Introduction
Every occupation has codified and binding standards of honesty and professional integrity to ensure that people are treated with dignity and fairness. Experts who treat specific individuals, such as lawyers or doctors, commonly have confidentiality agreements to cultivate clients’ trust and respect their right to privacy. Speech-language pathologists and audiologists (SLPA) are also expected to maintain confidentiality when discussing the status of their research or clinical services, such as patient history, progress in treatment, or diagnostic evaluation results. Student clinicians may encounter challenges related to confidentiality during clinical practice and research that require the application of critical thinking and ethical decision-making.
Ethical Dilemma
A common ethical dilemma a student clinician may face regarding confidentiality is gossiping or complaining about patients among colleagues. Humans are social creatures and have a natural impulse to share their experiences with others in search of commonality or empathy. Since work is a significant part of people’s lives, it is expected that they would also have the desire to communicate their feelings about certain aspects of their job without realizing that this violates professional confidentiality standards. An SLPA might meet other school service providers, such as occupational therapists or psychologists, that have the same students on their caseload. One of them might make an inappropriately derogatory remark regarding a particular student. This problem is further exacerbated if done in common areas such as the front office in front of other students, parents, or employees.
I once faced this exact confidentiality dilemma when working as an SLPA in a public school. The school service providers would often congregate in the front office because that is where the secretary, student records, and the copy machine were located. Once when I was making copies, the school’s psychologist loudly asked me what we would do about Student X since his Individualized Education Program (IEP) was pending. She added that she “could not tolerate Student X’s behavior; he does not attend his sessions, and his parents are a mess”. This comment was made in front of the secretary, two volunteer students helping the front office, and other parents waiting for a meeting in the special education department. When I invited her to discuss this issue privately in my office and expressed my discomfort at the blatant disregard for confidentiality, she laughed off my concern and insisted that this was normal behavior in a workplace where “everyone knows everyone.” This ethical dilemma clearly has the potential to violate several principles of the American Speech-Language-Hearing Association’s (ASHA) Code of Ethics.
ASHA Principles
Firstly, according to ASHA, there are federal statutes in place that protect an underage minor’s right to privacy. Principle I states that professionals may disclose confidential information only if it is legally required or necessary to protect the patient’s or the community’s welfare (American Speech-Language-Hearing Association [ASHA], 2016). Barring these conditions, the patient’s parent or guardian must authorize any release of confidential information through a written agreement (ASHA, 2016). An SLPA may collaborate with a school psychologist in a private setting to outline the best IEP for students out of concern for their educational success. However, in this situation, for an SLPA to participate in a public discussion about a student’s treatment without their consent or legal requirement would have violated ASHA’s first principle of the patient’s legal right to privacy.
Furthermore, ASHA’s Principle II states that SLPAs are responsible for maintaining professional competence and performance. It is only by virtue of trust in the “sacredness” of confidentiality that patients are able to communicate honestly and reveal private, personal information about themselves (O’Neil-Pirozzi, 2001). Furthermore, patients trust that they are being treated by a professional who will not judge them in a negative light. Participating in gossip and making inappropriate statements about a patient reflects unfavorably on the SLPA’s ability to provide quality patient care (O’Neil-Pirozzi, 2001). Thus, making derogatory remarks about the student would have broken ASHA’s second principle by undermining their ability to meet the standards of professional competence.
Resolution
The best solution in this situation is to refrain from participating in public gossip or making negative remarks about students and privately pull the colleague aside to discuss why their behavior is unprofessional. If they attempt to dismiss the issue, clearly state your concerns about confidentiality and that you refuse to publicly discuss a patient’s information with professionals who are not directly involved in the case. If confidentiality violations persist and other colleagues willingly participate, approach the program coordinator to report the problem so they can take the appropriate further steps. It should be noted that if a fellow SLPA displays this type of behavior and does not respond to interventions, his actions should be reported to the ASHA Board of Ethics (Lansing, 2002). It is important to maintain confidentiality standards and raise the alarm if gossip is a recurrent issue to protect students’ welfare.
Conclusion
In conclusion, SLPAs have a moral and legal obligation to maintain confidentiality agreements, even if they are faced with an ethical dilemma. For example, SLPAs in school settings might be invited to participate in gossip, publicly disclose confidential patient information, or make derogatory remarks about students. However, this behavior violates the first and second principles of the ASHA professional Code of Ethics and federal statutes about the protection of underage minors. In such cases, SLPAs should clearly state their concerns regarding confidentiality and raise the issue with the administration if the problem persists. Their foremost responsibility is to their patient’s welfare and maintains the highest professional competence standard.
References
American Speech-Language-Hearing Association. (2016). Code of ethics. Web.
Lansing, C. R. (2002). Loose lips: confidentiality in relationships with colleagues. American Speech-Language-Hearing Association. Web.
O’Neil-Pirozzi, T. M. (2001). Please respect patient confidentiality. Contemporary Issues in Communication Science and Disorders, 28(Spring), 48-51.