Applying ethical reasoning approaches to complex cases in professional practice

Belinda Kenny

doi:10.11157/fohpe.v16i3.87

Authors

Belinda Kenny The University of Sydney

DOI:

https://doi.org/10.11157/fohpe.v16i3.87

Keywords:

ethics, professional ethics, clinical speech?language pathology, deglutition disorders

Abstract

Background: This study explored speech pathologists’ experiences with dysphagia management—an ethically complex area of professional practice. It aimed to describe speech pathologists’ responses to ethical dilemmas and to interpret their responses using four different approaches to ethical reasoning.

Research approach: Four cases were drawn from a multisite qualitative study of ethics in the speech pathology profession. Cases were based upon findings from individual interviews with experienced speech pathologists. Participants’ narratives were analysed by mapping responses against features of bioethical principles, casuistry, narrative and ethics of care approaches.

Findings: Speech pathologists’ ethical reasoning stories demonstrate how experienced professionals may apply elements of principle-based, casuistry, ethics of care and narrative approaches to resolve ethical conflict.

Conclusions: Contributions of each approach are discussed with examples of how theoretical approaches may guide healthcare professionals and students to manage ethically troubling scenarios.

References

American Speech-Language-Hearing Association (ASHA). (2010). Code of ethics. doi:10.1044/policy.ET2010-00309

Angel, L. A., & Simpson, M. D. (2007). Report of best practice: Development of an ethics manual as an integral component of undergraduate curriculum and application for graduates and practitioners. Journal of Learning Design, 2(1), 1‒13.

Beauchamp T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). New York, NY: Oxford University Press.

Body, R., & McAllister, L. (Eds.). (2009). Ethics in speech and language therapy. Oxford, England: John Wiley & Sons.

Boud, D., Keough, R., & Walker, D. (1985). Reflection: Turning experience into learning. London, England: Kogan Page.

Bowden, P. (2010). Teaching ethics to engineers: A research-based perspective. European Journal of Engineering Education, 35(5), 563‒572.

Branch, Jr., W. T. (2000). The ethics of caring and medical education. Academic Medicine, 75(2), 127‒132.

Clark, P. G., Cott, C., & Drinka, T. J. K. (2007). Theory and practice in interprofessional ethics: A framework for understanding ethics issues in health care teams. Journal of Interprofessional Care, 21(6), 591‒603.

Coope, C. (1996). Does teaching by cases mislead us about morality? Journal of Medical Ethics, 22, 46‒52.

Cowley, C. (2005). The dangers of medical ethics. Journal of Medical Ethics, 31, 739‒742.

Crary, M. A., & Groher, M. E (2008). Introduction to adult swallowing disorders. St. Louis, MO: Butterworth Heinemann.

Creswell, J. (2013). Research design: Qualitative, quantitative and mixed methods approaches (4th ed.). Thousand Oaks, CA: Sage.

DiCicco-Bloom, B., & Crabtree, B. F. (2006). The qualitative research interview. Medical Education, 40(4), 314‒321.

Elkin S. A. (2004). The integration of ethics teaching in the therapy professions. Focus on Health Professional Education: A Multi-Disciplinary Journal, 5(3), 1‒6.

Furnari, M. G. (2004). Bioethics, women and the voice of care. International Journal

of Ethics, 3, 355‒369.

Gilligan, C. (1982). In a different voice: Psychological theory and women’s development. Cambridge, MA: Harvard University Press.

Goodfellow, J. (1998). Analysing data in narrative inquiry research. In J. Higgs (Ed.), Writing qualitative research (pp. 105‒120). Five Dock, NSW, Australia: Hampden Press.

Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical psychologists: An acculturation model. Professional Psychology: Research and Practice, 36(1), 59‒65.

Hudson Jones, A. (2002). The colour of the wallpaper: Training for narrative ethics. In R. Charon & M. Montello (Eds.), Stories matter: The role of narrative in medical ethics (pp. 160‒167). New York, NY: Routledge.

