Assumptions about Decision-Making Capacity and Aphasia: Ethical Implications and Impact.

This article explores the issue of aphasia and decision-making within the context of clinical ethics and patient rights. The cases described illustrate the danger of making assumptions about the inherent competence of people with aphasia and the life-altering consequences if no attempt is made to "accommodate" or support communication when competence may be masked by aphasia. Speech-language pathologists have a moral obligation and a key role to play in providing communication support that may serve to reveal a person's intact capacity to make specific decisions, as well as in supporting the steps involved in the decision-making process. This role also extends to providing guidance, education, and training for others involved in evaluating the decision-making capacity of people with aphasia. Communication support strategies useful at each stage of the decision-making process are detailed.

Complexity of Clinical Decision Making: Consent, Capacity, and Ethics.

Speech-language pathologists (SLPs), and really their patients, are often faced with challenging clinical decisions to be made. Patients may decline interventions recommended by the SLP and are often inappropriately labeled "noncompliant." The inappropriateness of this label extends beyond the negative charge; the patient's right to refuse is, in fact, protected by law. Anecdotal exchanges, social media platforms, and American Speech-Language-Hearing Association forums have recently revealed that many SLPs are struggling with the patient's right to decline. Many are not comfortable with the informed consent process and what entails patients' capacity to make their own medical decisions. Here, we discuss the basics of clinical decision-making ethics with intent to minimize the clinician's discomfort with the right to refuse those thickened liquids and eliminate the practice of defensive medicine.

Use of images of patients in social networks: how do speech-language therapists perceive and act? / Uso de imagens de pacientes em redes sociais: como percebem e agem os fonoaudiólogos?

PURPOSE: Investigating the perception and self-reported behavior of speech-language therapist about ethical and legal aspects related to the use of images of patients in social networks, comparing such findings with sociodemographic data. METHODS: An online questionnaire with 13 questions was the instrument used to collect data related to the demographic data of the participants and to the perception of speech-language therapists. The questionnaire was available on the Google Forms platform e was answered by 765 participants. RESULTS: Most participants agreed that the Code of Ethics of Speech-Language Pathology gives information about the use of images in social networks (67.98%), that the publication of photos and / or videos of patients in social networks without authorization by written is an ethical infraction (93.33%) and that the image´s rights is guaranteed by the Brazilian Constitution (89.94%). 18.56% of speech-language pathologists stated that they had never used the Code of Ethics in Speech-Language Pathology. Concerning the exhibition of images in social networks, 5.1% stated that they had shown on their social networks photographs and / or videos without authorization, and 21.18% did so with only verbal authorization. Almost all participants (95.16%) mentioned having seen photographs or videos of patients on virtual social networks posted by speech-language therapist. CONCLUSION: It was possible to verify the relevance of the results obtained and the impact of the research to encourage reflection on the subject.

OBJETIVO: Investigar a percepção e a conduta autodeclarada de fonoaudiólogos sobre aspectos éticos e legais relacionados ao uso de imagens de pacientes em redes sociais, comparando tais achados com dados sociodemográficos. MÉTODO: Para a coleta de dados, utilizou-se um questionário online disponibilizado na plataforma do GoogleDrive, que continha 13 questões abrangendo dados sociodemográficos e questões voltadas para a percepção de fonoaudiólogos quanto ao assunto estudado. A amostra da pesquisa foi composta por 765 participantes. RESULTADOS: A maior parte dos respondentes concordou, em algum grau, que o Código de Ética da Fonoaudiologia esclarece sobre o uso de imagens em redes, assim como a publicação de fotos e/ou vídeos de pacientes em redes sociais sem autorização por escrito, constitui infração ética e o direito de imagem está garantido pela Constituição Brasileira. Apenas 18,6% dos fonoaudiólogos afirmaram nunca terem recorrido ao Código de Ética em Fonoaudiologia. Quanto à exibição de fotografias ou vídeos em redes sociais, 5,1% afirmaram ter publicado, em alguma frequência, sem autorização e 21,18% o fizeram apenas com autorização verbal. Praticamente todos os participantes mencionaram já ter visto fotografias ou vídeos de pacientes em redes sociais virtuais postados por fonoaudiólogos. CONCLUSÃO: Foi possível notar a relevância do estudo para impulsionar debates sobre o assunto e a essencialidade de novos estudos no tema abordado.

