Ethical Practice in Speech-Language Pathology: Core Principles and Emerging Challenges

Editor’s note: This content was created by Farzana Vela, MS, CCC-SLP, BSRC, RRT-NPS, with Continued AI assistance. The course has been reviewed by subject matter expert, Melissa Jakubowitz, M.A., CCC-SLP, ASHA Fellow, Board Certified Specialist-Child Language (BCS-CL).

Learning Outcomes

After this course, participants will be able to:

• Discuss ethical principles (e.g., beneficence, veracity) to evaluate complex scenarios involving billing and documentation.
• Analyze common patient safety risks and describe ways to reduce them in telepractice and in-person settings.
• Review a professional development plan that addresses the integration of emerging technologies and complex ethical-legal standards into clinical practice.

Introduction

In today’s rapidly evolving healthcare landscape, maintaining ethical integrity and the highest standards of care is essential. This course serves as a thought partner, offering a deep dive into ethics grounded in professional guidelines and real-world examples. Together, we will explore not only the what but also the why of ethical decision-making, leaving you with practical strategies that you can apply across various settings and patient populations.

As we dive into these complex topics, it is essential to acknowledge the limitations of a single continuing education course. First and foremost, this presentation provides a professional overview and is not a source of legal counsel. While we are grounding our discussion in the ethical codes of ASHA and Speech-Language & Audiology, these are broad frameworks. Your specific practice is governed by the laws and regulations of your state or province, as well as the policies of your institution. We highly encourage you to consult with your local licensing board and your employer’s compliance department for specific guidance.

Second, we must always consider the diversity of our patient populations. While the ethical principles we discuss—like beneficence and non-maleficence—are universal, their application in practice is not one-size-fits-all. We must be mindful of how cultural and linguistic backgrounds may influence a patient’s understanding of our services, their comfort with technology, and their preferences for care. Ensuring equitable access and culturally competent care is an ethical imperative in itself.

The Pillars of Professional Ethics

Before we dive into the specific topics and case studies in this course, it is essential to ground our discussion in the foundational principles that shape ethical practice across our professions. Regardless of the country, clinical setting, or population served, the core ethical values emphasized by professional organizations, such as the American Speech-Language-Hearing Association (ASHA), remain remarkably consistent. These guiding principles include beneficence, the duty to do good and promote positive outcomes; non-maleficence, the obligation to avoid harm; veracity, the commitment to truthfulness and honesty in all professional interactions; and autonomy, the respect for an individual’s right to make informed decisions about their own care (American Medical Association, 2024).

Together, these values form the ethical bedrock of clinical practice, shaping not only how we provide therapy but also how we interact with clients, families, colleagues, and the broader healthcare system. They influence decisions at every level, including designing and adapting therapy plans, communicating clearly and honestly with clients, collaborating effectively with interdisciplinary teams, documenting and billing accurately, and navigating professional challenges and conflicts. Ethical principles are not abstract ideals—they are active guides that inform our daily practice and help us prioritize patient welfare, professional integrity, and societal trust.

A thorough understanding of these principles provides more than a moral framework; it serves as a practical compass in situations where ethical dilemmas arise. In real-world practice, clinicians frequently encounter “gray areas” where rules may be ambiguous or policies do not provide a clear answer. By grounding decisions in these core values, clinicians can navigate complex scenarios with confidence, making choices that are both ethically sound and patient-centered, and professionally responsible (Beauchamp & Childress, 2019; Kummer & Turner, 2011).

Ultimately, familiarity with and commitment to these foundational principles equips clinicians to approach their work not only with technical competence but also with the ethical discernment necessary to provide high-quality, trustworthy care in every context.

Ethical Decision-Making Model

When faced with a complex or uncertain situation, it can be tempting to act on instinct—especially when time is limited or the stakes are high. However, as professionals, our ethical responsibilities require more than good intentions. Professional codes of ethics serve as essential tools, providing a structured model for ethical decision-making that translates abstract principles into practical steps for real-world clinical practice (Kummer & Turner, 2011).

This process provides a reliable framework for navigating complex choices, minimizing bias, and maintaining accountability to clients, colleagues, and the profession. By following a deliberate decision-making model, clinicians ensure their actions reflect both sound judgment and ethical standards, even under pressure.

The process begins by clearly defining the problem. What is at stake? Is it a minor oversight, a misunderstanding, or a deeper ethical conflict involving competing values or interests? Accurately framing the issue prevents premature conclusions and allows for balanced, thoughtful analysis.

Next, gather all relevant information, including professional codes, workplace policies, laws, and any contextual or cultural factors that may be applicable. Seeking input from colleagues or supervisors can help ensure important details are not overlooked and offer perspectives that might reveal hidden consequences.

With background information in hand, identify and evaluate possible courses of action. Consider how each alternative affects client well-being, professional integrity, and the trust placed in your organization. This often involves weighing principles such as beneficence, nonmaleficence, autonomy, and justice.

After analysis, select the most ethical course of action. Implementation should be thoughtful, transparent, and documented when appropriate. Finally, reflect on the outcome. Did your decision achieve the intended ethical goal? Were there unintended consequences? What might you do differently next time?

This reflective, iterative process does more than resolve a single dilemma—it cultivates ongoing ethical awareness and professional growth. Over time, clinicians who engage in reflection develop stronger moral reasoning, greater confidence in navigating future challenges, and enhanced ability to mentor others in ethical practice.

A concise version of this model includes:

• Identify the Ethical Question or Dilemma: What is the core issue?

• Gather the Facts: What are the relevant details and codes?

• Identify Alternatives: What possible courses of action exist?

• Evaluate Each Alternative: How does each align with ethical principles?

• Select the Best Course of Action: Which option upholds ethical values and client welfare?

• Implement and Reflect: Act, evaluate, and use insights to guide future practice.

