, S. Healthcare Integrity & Protection Databank Updates. NCSB, 2008.
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NPDB-HIPDB Purpose
NPDB-HIPDB
Purpose
The
intent is to protect
the public,
improve the quality of health care and
deter fraud and abuse in the health care
system by providing information about
past adverse actions of practitioners,
providers, or suppliers to authorized
health care entities and agencies.
What is reportable to the NPDB-HIPDB?
•NPDB
•Medical Malpractice
Payments
– All practitioners
•Adverse Actions
• (physicians and dentists)
– Licensure
– Clinical Privileges
– Professional Society Membership*
•Medicare and Medicaid Exclusions
– All practitioners
•DEA Actions
– All practitioners
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*other practitioners may be reported
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HIPDB
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Licensure Actions
Medicare & Medicaid Exclusions
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Criminal Convictions or Civil Judgements
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Federal and State Health Care Programs
Must be health related
Other Adjudicated Action
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Formal or official action
Availability of a due process mechanism
Acts or omissions that affect/could affect the payment, provision, or delivery of health
care
HIPDB
Cumulative Data - As of June 30, 2009
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388,074 reports
80% were for state
for 208,986
licensure actions
individual
13.7% for Federal
and State health care exclusion
actions
actions
practitioners
6% for Federal and State
convictions and health
Illich, D., Hua, J., and Wright, A. (2010). Reporting of speech-language pathologists and
audiologists to the National Practitioner Data Bank and Healthcare Integrity and Protection Data
Βανκ ανδ Ηεαλτηχαρε Ιντεγριτψ ανδ Προτεχτιον ∆ατα Βανκ. Λιχενσυρε, 1
HIPDB - As of 6-30-2009
oTotal of 658 Reports
o179 reports for audiologists
o479 reports for speech-language pathologists
o87.5% for state licensure actions
oNPDB - As of 6-30-2009
Total
of 60 Reports
52 reports for audiologists
8 reports for speech-language pathologists
66% for medical malpractice
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HIPDB – “Repeat Offenders”
• Audiology Practitioners with Reports in HIPDB
–One Report – 96
–Two Reports – 29
–Three Reports – 2
–Four Reports – 2
–Five Reports – 3
HIPDB – “Repeat Offenders”
• SLP Practitioners with Reports in HIPDB
–One Report – 239
–Two Reports – 96
–Three Reports – 9
–Four Reports – 3
–Five Reports – 1
HIPDB – As of 6-30-09 (Cumulative Data)
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AUDIOLOGISTS
–Other, not classified [25]
–Unprofessional conduct [28]
–License action by Federal, State, or local licensing authority
[16]
Violation of Federal/State statutes, regulations, or rules [19]
Practicing without a valid license [17]
Failure to comply with continuing education requirements
[10]
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HIPDB – As of 6-30-09 (Cumulative Data)
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AUDIOLOGISTS (Continued)
–Negligence [9]
–Submitting false claims [7]
–Criminal convictions [15]
–Filing false reports [1]
–Fraud [4]
–Improper or inadequate supervision or delegation [0]
–Fraud, deceit, or material omission in obtaining license or
credential [1]
HIPDB – As of 6-30-09 (Cumulative)
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SPEECH-LANGUAGE PATHOLOGISTS
–Other, not classified [34]
–Unprofessional conduct [50]
–License action by Federal, State, or local licensing authority
[19]
Violation of Federal/State statutes, regulations, or rules [66]
Practicing without a valid license [67]
Failure to comply with continuing education requirements
[57]
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HIPDB – As of 6-30-09 (Cumulative)
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SPEECH-LANGUAGE PATHOLOGISTS (Continued)
–Negligence [10]
–Submitting false claims [3]
–Criminal convictions [25]
–Filing false reports [15]
–Fraud [14]
–Improper or inadequate supervision or delegation [13]
–Fraud, deceit, or material omission in obtaining license or
credential [10]
HIPDB Data for Collection Period
•Practicing with an Expired License [48; 4 Aud/44 SLP]
•Failure to Comply with CE Requirements [45; 5 Aud; 40 SLP]
•Practicing without a License [24; 2 Aud/22 SLP]
•Improper or Inadequate Supervision or Delegation [17; 5
Aud/12 SLP]
Filing False Reports or Falsifying Records [13; 1 Aud/ 12 SLP]
Misrepresentation of Credentials [11; 2 Aud/9 SLP]
Criminal Conviction [9; 3 Aud/6 SLP]
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• The standard for ethical professional
practices has changed as our field has
matured and expanded
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The decision-making process begins with the question,
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“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
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“Yes.”
(Morris & Chabon, Rockhurst University, 2005)
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The decision-making process may include the question,
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“Am I facing a legal quandary?”
If the situation is one in which violating the licensure law or
regulation is possible, the answer will likely be
“Yes.”
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Before an appropriate decision can be made about whether an
ethical/legal problem exists, you should:
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Consider all relevant facts, values and beliefs
Consider different perspectives about the issue
Identify all individuals who have an interest in the
outcome
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Once it is established that an ethical and/or legal dilemma exists, the
questions addressed include:
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“What possible courses of action are permissible, impermissible or
necessary?”
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and
“What are the effects (benefits and burdens) of each
action?”
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
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Each conflict is evaluated in consideration of the ASHA Code of
Ethics and of the ethical principles that form the philosophical basis of
the Code.