Hunter Montgomery, K. (1996). Narrative, literature, and the clinical exercise of practical reason. The Journal of Medicine and Philosophy, 21, 303‒320.

Jonsen, A. R. (1991). Casuistry as methodology in clinical ethics. Theoretical Medicine, 12(4), 295‒307.

Jonsen, A. R., Siegler, M., & Winslade, W. J. (2010). Clinical ethics: A practical approach to ethical decisions in clinical medicine (7th ed.). New York, NY: McGraw-Hill.

Kenny, B., Lincoln, M., & Balandin, S. (2007). A dynamic model of ethical reasoning in speech pathology. Journal of Medical Ethics, 33, 508‒513.

Kenny, B., Lincoln, M., & Balandin, S. (2010). Experienced speech pathologists’ response to ethical dilemmas: An integrated approach to ethical reasoning. American Journal Speech‒Language Pathology, 19(2), 121‒134.

Kenny, B., Lincoln, M., Blyth, K., & Balandin, S. (2009). Ethical perspective on quality of care: The nature of ethical dilemmas identified by new graduate and experienced speech pathologists. International Journal of Language and Communication Disorders, 44, 421‒439.

Kirklin, D. (2007). Minding the gap between logic and intuition: An interpretive approach to ethical analysis. Journal of Medical Ethics, 33, 386‒389.

Leitão, S., Bradd, P., McAllister, L., Russell, A., Block, S., Kenny, B., . . . Wilson, C. (2014). The 2014 ethics education package. Melbourne, Australia: Speech Pathology Association of Australia.

Maeckelberghe, E. (2004). Feminist ethic of care: A third alternative approach. Health Care Analysis, 12(4), 317‒327.

Nelson, H. L. (2002). Context: Backwards, sideways and forward. In R. Charon & M. Montello (Eds.), Stories matter: The role of narrative in medical ethics (pp. 39‒47). New York, NY: Routledge.

Noddings, N. (2013). Caring: A relational approach to ethics and moral education. Berkeley, CA: University of California Press.

Pollens, R. (2004). Role of the speech-language pathologist in palliative hospice care. Journal of Palliative Medicine, 7(5), 694‒702.

Pollens, R. (2012). Integrating speech-language pathology services in palliative end- of-life care. Topics in Language Disorders, 32(2), 137‒148.

Roe, J. W. G., & Leslie, P. (2010). Beginning of the end? Ending the therapeutic relationship in palliative care. International Journal of Speech-Language Pathology, 12(4), 304‒308.

Sharp, M., & Brady Wagner, L. (2007). Ethics, informed consent, and decisions about nonoral feeding for patients with dysphagia. Topics in Geriatric Rehabilitation, 23(3), 240‒248.

Sharp, H. M., & Geneson, L. B. (1996). Ethical decision-making in dysphagia management. American Journal of Speech-Language Pathology, 5, 15‒22.

Smith, H., Muller, N., & Bradd, T. (2011). Dysphagia assessment and management at the end of life: Some ethical considerations. ACQuiring Knowledge in Speech, Language, and Hearing, 13(2), 88‒91.

Speech Pathology Australia (SPA). (2012). Dysphagia clinical guidelines. Melbourne, Australia: Author.

Speech Pathology Australia (SPA). (2010). Code of ethics. Melbourne, Australia: Author.

Speech Pathology Australia (SPA). (2002) Dysphagia: Position paper. Melbourne, Australia: Author.

Vergés, A. (2010). Integrating contextual issues in ethical decision making. Ethics & Behaviour, 20(6), 497‒507.

West, C., & Chur-Hansen, A. (2004). Ethical enculturation: The informal and hidden ethics curricula at an Australian medical school. Focus on Health Professional Education: A Multi-Disciplinary Journal, 6(1), 85‒99.

White, K. (2001). Professional craft knowledge and ethical decision making. In J. Higgs & A. Titchen (Eds.), Practice knowledge and expertise in the health professions (pp. 142‒149). Oxford, England: Butterworth-Heinemann.