By incorporating these steps into daily reasoning, professionals can approach ethical situations with clarity, confidence, and compassion, ensuring their decisions uphold the highest standards of care, integrity, and accountability.

Billing & Documentation

The Nuances of Billing & Documentation

Now let’s turn our attention to billing and documentation—an area of both high risk and high scrutiny (American Medical Association, 2024). Every claim we submit tells a story about the care we provided, so our documentation must be accurate, timely, and an honest reflection of the services rendered (American Medical Association, 2024).

Ethical issues in billing are not always the result of intentional fraud. More often, they arise from oversight, misunderstanding, or negligence. Common errors include unbundling, where separate charges are submitted for procedures that should be billed together (American Speech-Language-Hearing Association, 2023), and upcoding, which involves billing for a more complex service than was actually performed (American Speech-Language-Hearing Association, 2024b). Another frequent issue is billing for non-billable activities, such as documentation or administrative work. While documentation time is built into the overall value of most CPT codes, it should never be billed as a separate service (American Speech-Language-Hearing Association, 2024b).

As clinicians, we carry an ethical and professional obligation to ensure that our billing practices are transparent, accurate, and fully aligned with the services provided. Ethical billing is not just about compliance—it reflects our integrity, accountability, and respect for the trust placed in us by clients, payers, and the profession itself.

Case Study #1: The Patient Who Isn’t Improving

Scenario: You have been treating a 75-year-old patient with non-fluent aphasia for 6 months. Progress has plateaued, and while the patient enjoys the sessions, functional communication gains are minimal. The family insists on continuing therapy, and your clinic has productivity targets that incentivize a high caseload.

Ethical Dilemma: Is it ethical to continue billing for services that are not demonstrating a clear benefit to the patient?

Interactive Question

In this case study, the primary ethical principle most at risk of being violated by continuing to bill for services with no clear functional benefit is:
A) Non-maleficence, because the patient is being harmed financially
B) Veracity, because the billing may be a misrepresentation of services
C) Autonomy, because the patient’s choices are being overridden
D) Beneficence, because the therapy is not acting in the client’s best interest

Correct Answer: B – Veracity

While beneficence (acting in the client’s best interest) is certainly a concern, the primary ethical principle most directly at risk here is veracity. By continuing to bill for services that offer no measurable or functional benefit, the clinician risks misrepresenting the truth in documentation and billing. This misrepresentation can cross into the realm of fraudulent behavior, which carries serious ethical and legal implications (American Medical Association, 2024).

Practicing veracity requires honesty and transparency—not only in how we document and bill for services, but also in how we communicate with patients, families, and colleagues about progress and prognosis. Beneficence guides the ultimate decision to discontinue therapy when it no longer benefits the client, but veracity is the ethical principle most directly compromised if services continue under false pretenses.

Applying Ethical Framework to Clinical Action

The most appropriate course of action involves re-evaluating the patient’s plan of care in collaboration with both the patient and their family. The process should begin with a formal reassessment, clearly documenting that the patient has reached a therapeutic plateau. This objective evidence forms the foundation for ethical decision-making and protects against perceptions of arbitrary or premature service termination (American Medical Association, 2024).

The next step is to facilitate a family meeting to discuss the current prognosis and the limited benefit of continuing active therapy. It is important to frame this conversation within our ethical obligation to provide care that is necessary, evidence-based, and truly beneficial. Emphasize that discontinuing direct treatment does not mean withdrawing support. Instead, it represents a transition of care—redirecting services toward interventions that are more appropriate to the patient’s current needs and goals.

During this meeting, clinicians should empower the family by offering a comprehensive home exercise or maintenance program and connecting them with relevant community resources, such as support groups or wellness programs. These actions demonstrate continued commitment to the patient’s overall well-being, even as direct therapy services conclude.

All decisions should be thoroughly documented in the medical record, including the results of the reassessment, the rationale for the care transition, and a summary of the family discussion. Such documentation not only supports ethical transparency but also provides both clinical and legal protection (American Medical Association, 2024).

Clinicians must acknowledge and address external pressures, such as productivity expectations, that may influence decision-making. Engaging in an open, professional dialogue with supervisors or administrators about the importance of ethical care over productivity metrics reinforces integrity and protects against potential compliance or fraud risks. Ultimately, this approach demonstrates a steadfast commitment to ethical, patient-centered practice.

Billing for Telepractice: A New Frontier

Telepractice has introduced a new layer of complexity in billing and documentation (ASHA, n.d.). In this service model, compliance extends beyond the therapy itself—it also depends on where both the clinician and the patient are physically located during the session. As a general rule, you must hold a valid license (or equivalent authorization) in the jurisdiction where the patient is located at the time of service, while also maintaining compliance with your own state or province’s licensing requirements, as applicable.

Reimbursement policies for telepractice are highly variable and frequently changing, particularly across different payers and regions. Therefore, it is essential to verify coverage with each payer before initiating telepractice services. What may be reimbursable under one policy—such as Medicaid or private insurance—may not be covered under another (asha.org).

Equally important is the documentation of informed consent for telepractice. This step is not only a best practice for patient safety but also a billing and compliance requirement in many jurisdictions (Federation of State Medical Boards, 2014). Documentation should clearly indicate:

• Session was conducted via telepractice
• Platform or technology used
• Confirmation that the patient or caregiver provided informed consent
• Duration and nature of the services provided

Finally, clinicians must uphold the ethical principle of veracity—truthfulness and accuracy in all records and claims. Whether documenting session details, reporting technology used, or submitting claims for reimbursement, our ethical and professional responsibility is to ensure transparency, accuracy, and compliance at every step.

Case Study #2: The Telepractice Dilemma

Scenario: You are a licensed SLP in Texas, and your patient, who typically resides in Texas, is on vacation in Colorado. The patient and caregiver ask for a telepractice session. You are not licensed in Colorado.