Children as curators: how to incorporate young visitors' voices into the elaboration and evaluation of a microbiology exhibition / Crianças como curadores: como incorporar as vozes dos jovens visitantes na elaboração e avaliação de uma exibição de microbiologia

Abstract Studies of museum publics are relatively recent, and studies of child visitors are even more recent. In this paper we summarize the types of exhibition evaluations mentioned in the literature and present an evaluation process for an exhibition about microbiology developed for and with input from 4-to-6-year-old children. As a case study we analyzed an exhibition entitled "The Giant World of Microbes." Audio and video interviews were recorded with child visitors, and the stimulated recall technique was also employed. The data indicate the importance of interactive activities in enhancing child motivation and providing pertinent routes to follow when preparing an exhibition geared toward children.

Resumo Os estudos sobre exibições em museus são relativamente recentes, e estudos sobre crianças visitantes são mais recentes ainda. Este trabalho faz um resumo dos tipos de avaliações de exibição mencionados na literatura e apresenta um processo de avaliação para uma exibição de microbiologia desenvolvida para, e com o auxilio de, crianças entre 4 e 6 anos. Como estudo de caso analisamos uma exibição intitulada "O Mundo Gigante dos Micróbios". Foram gravadas entrevistas de áudio e vídeo com os visitantes mirins, e também se utilizou a técnica de estimulação da memória. Os dados indicam a importância das atividades interativas no fortalecimento da motivação das crianças e oferecem caminhos pertinentes a seguir na elaboração de exibições focadas no público infantil.

Uso de imagens de pacientes em redes sociais: como percebem e agem os fonoaudiólogos? / Use of images of patients in social networks: how do speech-language therapists perceive and act?

RESUMO Objetivo Investigar a percepção e a conduta autodeclarada de fonoaudiólogos sobre aspectos éticos e legais relacionados ao uso de imagens de pacientes em redes sociais, comparando tais achados com dados sociodemográficos. Método Para a coleta de dados, utilizou-se um questionário online disponibilizado na plataforma do GoogleDrive, que continha 13 questões abrangendo dados sociodemográficos e questões voltadas para a percepção de fonoaudiólogos quanto ao assunto estudado. A amostra da pesquisa foi composta por 765 participantes. Resultados A maior parte dos respondentes concordou, em algum grau, que o Código de Ética da Fonoaudiologia esclarece sobre o uso de imagens em redes, assim como a publicação de fotos e/ou vídeos de pacientes em redes sociais sem autorização por escrito, constitui infração ética e o direito de imagem está garantido pela Constituição Brasileira. Apenas 18,6% dos fonoaudiólogos afirmaram nunca terem recorrido ao Código de Ética em Fonoaudiologia. Quanto à exibição de fotografias ou vídeos em redes sociais, 5,1% afirmaram ter publicado, em alguma frequência, sem autorização e 21,18% o fizeram apenas com autorização verbal. Praticamente todos os participantes mencionaram já ter visto fotografias ou vídeos de pacientes em redes sociais virtuais postados por fonoaudiólogos. Conclusão Foi possível notar a relevância do estudo para impulsionar debates sobre o assunto e a essencialidade de novos estudos no tema abordado.

ABSTRACT Purpose Investigating the perception and self-reported behavior of speech-language therapist about ethical and legal aspects related to the use of images of patients in social networks, comparing such findings with sociodemographic data. Methods An online questionnaire with 13 questions was the instrument used to collect data related to the demographic data of the participants and to the perception of speech-language therapists. The questionnaire was available on the Google Forms platform e was answered by 765 participants. Results Most participants agreed that the Code of Ethics of Speech-Language Pathology gives information about the use of images in social networks (67.98%), that the publication of photos and / or videos of patients in social networks without authorization by written is an ethical infraction (93.33%) and that the image´s rights is guaranteed by the Brazilian Constitution (89.94%). 18.56% of speech-language pathologists stated that they had never used the Code of Ethics in Speech-Language Pathology. Concerning the exhibition of images in social networks, 5.1% stated that they had shown on their social networks photographs and / or videos without authorization, and 21.18% did so with only verbal authorization. Almost all participants (95.16%) mentioned having seen photographs or videos of patients on virtual social networks posted by speech-language therapist. Conclusion It was possible to verify the relevance of the results obtained and the impact of the research to encourage reflection on the subject.

Getting comfortable with "comfort feeding": An exploration of legal and ethical aspects of the Australian speech-language pathologist's role in palliative dysphagia care.

