Tele-Ethics in Communication Disorders: Asking the Right Questions, Finding the Right Answers

Abstract

Purpose: A hypothetical case is used to illustrate legal and ethical issues involving the decision to replace the traditional in-person service delivery model with telepractice in schools beyond the context of the initial COVID-19 health emergency. In this clinical focus article, the reader follows Maria, the lead speech-language pathologist (SLP) in the district, as she determines the feasibility of continuing telepractice in her district now that students and clinicians are returning to schools. First, she considers the support needed to implement this service delivery model within the school setting given the anticipated changes to the rules and regulations governing lawful and ethical provision of telepractice after the health emergency ends. Next, she decides if telepractice is warranted in the district by considering the rationales behind the requests. Faced with balancing school, student, and clinician needs, Maria uses an ethical decision-making model to determine if requests for telepractice, tied to health safety concerns and potentially influenced by implicit bias, reflect legal, ethical, and/or moral issues driven by fear or unconscious discriminatory motives. Conclusions: The health emergency gave SLPs working in schools the unique opportunity to experience the benefits and utility of telepractice. Following the return to schools, continuation of telepractice services will require support and training of SLPs. Many factors must be considered including equivalency of services, technology, and protection of privacy as they relate to the changes to the laws and regulations governing telepractice after the health emergency allowances end. Of primary importance is the selection of telepractice to address student needs, not to avoid specific schools because of their characteristics or location. An ethical decision-making model can be used as a framework to guide service delivery model decisions that balance the needs of the student, the clinician, and the district.