Ethical Dilemma: Is it ethical or legal to provide a telepractice session to this patient while they are in a state where you are not licensed?

Interactive Question

In this case study, what is the primary ethical principle most at risk if you proceed with therapy while the patient is traveling in a state where you are not licensed?
A) Autonomy, because the patient’s preference is not being respected
B) Justice, because the patient is denied equal access to care while traveling
C) Non-maleficence, because providing services without a license could harm the patient and risk your license
D) Beneficence, because you are not acting in the patient’s best interest by refusing therapy

Correct Answer: C – Non-maleficence

The core ethical concern in this scenario is non-maleficence, or the duty to “do no harm.” Providing services in a state where you are not licensed exposes both the patient and the clinician to significant risk. The patient could experience an abrupt disruption in care if a complaint is filed or if coverage is denied, while the clinician faces the potential for disciplinary action, fines, or loss of licensure.

While autonomy (respecting patient choice) and beneficence (acting in the patient’s best interest) are important considerations, they cannot override legal and ethical boundaries that govern where and how we practice. According to the Council of State Governments (2023) and the American Speech-Language-Hearing Association (ASHA), clinicians must be licensed—or otherwise authorized to practice—both in their home state and in the state where the patient is physically located at the time of service.

Refusing to provide therapy across state lines without licensure is not denying care; it is protecting the patient, yourself, and the integrity of the profession from potential harm.

Implementing Ethical Cross-State Practice Management

The most ethical approach requires transparency and proactive planning. Inform the patient that you cannot legally provide services while they are in Colorado, then offer concrete alternatives: pause therapy until they return home, refer them to a licensed professional in that state for continuity of care, or explore whether obtaining temporary or reciprocal licensure is possible for future situations.

To handle these situations proactively, discuss travel plans with patients during initial intake to identify potential licensure issues early. Maintain a resource list of licensed colleagues in common travel destinations for referrals. When you must decline cross-state services, document your refusal and clinical reasoning thoroughly—this protects you legally and demonstrates ethical decision-making if ever questioned.

Remember that some states have temporary licensure or emergency provisions, but these typically require advance application and cannot be obtained retroactively (Council of State Governments, 2023). It is crucial to understand that “the patient really needs it” or “it is just one session” are never valid justifications for practicing without proper licensure. Maintaining licensure standards protects not only individual practitioners but also the entire profession’s credibility and public trust. Violations can result in disciplinary action in your home state, even for services provided elsewhere, making compliance both an ethical imperative and a practical necessity for career protection.

Patient Privacy and Confidentiality

Protecting Client Information

Before we dive into patient safety in telepractice, we need to pause and revisit one of the most fundamental responsibilities in healthcare: protecting patient privacy and confidentiality. This responsibility is not just about following rules—it is both a legal requirement and a core ethical obligation (U.S. Department of Health & Human Services, Office for Civil Rights, n.d.).

In the United States, the Health Insurance Portability and Accountability Act (HIPAA) sets the legal standard for safeguarding Protected Health Information (PHI). PHI includes any information that could identify a patient, such as:
•    Names, addresses, and dates of birth
•    Medical record numbers or insurance information
•    Diagnoses, therapy notes, or progress reports
•    Audio, video, or written documentation from therapy sessions

From an ethical perspective, the principle of confidentiality requires that we maintain the privacy of all patient information unless the patient (or their legal guardian) has given explicit consent for it to be shared (American Medical Association, 2024). This applies to:
•    Family members who are not designated caregivers
•    School staff, employers, or community members without consent
•    Other professionals not directly involved in the patient’s care

In telepractice, this obligation becomes even more complex. Common, seemingly harmless actions can become violations if not handled correctly:
•    Emailing therapy plans or evaluations without encryption could expose sensitive information if the email is intercepted
•    Using public Wi-Fi (e.g., at a coffee shop or airport) to access or upload patient files increases the risk of unauthorized access
•    Video sessions conducted on platforms without proper security features may leave patient data vulnerable to hacking or breaches

To uphold both legal and ethical standards, clinicians must be vigilant in protecting patient information in all its forms—verbal, written, and electronic (U.S. Department of Health & Human Services, Office for Civil Rights, n.d.). This includes:
•    Using only HIPAA-compliant telepractice platforms
•    Encrypting emails and files that contain PHI
•    Storing electronic records on secure, password-protected systems
•    Ensuring that therapy sessions are conducted in private, sound-protected environments
•    Educating patients and families about their own role in maintaining privacy (for example, not recording sessions without permission)

Ultimately, respecting privacy and confidentiality is about more than compliance—it’s about maintaining the trust that is the foundation of the therapeutic relationship.

Case Study #3: The Privacy Breach

Scenario: An SLP receives an email from a patient’s family member requesting an update on progress. This family member, however, is not listed on the patient’s HIPAA release form. Wanting to be helpful, the SLP quickly responds using their personal Gmail account, providing a detailed clinical update.

Ethical Dilemma: This may seem like a small, well-intentioned act, but what are the potential consequences of this seemingly helpful response?

Interactive Question

In this case, what was the primary ethical principle violated when the SLP responded to the family member’s email using a personal account?
A) Autonomy, because the family member’s wishes were not respected
B) Confidentiality, because private health information was shared without consent
C) Justice, because the SLP did not treat all family members equally
D) Beneficence, because the SLP did not act in the patient’s best interest

Correct Answer: B – Confidentiality

The primary ethical principle violated in this case is confidentiality, as private health information (PHI) was shared without proper consent (U.S. Department of Health & Human Services, Office for Civil Rights, n.d.). Even though the SLP’s intent may have been to be responsive and helpful, this action resulted in both an ethical and legal breach.