PURPOSE: With an ageing population, speech-language pathologists (SLPs) can expect to encounter legal and ethical challenges associated with palliative and end-of-life care more frequently. An awareness of the medico-legal and ethical framework for palliative dysphagia management will better equip SLPs to work effectively in this area. METHOD: This narrative review examines a range of legislation, legal, ethical and SLP literature that is currently available to orient SLPs to legal and ethical palliative dysphagia management in the Australian context. RESULT: Relevant legal and ethical considerations in palliative and end-of-life care are described. CONCLUSION: SLPs have a role in palliative dysphagia management, however, this can involve unique legal and ethical challenges. The legal position on provision and cessation of nutrition and hydration differs between Australian States and Territories. Decisions by the courts have established a body of relevant case law. This article introduces SLPs to some of the important considerations for legal and ethical palliative care, but is not intended to be directive. SLPs are encouraged to explore their local options for ethical and medico-legal guidance. It is hoped that increasing SLPs awareness of many of the concepts discussed in this article enhances the provision of high-quality patient-centred care.

Comparing the codes of ethics of the six signatory associations of the Mutual Recognition Agreement.

PURPOSE: The Agreement for the Mutual Recognition of Professional Association Credentials (MRA) between six national associations provides a mutually negotiated expedited process for applying for certification in speech-language pathology by any of the signatory associations. Although the MRA recognizes common standards in academic and clinical practice and eases the process to have credentials recognized, an interesting concept is that SLPs who have membership in more than one association must adhere to the code of ethics in each association. Thus, as SLPs will need to abide by them the question then becomes, are the codes of ethics in the six national associations comparable? METHOD: Using a content analysis procedure, the authors sought to identify similarities between the six codes of ethics. RESULT: The results revealed similarities between the six codes in areas such as responsibility to clients, professional conduct and practitioner competence. CONCLUSION: The findings should not to be interpreted to imply that one code of ethics was better or more comprehensive than another, as each code of ethics must be understood and interpreted in temporal, situational and local cultural contexts. Rather, the discussion includes a proposal to create a unified document.

Ethical dilemmas experienced by speech-language pathologists working in private practice.

Speech-language pathologists experience ethical dilemmas as they fulfil their professional roles and responsibilities. Previous research findings indicated that speech-language pathologists working in publicly funded settings identified ethical dilemmas when they managed complex clients, negotiated professional relationships, and addressed service delivery issues. However, little is known about ethical dilemmas experienced by speech-language pathologists working in private practice settings. The aim of this qualitative study was to describe the nature of ethical dilemmas experienced by speech-language pathologists working in private practice. Data were collected through semi-structured interviews with 10 speech-language pathologists employed in diverse private practice settings. Participants explained the nature of ethical dilemmas they experienced at work and identified their most challenging and frequently occurring ethical conflicts. Qualitative content analysis was used to analyse transcribed data and generate themes. Four themes reflected the nature of speech-language pathologists' ethical dilemmas; balancing benefit and harm, fidelity of business practices, distributing funds, and personal and professional integrity. Findings support the need for professional development activities that are specifically targeted towards facilitating ethical practice for speech-language pathologists in the private sector.

Competence-based curricula for the education of speech-language pathologists and audiologists in Brazil.

OBJECTIVE: The aim of this paper is to present the academic requirements for the education of speech-language pathologists (SLPs) and to discuss some of the challenges in providing quality supervised practice and the solutions proposed by some programs in Brazil. METHODS: Brazilian proposals regarding the training of SLPs are reviewed, with guidelines provided by the International Association of Logopedics and Phoniatrics (IALP) and the Comité Permanent de Liaison des Orthophonistes-Logopèdes de l'UE (CPLOL), and descriptions of the specific experience of the oldest Brazilian program are provided. RESULTS: The bachelor's degree is the minimum level required for the independent practice of speech-language pathology and audiology in Brazil, where there are 75 undergraduate programs. In several programs, students are encouraged to enjoy the diversity at their university, enrolling in courses of different areas to broaden their experience. The basic areas of the undergraduate program are mandatory as per recommendation of the Ministry of Education and include competences related to the health system, decision making, communication, leadership and continued education. Since practice training is part of the undergraduate programs, it is incorporated into the pedagogical concept and has a major role in it. CONCLUSION: The structure of the programs allows the dissociation of theory from practice to be attenuated; both educational strategies are used together as part of the pedagogical concept.