These ethical principles include:
Ethical Principles
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Moral obligations reflected in ethical principles:
Beneficence (Principles of Ethics II)
Non-maleficence
Autonomy (Rules of Principle IV, Rules C, C, F, K, J)
Justice (Principle I, Rules A, D, E, F, G; Principle III, Rules B & C)
distributive justice (i.e., just distribution of benefits & burdens); fidelity
(the keeping of promises)
F
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of four principles
consists of four
code.
The ASHA Code of Ethics consists
of four Principles of ethics which
constitute the moral basis for the
code.
Principles of Ethics
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I – Responsibilities to persons served professionally
II – Responsibility for one’s professional competence
III – Responsibility to the public
IV – Responsibilities involving inter- and intra-professional
relationships
A code of ethics does not make a person ethical nor is it the
mechanism by which we solve ethical problems
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Ethical decision-making involves a commitment to applying the ethics
code to construct rather than simply to discover solutions to ethical
quandaries.
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The proposed course of action is also
examined in relation to to personal interests,
social roles and expectations and the ensuing
obligations that accompany these roles.
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
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The final step in the process is to determine whether the proposed
course of action leads to consensus. If consensus has been achieved,
deliberation may be complete. If it has not been, the information which
influenced the decision is re-assessed and other solutions or
interpretations proposed.
Ethical/Legal Decision-Making Model
What are the relevant
facts, values, & beliefs
Am I facing an
Ethical/Legal
dilemma here?
Who are the key people
involved
Ethical/Legal Decision-Making Model
State the dilemma
clearly
Analysis
Ethical/Legal Decision-Making Model
What are the possible
courses of action?
What are the conflicts
that arise from
each action?
Proposed
course of action
Ethical/Legal Decision-Making Model
Evaluate:
1. Ethical Principles
2. Code of Ethics
3. Social Roles
4. Self- Interests
5. Laws
Does your proposed course
of action lead to
CONSENSUS?
if yes- then proceed ...
• ASHA
• State Licensure Boards
• Colleagues
• Employers
• Unions
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, presenting in-services on the importance of
ethics in the workplace.
Develop a library of ethics resources
Connect the Code of Ethics with your
program’s mission statement, policies &
procedures and performance evaluations
Familiarize yourself with the Code of
Ethics

Good decisions
pave the way
for more good
decisions
Ethical Situations and Dilemmas
Bad Moon Rising
Credence Clearwater Revival
Ethical Situation
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You and another supervisor have been assigned to
supervise graduate student clinical practicum
activities in a rehabilitation center off-campus. The
other supervisor often lets his/her supervisees
dismiss therapy early and go home, but still lets the
students claim the full amount of clinical practicum
hours.
Is this an ethical dilemma?
What is the major ethical issue?
How should the problem be resolved?
What are the potential consequences?
Mustang Sally
Wilson Pickett
Is this an ethical dilemma?
What is the major ethical issue?
How should the problem be resolved?
What are the potential consequences?
Crying in the Chapel
Elvis
Ethical Situation - SLP
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An SLP who is planning to get married over the weekend
and go on her honeymoon the following week, is intent on
having all of her paperwork completed before she leaves
work on Friday. On Thursday, she completes the Medicaid
billing for the month and includes therapy sessions for two
sessions for two children who are usually seen on Friday
mornings. The children are both absent on Friday, but she
submits the billing as it was completed with the intention to
omit one of the Medicaid billings for the next session with
the children.
Is this an ethical dilemma?
What is the major ethical issue?
How should the problem be resolved?
What are the potential consequences?
What’s Going On?
Smokey Robinson
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Ethical Situation - SLP
Is this an ethical dilemma?
What is the major ethical issue?
How should the problem be resolved?
What are the potential consequences?
Wake Up Little Susie
TheBrothers TtT
The Everly Brothers
Ethical Dilemma - SLP
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An SLP assistant enters a therapy room to get
materials for her next group session. Upon entering
the room, she discovers a child coloring pictures
while the supervisor, Susie Jones, is asleep in a
chair. After being awakened, Susie asks the
assistant to not mention the incident to anyone.
Is this an ethical dilemma?
What is the major ethical issue?
How should the problem be
resolved?
What are the potential
consequences?
Elvis
ETHICAL DILEMMA
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Janie Smith is a new, enthusiastic SLP who began work at
a local hospital. She enjoys communicating with patients
and their families at work and outside of work and has
“friended” several of her patients as well as the families of
her patients on Facebook. Contained within Janie’s
Facebook postings is information about how much progress
her stroke patients made that week.
Is this an ethical dilemma?
What is the major ethical issue?
How should the problem be resolved?
What are the potential consequences?
Money (That’s What I Want)
Barrett Strong
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ETHICAL SITUATION
SPEECH-LANGUAGE PATHOLOGY
Bonnie Baker was evaluated by the SLP at Bayou
Elementary School and it was determined that
Bonnie was eligible to receive therapy through the
school system. However, the SLP convinces Mr.
and Mrs. Baker that Bonnie’s needs would be better
served if they enrolled Bonnie in private therapy.
Is this an ethical dilemma?
What is the major ethical issue?
How should the problem be resolved?
What are the potential consequences?
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Shelly Chabon
[email protected]
Ellen Estomin
[email protected]
Theresa Rodgers
[email protected]