By responding to a family member’s inquiry through a personal email account, the clinician exposed PHI through an unsecured communication channel. This constitutes two violations:

1. A privacy violation, because identifiable health information was disclosed to someone without proper authorization.

2. A security violation, because the communication occurred through an unprotected system not compliant with HIPAA standards.

This scenario illustrates how well-intentioned actions can have unintended and significant ethical and legal consequences. In healthcare, confidentiality is not just a professional courtesy—it is a legal obligation and a foundational pillar of patient trust.

Analyzing the Dual HIPAA Violations

This scenario illustrates two distinct but related violations that compound the severity of the breach. First, the Privacy Violation. The SLP disclosed protected health information (PHI) to a family member without the patient’s authorization. Under the HIPAA Privacy Rule (www.hhs.gov), PHI can only be shared with explicit patient consent. Providing information without a signed release directly violates this rule, compromising confidentiality, the patient’s rights, and the clinician’s professional integrity.

Second, the security considerations. The SLP used a personal, non-secure email account to transmit PHI. HIPAA requires healthcare providers to safeguard electronic PHI (ePHI) through reasonable and appropriate safeguards (e.g., encryption in transit, access controls, secure systems). Personal email accounts often lack these protections, creating elevated risk. Even if the family member had been properly authorized, using a personal email service could still violate organizational policy or HIPAA safeguards, depending on configuration and agreements.

Together, these privacy and security issues compounded the seriousness of the breach. The clinician’s actions not only endangered patient confidentiality but also exposed the organization to potential complaints, penalties, and loss of trust.

Implementing Ethical Communication Protocols

To comply with HIPAA and maintain ethical standards, the SLP should have followed a different approach entirely. Demonstrate professionalism while protecting patient privacy. A professional response might sound like: “I understand your concern for [patient’s name], but due to federal privacy regulations, I am not able to share any information without their specific written consent. I would be happy to provide you with the HIPAA release form; once the patient signs/completes and returns it, we can include you in future updates.”

This scenario highlights the importance of having clear protocols for family communication requests. When contacted by unauthorized family members, always respond with empathy while maintaining boundaries. This approach shows professionalism while protecting patient privacy (www.hhs.gov).

Once consent is properly obtained through the appropriate HIPAA release form, any communication containing PHI should be conducted through a secure, HIPAA-compliant platform. Avoid using personal email accounts, text messages, or other unsecured communication methods to exchange patient information.

Best Practices for Data Privacy

To protect yourself and your patients, implement comprehensive privacy protection strategies. First, establish secure communication protocols. Always use secure and encrypted platforms for communication. Maintain a clear distinction between personal and professional communication channels.

Second, implement robust device and account security. Protect your devices and accounts with strong passwords, enable two-factor authentication where available, and ensure automatic screen locks are activated. Regular software updates are essential for maintaining security patches.

Third, prioritize physical security measures. A patient’s chart left on a desk or in a common area constitutes a privacy breach. Ensure that all physical documents are stored securely, computer screens are positioned out of public view, and conversations about patients occur only in private settings.

Fourth, apply the “minimum necessary” rule when communicating with other professionals. Share only the information required for the other provider to perform their job effectively. Avoid sharing comprehensive case histories when a brief, targeted update would suffice.

Finally, develop emergency protocols for potential breaches. Know your organization’s breach notification procedures, understand your reporting obligations, and maintain documentation of all privacy protection measures you’ve implemented (www.hhs.gov). 

Patient Safety

The Ethical Imperative of Patient Safety

Patient safety is at the heart of our ethical obligations as clinicians. The principle of non-maleficence, or “doing no harm,” serves as a foundational guide in every decision we make (Beauchamp & Childress, 2019). Ensuring patient safety extends far beyond avoiding obvious physical injury—it includes delivering effective treatment, safeguarding sensitive health information, and coordinating care seamlessly with the broader healthcare team.

In everyday practice, patient safety risks can be both immediate and apparent—for example, preventing aspiration in a patient with dysphagia—or more subtle and systemic, such as providing an ineffective therapy plan that consumes the patient’s time, energy, and financial resources without meaningful benefit. Each of these risks carries ethical weight, as failing to address them can compromise patient well-being and trust in the healthcare system.

The rise of telepractice introduces additional layers of safety considerations. Clinicians must account for the physical environment in which the patient receives care, verify the patient’s location for emergency purposes, ensure secure and HIPAA-compliant communication platforms, and prepare contingency plans for technical failures. Despite the convenience and accessibility telepractice provides, these unique factors require careful attention to maintain the same high standards of safety expected in traditional in-person care.

Ultimately, patient safety is not an optional aspect of practice—it is an ethical imperative that shapes every clinical decision. By maintaining vigilance across physical, clinical, and informational dimensions of care, clinicians honor their professional responsibility to protect and promote the well-being of every patient.

Patient Safety in Telepractice

Telepractice provides incredible access to care, but it also creates a new set of safety considerations (Molini-Avejonas et al., 2015). You are no longer in the same room as the patient, which means you must be proactive in managing potential risks. Before a session, verify the patient’s physical location to ensure you have a plan in case of an emergency. This plan should include the patient’s address and contact information for an on-site caregiver or emergency services. The technology itself can be a risk; a poor connection can compromise a session and potentially lead to inaccurate data collection or ineffective therapy.

You must acknowledge the limitations of telepractice (asha.org). Some of our core professional duties, such as a thorough oral mechanism examination, FEES, or MBSS, cannot be performed remotely. We must be honest about these limitations and refer for in-person services when necessary. Training an on-site helper is crucial for successful telepractice sessions. This ensures the caregiver or “eHelper” is well-prepared to assist with technology, materials, and direct patient support, which helps the remote session run smoothly and effectively (Speech-Language & Audiology Canada, n.d.).

Case Study #4: Emergency During Telepractice

Scenario: You are conducting a telepractice session with a 6-year-old child who has a severe phonological disorder. The child is at home with their grandparent, who is serving as the “eHelper” for the session. Suddenly, in the middle of therapy, the child begins choking on a piece of food.