Sport, scales, or war? Metaphors speech-language pathologists use to describe caseload management.

Professionals' experiences, perceptions, and attitudes may be reflected in the metaphors they use to describe and discuss important professional issues. This qualitative study explored speech-language pathologists' experiences of caseload management through metaphorical analysis. Metaphors provided a lens for reflecting participants' lived experiences and professional knowledge construction. Data was obtained from 16 practising speech-language pathologists during individual work place interviews. Participants included new graduate and experienced speech-language pathologists who were employed in hospital and community settings. Metaphors for caseload management were identified from participants' transcribed narratives, then coded and organized into themes. Participants produced a total of 297 metaphors during professional practice narratives. Thematic analysis indicated that participants used three salient metaphors of sport, measuring scales, and war when they addressed caseload issues. Metaphors of sport, scales, and war reflected speech-language pathologists' concerns about managing clients efficiently, perceived caseload burdens, and the conflict they experienced when resources were inadequate. These metaphors may also represent a continuum in speech-language pathologists' personal and professional responses to caseload demands. Shared metaphors may contribute to the professional socialization of individuals entering a profession and to changing or maintaining workplace culture. Hence, speech-language pathologists need to consider the impact of using metaphors of sport, measuring scales, and war during interactions with clients and colleagues.

Ethics of disability: foundation of the profession of speech-language pathology.

Ethics is a continuous and dynamic decision process that ultimately seeks to render a judgment about the morality of human conduct. A genre of applied ethics, social ethics is concerned with promoting societal morality, specifically ensuring the rights of disenfranchised groups such as people with disabilities. This article will examine concepts of ethical theory and practice and also trace the historical development and evolution of social ethics for disability. In its conclusion, this article will highlight the advocacy role of speech and language professionals to ensure an ethical response to disability.

Good ethical tone in the work setting.

Speech-language pathologists report a broad range of situations that they believe represent professional dilemmas. Some arise in their employment settings because of mandates and employment-related policies established by their employers, supervisors, and administrators. Their reports do not as often reflect the many instances where ethical problems associated with the workplace may occur because of the conduct and actions of speech-language pathologists themselves. The purpose of this article is to identify and discuss some common quandaries speech-language pathologists and their employers may experience that are associated with workplace-related matters.

Ethical deliberation: a foundation for evidence-based practice.

Infusing evidence-based practice (EBP) into the clinical setting implies that professionals use evidence that is relevant and credible, maintain their pursuit of best current knowledge, respect their clients' preferences and values, and keep these clients and their families appropriately informed about their treatment options. Thus, rational and judicious EBP must be guided by speech-language pathologists' or audiologists' ethical principles of beneficence, non-maleficence, justice, and autonomy. In this article, we will affirm the centrality of ethical reasoning in EBP by describing what it means to be a professional as reflected in our Code of Ethics, reviewing the principles of ethics that underlie clinical decision making, and demonstrating how an ethical framework can and should provide the context in which EBP is conducted.

Ethics in stuttering treatment in the schools: issues and intersections.

When the challenges of providing speech-language pathology services in school settings intersect with the complexities of meeting the unique needs of students who stutter, clinicians may encounter a variety of ethical issues. This article explores some of the ethical challenges of treating stuttering in school settings by discussing three clinical scenarios. Seedhouse's Ethics Grid is provided as a scaffold to support the critical analysis of school-based stuttering treatment issues. Factors examined include creating and respecting autonomy, serving student needs, doing good and minimizing risks, and telling the truth and keeping promises. In addition, clinical outcomes are considered in terms of their impact on students and family members, clinicians, students with communication disorders other than stuttering, and school personnel. Finally, some of the practical concerns when treating stuttering in school settings are discussed, including the law, codes of practice, wishes of others, as well as the effectiveness and efficiency of actions.

Ethics in the practice of speech-language pathology in health care settings.

ETHICS refers to a moral philosophy or a set of moral principles that determine appropriate behavior in a society. Medical ethics includes a set of specific values that are considered in determining appropriate conduct in the practice of medicine or health care. Because the practice of medicine and medical speech-language pathology affects the health, well-being, and quality of life of individuals served, adherence to a code of ethical conduct is critically important in the health care environment. When ethical dilemmas arise, consultation with a bioethics committee can be helpful in determining the best course of action. This article will help to define medical ethics and to discuss the six basic values that are commonly considered in discussions of medical ethics. Common ethical mistakes in the practice of speech-language pathology will be described. Finally, the value of a bioethics consultation for help in resolving complex ethical issues will be discussed.

