In The Presence Of Other Lives Ethics and SLT

1
In The Presence Of Other LivesEthics and SLT

• Dr Richard Body
• Department of Human Communication Sciences

2
A ScenarioWhats So Bad About Lying?

• SLT in an acute hospital
• 54-year old woman being seen for intermittent
  voice problems
• Advised by ENT to have nasendoscopy not keen at
  all

3
A ScenarioWhats So Bad About Lying?

• SLT in an acute hospital
• 54-year old woman being seen for intermittent
  voice problems
• Advised by ENT to have nasendoscopy not keen at
  all
• Th erapist Its really important that you have
  the nasendoscopy done so that we know whats
  going on .

4
A ScenarioWhats So Bad About Lying?

• SLT in an acute hospital
• 54-year old woman being seen for intermittent
  voice problems
• Advised by ENT to have nasendoscopy not keen at
  all
• Th erapist Its really important that you have
  the nasendoscopy done so that we know whats
  going on .
• Client Yes, but I really dont want to have a
  tube stuck up my nose.

5
A ScenarioWhats So Bad About Lying?

• SLT in an acute hospital
• 54-year old woman being seen for intermittent
  voice problems
• Advised by ENT to have nasendoscopy not keen at
  all
• Th erapist Its really important that you have
  the nasendoscopy done so that we know whats
  going on .
• Client Yes, but I really dont want to have a
  tube stuck up my nose.
• Therapist Its not actually that bad.

6
A ScenarioWhats So Bad About Lying?

• SLT in an acute hospital
• 54-year old woman being seen for intermittent
  voice problems
• Advised by ENT to have nasendoscopy not keen at
  all
• Th erapist Its really important that you have
  the nasendoscopy done so that we know whats
  going on .
• Client Yes, but I really dont want to have a
  tube stuck up my nose.
• Therapist Its not actually that bad.
• Client How do you know have you had it done?

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The Issue

• Is lying acceptable in this situation ?
• RCSLT Code of Ethics
• RCSLT members must act in the best interests of
  individuals using speech and language therapy
  services.

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The Verdict

• Is lying acceptable in this situation ?
• 1) Yes, thats a neat trick. I might try it.
• 2) Yes, but dont do it again.
• 3) No, but I understand why you did it.
• 4) No, you should be struck off.

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Discussthe following proposition

• Therapists should not display any sign of
  sporting allegiance in their clothing or
  workplace.

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Discuss

• Therapists should not display any sign of
  political affiliation in their clothing or
  workplace.

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Discuss

• Therapists should not display any sign of
  political affiliation in their clothing or
  workplace.
• One of the uncontroversial hallmarks of
  professionalism is that it requires the
  professional to act in an impartial, unbiased
  manner.
• Schuklenk, U. (2006) Medical professionalism
  and ideological symbols in doctors rooms.
  Journal of Medical Ethics 32, 1-2.

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Discuss

• Therapists should not display any sign of
  political affiliation in their clothing or
  workplace.

13
Discuss

• Therapists should not display any sign of
  religious affiliation in their clothing or
  workplace.

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• The issue at hand is how the patient perceives
  and interprets the symbols
• and the negative consequences of with-holding
  vital lifestyle or health-related information for
  fear of disapprobation from the doctor or other
  health professional.
• Perhaps it is time to leave the non-professional
  aspects of personal life at the door and face
  patients as medical professionals and no more.
• Schuklenk, U. (2006) Medical professionalism and
  ideological symbols in doctors rooms. Journal of
  Medical Ethics 32, 1-2.

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Introduction(slightly late)

• Ethics in speech and language therapy
• What Im not going to do
• discuss ethical theories (deontology,
  utilitarianism)
• tell you how to lead a morally better life
• put up any more pictures of footballers
• What I am going to do
• highlight current ethical issues from outside SLT
• discuss their relevance to SLT

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The Point

• As a profession we need to discuss ethical issues
  more openly / widely / often in the way that
  medical professionals do.

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The Title

• a process of deliberation about how best to act
  in the presence of other lives
• David Seedhouse
• Ethics The Heart of Healthcare
• Wiley (1998)

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Scenario

• Saying no to the staff an analysis of refusals
  in a home for people with severe communication
  difficulties.
• Finlay, Antaki Walton (in press) Sociology of
  Illness Health
• Staff are under obligation to
• weigh residents regularly for health screening
• promote choice, control and empowerment for
  clients
• 1 client, Matthew, has a strong aversion to
  stepping on the scales
• Matthew has a vocabulary of about 20 words,
  mostly in set routine interactions. Mainly uses
  vocalisation.
• Staff dyou wanna get weighed?
• M (turning away from staff) nehr
• Staff ?

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Scenario

• Saying no to the staff an analysis of refusals
  in a home for people with severe communication
  difficulties.
• Finlay, Antaki Walton (in press) Sociology of
  Illness Health
• Staff are under obligation to
• weigh residents regularly for health screening
• promote choice, control and empowerment for
  clients
• 1 client, Matthew, has a strong aversion to
  stepping on the scales
• Matthew has a vocabulary of about 20 words,
  mostly in set routine interactions. Mainly uses
  vocalisation.
• Staff dyou wanna get weighed?
• M (turning away from staff) nehr
• Staff (after a few minutes) dyou want another
  go?