Ethical & Safety Dilemma: A medical emergency unfolding on-screen while you are miles away and unable to physically intervene. How do you respond to a medical emergency when you are not physically present?

Interactive Question

In this scenario, what is the clinician’s most important ethical responsibility when faced with a medical emergency during a telepractice session?
A) Attempt to coach the caregiver step-by-step through a lifesaving procedure
B) Remain passive, because the caregiver is responsible for the child’s safety
C) Direct the caregiver to respond immediately and also contact emergency services
D) End the session and document the event for liability protection

Correct Answer: C – Direct the caregiver to respond immediately and also contact emergency services

In a medical emergency during a telepractice session, the clinician’s primary ethical responsibility is to ensure that immediate, appropriate action is taken on-site and that professional emergency responders are contacted promptly (Federation of State Medical Boards, 2014).

While telepractice allows clinicians to provide guidance remotely, attempting to coach a caregiver through complex lifesaving procedures can be risky. It may:

• Exceed the clinician’s scope of practice,

• Contradict institutional policies, and

• Increase liability if outcomes are unfavorable.

Similarly, remaining passive is not ethically acceptable, as clinicians have a duty to act within their professional capabilities to protect patient safety. Documentation and liability concerns are important, but these should only occur after the immediate emergency has been addressed and the patient is safe.

Understanding Professional Scope During Emergencies

This scenario illustrates key ethical and professional lessons about the limits and responsibilities of remote practice. The central dilemma involves balancing your duty to protect patient safety with the recognition of what you can—and cannot—do remotely. Your immediate response protocol should be clear and deliberate: remain calm, and promptly direct the on-site caregiver to provide appropriate emergency assistance within their scope of training. At the same time, contact emergency services yourself, providing the child’s exact location and relevant information.

Although you are unable to provide direct physical intervention, your actions ensure that professional help is dispatched without delay. This scenario underscores a critical professional boundary: clinicians should not attempt to provide detailed medical instructions or perform lifesaving procedures remotely. Your ethical and professional role is to facilitate appropriate assistance and ensure the patient’s safety, while staying within the limits of your scope of practice. Adhering to these boundaries protects the patient, the clinician, and the integrity of remote service delivery.

Implementing Proactive Emergency Planning

This case highlights why comprehensive risk assessment and emergency planning are essential before the very first telepractice session (Speech-Language & Audiology Canada, n.d.). Pre-session preparation should include confirming who will serve as the responsible adult or eHelper during each session and verifying their ability to respond appropriately in the event of an emergency. It is also critical to document the patient’s exact physical location so that emergency services can be dispatched without delay if necessary.

Clinicians should develop and share a written safety protocol with the family, outlining specific steps to follow in the event of choking, seizures, allergic reactions, or other medical emergencies. Consider providing emergency contact cards that list local emergency numbers, poison control information, and basic first aid reminders tailored to the caregiver’s level of training. These resources should be readily accessible during every session, ensuring that both the caregiver and clinician are prepared to respond efficiently and safely in the event of an emergency.

Building a Culture of Proactive Safety

In telepractice, safety is fundamentally about being proactive, not reactive (Molini-Avejonas et al., 2015). We cannot prevent every emergency, but we can minimize risks through careful planning, clear communication, and thorough documentation. Establish routine safety checks at the beginning of each session: confirm the eHelper is present and prepared, verify the emergency contact information is current, and briefly review the emergency protocol. Document all safety planning measures in the patient’s record. This documentation demonstrates due diligence, serves as a reference for future sessions, and protects both the patient and the clinician.

Navigating Interprofessional & Organizational Ethics

Interprofessional & Organizational Ethics

While many ethical dilemmas focus on the patient-clinician relationship, an intermediate-level discussion must also address our responsibilities to colleagues, employers, and the profession itself (Swisher, 2022). What happens when your ethical judgment conflicts with the directives of a supervisor or the practices of a colleague? For example, productivity quotas might pressure you to bill for services that are not clinically justified, placing your professional ethics in direct conflict with employment expectations.

In these situations, ASHA's Code of Ethics reminds us that professionals must uphold the dignity and autonomy of the profession, maintain harmonious interprofessional relationships, and adhere to professional standards. Navigating such conflicts requires a thorough understanding of your ethical code, clear documentation of your clinical reasoning, and the skill to engage in respectful, solution-focused dialogue. When collaborative approaches fail, formal channels provided by your licensing body or professional association offer additional recourse.

Case Study #5: An Interprofessional Conflict

Scenario: You are a hospital SLP treating a patient with a traumatic brain injury (TBI). The physical therapist (PT) insists on a therapy schedule that conflicts with your recommendations for adequate rest between sessions to support cognitive recovery.

Ethical Dilemma: How do you resolve this conflict while upholding patient beneficence (acting in their best interest) and adhering to your professional standards?

Interactive Question

In this scenario, what is the most ethical first step the SLP should take in addressing the conflict with the PT?
A) Immediately escalate the conflict to the ethics committee
B) Use “I” statements and share objective data with the PT to seek resolution collaboratively
C) Adjust your schedule to match the PT’s plan, since interprofessional harmony is the priority
D) Document the disagreement but take no further action, as the PT has more authority over scheduling

Correct Answer: B – Use “I” statements and share objective data with the PT to seek resolution collaboratively

The most ethical first step is to engage in direct, professional communication with the PT using “I” statements and objective, evidence-based data to advocate for the patient’s best interest (Swisher, 2022). This approach:

• Demonstrates respect for your colleague,

• Centers the discussion on patient care rather than interpersonal conflict, and

• Encourages collaborative problem-solving rather than escalating prematurely.