Palliative care curriculum for speech-language pathology students.

This paper reports on the experience of undergraduate speech-language pathology students at one university chosen for the implementation stage of the Palliative Care Curriculum for Undergraduates (PCC4U) Project. Funded by a government department for health and ageing through a national palliative care programme, the project was managed by a team of researchers from the discipline of nursing. The PCC4U project championed the inclusion of palliative care education as an integral part of medical, nursing, and allied healthcare undergraduate training. Of the pilot sites chosen for the PCC4U project, only one site, reported here, included both speech-language pathology and social work disciplines, providing an important opportunity for interdisciplinary collaboration on novel curriculum development in an area of mutual interest. This synergy served as an excellent foundation for ongoing opportunities for interdisciplinary teaching and learning in the university. Speech-language pathology students reported that the project was an invaluable addition to their education and preparation for clinical practice.

Working with families of persons with aphasia: a survey of Swedish speech and language pathologists.

PURPOSE: The overall aim was to investigate how speech and language pathologists (SLPs), in Sweden are working with people with aphasia and their families and what their professional experiences are. METHOD: A cross-sectional study with a descriptive and comparative design. An 84-item study-specific questionnaire was sent to all Swedish SLPs, affiliated to SLOF (the Swedish professional association and trade union). RESULTS: The response rate was 72.5% (n = 758). Thirty per cent worked with people with aphasia and typically met with their families. The participants considered the involvement of families as very important, especially concerning providing information of aphasia and training of communication strategies. However, involvement of families was limited due to a shortage of time, but also to perceived limited skill and knowledge. CONCLUSIONS: There was an evident discrepancy between what the participants claimed to be an important part of their work, and their actual practice. It is suggested that to facilitate family intervention, this should be explicitly expressed in both local and national guidelines. The content of the SLP education, and the need of further education and implementation of new knowledge into clinical practice also requires consideration.

La evaluación del lenguaje: orientaciones alternativas / Language assessment: alternative approaches

En este trabajo se tratan algunas cuestiones de interés para la evaluación del lenguaje. Se establece la distinción entre métodos prescriptivos (formales, estandarizados y basados en razonamiento deductivo) y descriptivos (no formales o alternativos, derivados de razonamiento inductivo). Tras mencionar algunas de las limitaciones de los métodos formales y tradicionales en lo que a la evaluación del lenguaje se refiere, derivadas principalmente en sus dificultades para la evaluación de las interacciones comunicativas y de la diversidad contextual debidas al exceso de control y sistematización de la situación, se comentan algunas cuestiones éticas sobre uso de los tests formales y se hace una reflexión sobre la validez del tratamiento diseñado según los resultados de algunos de estos tests. En la segunda parte, se comentan algunas de las estrategias de evaluación consideradas alternativas a la evaluación estandarizada, como la evaluación referida por criterios y específica del paciente, la evaluación auténtica, la evaluación dinámica, los portafolios y la utilización de medidas dependientes del procesamiento y se comentan algunas de sus aportaciones a la evaluación del lenguaje y sus trastornos. Se concluye el trabajo analizando las causas de la poca utilización de estas técnicas por los logopedas y se plantea la necesidad de una mayor investigación sobre la fiabilidad, validez y aplicabilidad clínica de estas medidas (AU)

This article discusses some issues in language assessment and distinguishes between prescriptive methods (formal, standardized methods, based on deductive reasoning) and descriptive methods (non-formal or alternative methods, derived from inductive reasoning). After mentioning some of the limitations of formal and traditional methods of language assessment, mainly arising from difficulties in assessing communicative interactions and contextual diversity due to excessive and systematic control of the situation, we discuss some ethical issues in the use of formal tests and reflect on the validity of treatments based on the results of some of these tests. The second part of this article discusses some of the evaluation strategies considered as alternatives to standardized assessment, such as criterion-referenced and client-specific assessment, authentic assessment, dynamic assessment, portfolios and the use of processing-dependent measures, and describes some of their contributions to the evaluation of language and language disorders. Finally, the reasons for the low utilization of these techniques by speech therapists are analyzed and the need for further research on the reliability, validity and clinical applicability of these measures is discussed (AU)