20
Scenario

• Saying no to the staff an analysis of refusals
  in a home for people with severe communication
  difficulties.
• Finlay, Antaki Walton (in press) Sociology of
  Illness Health
• Staff are under obligation to
• weigh residents regularly for health screening
• promote choice, control and empowerment for
  clients
• 1 client, Matthew, has a strong aversion to
  stepping on the scales
• Matthew has a vocabulary of about 20 words,
  mostly in set routine interactions. Mainly uses
  vocalisation.
• Staff dyou wanna get weighed?
• M (turning away from staff) nehr
• Staff (after a few minutes) shall we get
  weighed?

21
Scenario

• Saying no to the staff an analysis of refusals
  in a home for people with severe communication
  difficulties.
• Finlay, Antaki Walton (in press) Sociology of
  Illness Health
• Choice and control are issues that arise in the
  way people talk to each other, in which
  utterances are taken up and which are ignored, in
  how and what options are offered, in how
  preferences are expressed, how information is
  presented, how spaces are opened up for people to
  express preference and how spaces are shut down.
• Even with changes in the ways services are
  commissioned and the types of services available,
  without a sensitive and well-trained workforce
  these broader values will not be achieved.

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Other Current Issuesfrom Journal of Medical
Ethics

• How physicians face ethical difficulties a
  qualitative analysis

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Other Current Issuesfrom Journal of Medical
Ethics

• How SLTs face ethical difficulties a
  qualitative analysis
• Do SLTs face ethical difficulties?
• people with dysphagia seen within 2 working days
• people without dysphagia seen within 10 working
  days
• Is it acceptable to undertake therapy, the effect
  of which is unproven?
• Is it acceptable not to?
• uncertainty of information

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Other Current Issuesfrom Journal of Medical
Ethics

• How physicians face ethical difficulties a
  qualitative analysis
• A review of 31 cases brought before a Clinical
  Ethics Committee
• Should doctors talk to relatives without a
  competent patients consent?

25
Other Current Issuesfrom Journal of Medical
Ethics

• How physicians face ethical difficulties a
  qualitative analysis
• A review of 31 cases brought before a Clinical
  Ethics Committee
• Should SLTs talk to relatives without a competent
  patients consent?
• many of the people we work with by definition
  find it difficult to represent themselves

26
Other Current Issuesfrom Journal of Medical
Ethics

• How physicians face ethical difficulties a
  qualitative analysis
• A review of 31 cases brought before a Clinical
  Ethics Committee
• Should doctors talk to relatives without a
  competent patients consent?
• Are patients morally responsible for their
  errors?

27
Other Current Issuesfrom Journal of Medical
Ethics

• How physicians face ethical difficulties a
  qualitative analysis
• A review of 31 cases brought before a Clinical
  Ethics Committee
• Should doctors talk to relatives without a
  competent patients consent?
• Are patients morally responsible for their
  failure to carry out therapy regimes?

28
Other Current Issuesfrom Journal of Medical
Ethics

• How physicians face ethical difficulties a
  qualitative analysis
• A review of 31 cases brought before a Clinical
  Ethics Committee
• Should doctors talk to relatives without a
  competent patients consent?
• Are patients morally responsible for their
  failure to carry out therapy regimes?
• The ethics of facial allograft transplantation

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Sources

• Clinical ethics in the context of language and
  cognitive impairment rights and protections
• Clinical and professional ethics in the
  management of motor speech disorders Seminars in
  Speech and Language (2003) 244
• Medical Ethics and the Speech-Language
  Pathologist
• Strand, Yorkston Miller (1998)
• from Medical Speech-Language Pathology A
  Practitioners Guide
• Sensible solutions or daft ideas
• To the golden rule of ethics - beneficence,
  non-maleficence, autonomy, justice - is added
  another communication need.
• Taylor Stansfield, Speech and Language Therapy
  in Practice (2003)

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Whats so bad about bribery?

• Bribe
• Prejudice
• Cents Sensibility

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• RCSLT Code of Ethics
• RCSLT members must decline gifts or hospitality
  from individuals which could be construed as
  inducements to gain preferential therapy

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• Higher ( less dodgy)
• Mid therapy
• A box of biscuits at Xmas
• Lower ( more dodgy)

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• Higher ( less dodgy)
• Mid therapy
• A 10 gift voucher at Xmas
• Lower ( more dodgy)

34

• Higher ( less dodgy)
• Mid therapy
• A bottle of brandy at Xmas
• Lower ( more dodgy)

35

• Higher ( less dodgy)
• Mid therapy
• A bunch of flowers for your birthday
• Lower ( more dodgy)

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• Higher ( less dodgy)
• End of therapy
• Lower ( more dodgy)

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• Higher ( less dodgy)
• End of therapy
• A bunch of flowers
• Lower ( more dodgy)

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• Higher ( less dodgy)
• End of therapy
• 50
• Lower ( more dodgy)

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• Higher ( less dodgy)
• End of therapy
• 50 to the charity of your choice
• Lower ( more dodgy)

40

• Higher ( less dodgy)
• End of therapy
• 50 to the charity
• of which you are treasurer
• Lower ( more dodgy)

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RCSLT Code of Ethics

• RCSLT members must
• make sure that personal behaviour does not
  damage the speech and language therapy
  professions reputation.
• What (not) to do at the weekends

• Probably acceptable
• origami
• attending student conferences
• going to the pub

• Probably unacceptable
• selling Class A drugs
• shoplifting

Might be acceptable, might not ??????????????????
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• The End