Immediate escalation to an ethics committee may become necessary if direct communication fails, but it is not the first-line approach. Adjusting your schedule solely to maintain harmony prioritizes convenience over patient care, which can compromise ethical responsibility. Documenting the disagreement without taking action fails to advocate for the patient and does not address the conflict constructively.

Building Patient-Centered Communication

Interprofessional disagreements are common, but when handled poorly, they can lead to patient harm, fractured team dynamics, and even liability concerns. When addressing interprofessional conflicts, anchor every discussion in the patient's best interest rather than professional territory disputes. Frame your reasoning in terms of evidence-based practice—for example, explaining how adequate rest is critical for neurorecovery in TBI patients and how overstimulation could impede cognitive progress.

Use "I" statements to express concerns without assigning blame: "I'm concerned that scheduling therapy back-to-back could negatively affect the patient's endurance and cognitive recovery." Support your position with objective data such as fatigue scores, progress notes, or medical recommendations, shifting the focus from "my schedule vs. your schedule" to "what does the research tell us the patient needs?" Avoid using accusatory or confrontational language, as this escalates tension rather than resolving the clinical disagreement.

Implementing Professional Documentation Standards

Thorough documentation serves multiple critical functions in interprofessional conflicts (American Medical Association, 2024). Document your clinical observations, reasoning, and all communication attempts clearly in the patient's chart. Include relevant evidence or clinical guidelines that support your recommendations. Record not just the disagreement itself, but your attempts at resolution, the rationale provided by both parties, and any compromises or alternative solutions explored. This creates a professional record that ensures accountability, demonstrates your position is grounded in clinical reasoning rather than personal preference, and provides documentation for future review if needed. 

Strategic Escalation When Direct Communication Fails

If direct communication does not resolve the clinical disagreement, follow the hospital's established chain of command for conflict resolution. This may involve engaging a clinical supervisor, case manager, or requesting consultation from the ethics committee. Escalation is not about "winning" the conflict—it is about ensuring the patient receives care that aligns with ethical and evidence-based standards. Present the situation objectively, focusing on clinical concerns rather than interpersonal dynamics. Bring your documentation, relevant research, and proposed solutions to demonstrate that you've attempted collaborative resolution. A broader team perspective can identify creative solutions that address both professionals' clinical concerns while prioritizing patient benefit.

Maintaining Professional Integrity Through Conflict

Conflicts with colleagues are inevitable in healthcare settings, but your ethical responsibility is to handle them with professionalism, respect, and patient-centered reasoning. The goal is not to avoid disagreements—healthy professional discourse can improve patient care—but to navigate conflicts constructively. By focusing on beneficence, using clear communication, documenting thoroughly, and escalating appropriately when necessary, you protect both your patient’s welfare and your professional integrity.

Ethical Considerations of Emerging Technology

Emerging Technology

As new technologies emerge, they introduce a new set of ethical questions (Healthcare Information and Management Systems Society, 2023; World Health Organization, 2023). Consider the rise of generative AI. While it can be a powerful tool to streamline documentation, the clinician remains ethically and legally responsible for the final output (World Health Organization, 2023). We must be vigilant to ensure the information is accurate and that the use of such a tool does not compromise the unique clinical judgment that is at the heart of our practice.

Similarly, every new app or platform must be evaluated through an ethical lens. Is it secure? Is it accessible? Do all of your patients have an equal opportunity to benefit from it? These are not just technical questions; they are ethical ones. In some cases, the use of a new technology may become an ethical obligation if it is the only way to provide a certain level of care.

Ethical Integration of AI and Digital Tools

The rapid pace of technological innovation presents both exciting opportunities and new ethical responsibilities for speech-language pathologists (Healthcare Information and Management Systems Society, 2023). As we adopt tools like generative AI and new digital therapy platforms, we must do so with a critical and ethical lens. First, the principle of veracity is paramount. If you use AI to assist with documentation, you must be transparent about its use; you remain professionally and legally responsible for the final content (World Health Organization, 2023). You cannot simply trust the AI’s output; you must verify every detail, as a single error could have significant consequences for a patient’s care.

Second, when evaluating any new digital tool or app, it is essential to apply the principles of beneficence and justice. This means ensuring the technology is not only practical and evidence-based, but also accessible to all your clients. A technology that is inaccessible due to cost, digital literacy, or physical ability creates a barrier to care and constitutes an ethical failure.

Case Study #6: Ethical AI Use in Documentation

Scenario: An SLP uses an AI-based transcription service to generate therapy notes. On the surface, this seems like a harmless shortcut—an efficient way to save time. However, the clinician relies on the AI’s output without carefully reviewing it. As a result, a significant error goes unnoticed: the AI incorrectly transcribes the patient’s diet level. This mistake, if acted upon, could lead to the patient being given food textures that are unsafe, increasing the risk of aspiration.

Ethical Dilemma: Which ethical principles are most at risk when we delegate verification responsibility to technology?

Interactive Question

In this case study, which ethical principle is most at risk when an SLP relies on AI-generated documentation without verifying its accuracy?
A) Autonomy, because the patient’s preferences were not prioritized
B) Justice, because technology use may not be accessible to all patients
C) Veracity, because the documentation may contain false or inaccurate information
D) Fidelity, because the clinician is not maintaining loyalty to their employer

Correct Answer: C – Veracity

The primary ethical principle at risk in this scenario is veracity, which refers to truthfulness and accuracy in professional documentation (Healthcare Information and Management Systems Society, 2023). AI-generated documentation can enhance efficiency, but it is not infallible. When clinicians fail to review and correct AI-generated notes, the medical record can contain errors or misleading information, potentially compromising patient care.

Non-maleficence is also critically relevant here. Inaccurate documentation—particularly regarding sensitive information such as swallowing safety—can directly endanger the patient, leading to inappropriate treatment, dietary recommendations, or other clinical decisions that increase the risk.

