Part 1: Ethics and Considerations in Patient and Caregiver Perspectives
Not unique to the field of Speech-Language Pathology, integration of Evidence Based Practice (EBP) is a hot topic and is essential in ensuring we are practicing at the top of our profession. Let’s begin by reviewing the three characteristics comprising the EBP triangle as outlined by the National Joint Committee for the Needs of Persons with Disabilities (NJC): (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) the perspectives of individuals with severe disabilities and their families and friends to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve (NJC, n.d.). Over the next few months, we will discuss each of these areas in more detail. Although patient value and perspective is listed last, we will address this first, as this is an area worth consistent reflection and application.
We are unable to practice EBP and place true value on our patient’s choices, without consideration of ethics. The ASHA Code of Ethics defines principles of ethical conduct the clinician is expected to value and uphold within practice. The first of which requires clinicians to “honor their responsibility to hold paramount the welfare of persons they serve professionally.” This principle states “Individuals shall obtain informed consent from the persons they serve about the nature and possible risks and effects of services provided, technology employed, and products dispensed.” Responsibility further outlined in the principle includes “informing persons served about possible effects of not engaging in treatment or not following clinical recommendations. If diminished decision-making ability of persons served is suspected, individuals should seek appropriate authorization for services, such as authorization from a spouse, other family member, or legally authorized/appointed representative” (ASHA, 2016).
Additionally, there are four basic principles of ethics to consider within EBP (Beauchamp & Childress, 1994):
- Autonomy - Acknowledging and respecting the patient’s decision making ability
- Beneficence - Placing value on the welfare of the patient
- Non-maleficence - Avoid doing harm to the patient
- Justice - Treating each patient with integrity and fairness
As we evaluate and formulate a plan of care for the patients we serve, we see how essential patient and caregiver involvement is in each step of the process. After all, we know the patient’s participation, values, and expectations are the best predictors of success or failure (Coyle & Leslie, 2006).
Careful consideration of the patient’s values may begin with an objective questionnaire or a more informal approach of inquiring into the patient’s goals and desires. We may present questions such as, “Do you (does the patient) have a favorite food or drink?” or “Do you (does the patient) have any food-focused events or occasions upcoming with family and friends?” We can continue the process as we complete thorough clinical and instrumental swallow assessments. Have we reviewed the results with the patient in a manner they understand? Have we provided results from recent research and clinical expertise to explain possible consequences of their specific swallowing impairments as well as interventions that may be beneficial? Are we involving the patient or caregiver in selection of the approach to swallowing therapy and food and liquid choices?
In the end, are we providing choices to our patients, listening to their specific needs and desires, and upholding their decisions? If we answer yes to these questions, we are on the right path to executing ethics and care in evidence based practice.
National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC). (n.d.). Evidence-Based Practice (EBP). Retrieved March 10, 2020, from https://www.asha.org/NJC/Evidence-Based-Practice/
American Speech-Language-Hearing Association. (2016). Code of ethics. Ethics. www.asha.org/policy/
Beauchamp, T. L. & Childress, J. F. (1994). Principles of Biomedical Ethics (4th ed.). Oxford University Press.
Coyle, J. L. & Leslie, P. (2006). Evidence-Based Practice—The Ethical Imperative. Perspectives on Swallowing and Swallowing Disorders (Dysphagia). https://doi.org/110.1044/sasd15.4.1