Understanding the Professional Responsibility Framework

This scenario highlights the very real risks associated with seemingly benign technological shortcuts. On the surface, relying on AI-generated documentation may appear efficient and harmless. However, in practice, the SLP’s unverified use of AI output led to a significant and potentially dangerous error. Two fundamental ethical principles were directly compromised: veracity, because the documentation was no longer truthful or accurate, and non-maleficence, because the error had the potential to cause direct harm to the patient through mismanaged diet orders or other clinical decisions. This case underscores a critical lesson about professional accountability: while technology can assist, it can never replace professional judgment and ethical responsibility (World Health Organization, 2023).

AI tools—such as transcription services, automated charting, or decision-support systems—can certainly improve workflow efficiency and reduce administrative burden. However, they cannot replicate the critical thinking, clinical expertise, and ethical discernment that define competent healthcare practice. Even when a tool provides a polished or seemingly complete output, the ultimate responsibility for accuracy, safety, and ethical compliance always rests with the clinician.

This case also serves as a cautionary example for the broader professional community. As healthcare increasingly integrates AI and digital tools, clinicians must develop habits of careful review, verification, and validation of all automated outputs. Neglecting this duty not only undermines patient safety but also erodes trust in the profession and the ethical standards that govern clinical practice.

Ultimately, this scenario reinforces an enduring principle: technology is a supportive aid, not a substitute for human expertise, accountability, and ethical vigilance. Clinicians must remain active stewards of patient care, critically evaluating every tool they use and ensuring that the information guiding clinical decisions is accurate, reliable, and ethically sound.

Implementing Safe AI Integration Practices

The key message is that while AI can assist in streamlining documentation processes and improving efficiency, it cannot replace the clinician's fundamental ethical duty to ensure accurate, truthful, and safe documentation (Healthcare Information and Management Systems Society, 2023). Every AI-generated note, transcription, or report must be thoroughly reviewed and verified before it becomes part of the official medical record.
To uphold this standard, establish systematic verification protocols for AI-assisted documentation.

Review all automatically generated content line by line, cross-reference AI outputs with your session notes, and verify that technical terminology and clinical recommendations are accurately captured. Pay particular attention to critical safety information such as diet levels, medication dosages, and therapy recommendations.

This responsibility cannot be delegated to technology, regardless of how sophisticated the AI system may be. Professional accountability means taking ownership of every word in your documentation, whether you typed it yourself or an AI tool assisted in its generation.

Advancing Professional Technology Standards

As technology continues to advance, our profession must develop clear guidelines for safe AI integration that protect both patients and practitioners.

Remember: AI can be a helpful partner in clinical work, but ethical clinicians must verify, not just trust, technological outputs. The goal is leveraging technology to enhance—not replace—our clinical expertise and ethical judgment

The Role of Professional Advocacy

Professional Advocacy

Ethical practice extends beyond personal choices to include advocacy at both internal and external levels. Internal advocacy involves speaking up when productivity pressures encourage unsafe shortcuts, advocating for HIPAA-compliant technology adoption, and requesting proper training. External advocacy involves contributing to professional organizations to ensure that ethical codes evolve thoughtfully in tandem with emerging technologies (American Medical Association, 2024).

Internal advocacy focuses on creating and maintaining an ethical environment within your immediate organization. This often involves navigating workplace pressures that can challenge best practices and patient well-being.

• With Employers and Administration:
  • Advocate for reasonable productivity quotas that allow time for essential, non-billable tasks like documentation, interprofessional collaboration, and professional development. Frame this by emphasizing that unrealistic pressures incentivize unsafe shortcuts and compromise the quality of care.
  • Advocate for essential resources, such as access to secure, HIPAA-compliant technology (e.g., electronic health record systems, telehealth platforms) and adequate, safe physical working spaces.
• Promote transparency regarding organizational policies that impact patient care, such as payment models and resource allocation.
  • With Supervisors and Clinical Directors:
  • Address billing or documentation concerns (e.g., potential upcoding, overly aggressive discharge plans) using a patient safety framing. Instead of simply complaining, present specific solutions and cite relevant professional standards (e.g., ASHA Code of Ethics principles).
  • Request proper training on new procedures or technologies to ensure competent, evidence-based service delivery, preventing the ethical violation of practicing beyond one's area of competence.
• With Colleagues and Teams:
  • Engage in ethical discussions and cultivate a culture of open communication where challenging unethical behavior is supported, not penalized.
  • Serve as a resource for colleagues facing complex scenarios, such as boundary issues, conflicts of interest, or determining medical necessity. This peer consultation helps normalize ethical self-reflection.

External advocacy involves contributing to the profession's evolution and influencing the policies, laws, and public perception that impact professional services.

• Professional Organizations (e.g., ASHA, SAC):
  • Participate in committees and surveys to ensure that the Code of Ethics and practice guidelines evolve thoughtfully alongside emerging technologies (e.g., AI in diagnosis, digital privacy) and changes in healthcare delivery.
  • Contribute to policy discussions to protect the scope of practice and ensure that reimbursement models support the delivery of ethical, evidence-based services.
• Licensing Boards and Regulatory Bodies:
  • Stay informed about proposed legislative and regulatory changes that affect licensure requirements, service delivery settings, or patient access.
  • Provide expert input when invited, lending a clinical perspective to legal frameworks to prevent unintended consequences that could undermine ethical care.
• The Public (Patients, Families, and Communities):
  • Educate the public about the value, evidence-based, and ethical delivery of Speech-Language Pathology services. This helps combat misinformation, protect consumers from unproven treatments, and ensure informed healthcare decisions.
  • Advocate for and educate policymakers on issues such as funding for services, coverage requirements, and addressing health disparities to ensure equitable and ethical access to care for all populations.

Ethical practice is not a passive state but an active responsibility. By engaging in both internal and external advocacy, professionals move beyond merely complying with rules to actively shaping an environment where the highest standards of care are both expected and structurally supported.

The Ripple Effects of Professional Advocacy

When practitioners engage in both internal and external advocacy, the cumulative impact strengthens not only individual practice but also the entire profession (American Medical Association, 2024). Internal advocacy may involve collaborating with colleagues, influencing workplace policies, or contributing to organizational decision-making processes. In contrast, external advocacy encompasses participation in professional associations, policy development, public education, and legislative initiatives. Together, these efforts create a profession that is responsive, resilient, and ethically accountable.

Advocacy also directly enhances your own clinical practice. By staying connected to emerging standards, regulatory changes, and evidence-based innovations, you ensure that your care remains current, effective, and aligned with best practices. This ongoing engagement supports professional growth, sharpens ethical reasoning, and fosters a culture of excellence in patient care.

Moreover, the ethical standards we uphold and the policies we influence today will shape how effectively our profession navigates future challenges, such as the integration of AI tools, the expansion of telehealth services, and the evolving needs of diverse patient populations. Ethical advocacy ensures that these innovations are implemented safely, equitably, and in a manner that truly serves patient welfare.

Professional advocacy is both a privilege and a responsibility of licensed practice. By actively engaging in advocacy, clinicians help protect the integrity of the profession, promote patient-centered care, and ensure that the voice of the profession is heard in shaping policies that affect both providers and the communities we serve.

A Framework for Lifelong Ethical Learning

Ethical practice is not something you "finish"—it is an ongoing process. As our field constantly evolves, developing a personal framework for lifelong learning becomes essential.

• Commit to Continuous Education: Set specific learning goals and dedicate time to ethics-focused continuing education. Stay current with updates to your profession's code of ethics and position statements (American Medical Association, 2024). Pursue interdisciplinary learning to enrich your reasoning (Swisher, 2022), and document your learning for reflection and professional development.
• Build a Network of Trusted Peers: Create a network of colleagues for consultation on complex cases. Consider forming a discussion group with proper anonymization protocols and clear ground rules. Include professionals from related fields (e.g., OT, social work, bioethics) for cross-disciplinary perspectives.
• Make Self-Reflection a Habit: Schedule regular reflection time and consider keeping a journal to process challenging scenarios. Practice applying frameworks in low-stakes situations, and be honest about limitations and biases that may influence your judgment.
• Create Personal Accountability Systems: Establish structures that support your growth: regular mentor check-ins, peer review partnerships, and environmental cues that prompt reflection. Track your development as you would clinical skill advancement.

When individual practitioners commit to lifelong learning, the collective effect elevates the entire profession. Ethical competence, like clinical competence, requires ongoing maintenance and development.

Your Ethical Foundation

Four principles guide ethical decision-making: beneficence (promoting patient welfare), non-maleficence (avoiding harm), veracity (honesty in communication), and autonomy (honoring patient choices) (Beauchamp & Childress, 2019). In practice, these principles frequently conflict. For example, telling a patient the whole truth about their prognosis (veracity) might cause psychological distress (non-maleficence), or respecting a patient's refusal of recommended treatment (autonomy) may conflict with your duty to provide beneficial care (beneficence). Balancing competing principles requires clinical judgment developed through experience, consultation with colleagues, and careful consideration of the specific context. Ethical practice is not about finding perfect solutions, but about engaging in deliberate and transparent reasoning and taking responsibility for the decisions you make.

Practical Implementation Strategies

Key principles for ethical practice include prioritizing client-centered care, always acting in the client’s best interest, even when external pressures tempt shortcuts or compromises. Maintaining documentation and billing integrity is essential, as these records reflect both professional honesty and legal accountability; when using AI or other technological tools, clinicians remain fully responsible for the accuracy and completeness of the final content (American Speech-Language-Hearing Association, 2023; 2024b). In telepractice, technology should enhance care without compromising ethical standards, which requires establishing protocols for technology failures, verifying patient location, preparing emergency procedures, understanding licensure obligations across jurisdictions, ensuring platform security, and obtaining informed consent that addresses telepractice-specific considerations (American Speech-Language-Hearing Association, n.d.). Comprehensive patient safety encompasses physical safety (emergency preparedness, risk assessment), clinical safety (evidence-based practice and honest evaluation of treatment effectiveness), and information safety (HIPAA compliance and secure handling of patient data). Finally, professional growth is a continuous process; ethical competence develops over time, and your ethical journey does not end with this course—it begins here.

Managing Professional Relationships Ethically

Ethical competence extends beyond individual practice decisions to include navigating interprofessional and organizational challenges (Swisher, 2022). These situations arise when productivity pressures conflict with clinical judgment, when colleagues use questionable practices, or when organizational policies may compromise patient care. Approach these challenges with professionalism, evidence-based reasoning, and a patient-centered focus. Use "I" statements to express concerns without assigning blame, and frame discussions around patient outcomes rather than professional territory disputes.

Document your clinical rationale thoroughly, present objective data such as research evidence or clinical guidelines, and escalate through appropriate channels when direct communication fails to resolve the issue. Proactively build collaborative relationships with colleagues, supervisors, and interdisciplinary team members that support ethical practice and create a culture of shared accountability. These relationships become your professional support system as you navigate complex ethical terrain.

Sustaining Ethical Growth

Ethical competence requires intentional, ongoing development throughout your career. Commit to continuing education that explicitly addresses ethics—attend workshops, complete ethics-focused CEUs, and pursue advanced training in areas like bioethics or healthcare law. Stay informed through multiple channels: subscribe to professional journals like the American Journal of Speech-Language Pathology, read ASHA's newsletters and position statements, monitor updates from your state licensing board, and track policy changes through state and national associations. Build a trusted peer network before ethical dilemmas arise. Identify colleagues with strong ethical judgment whom you can consult confidentially about complex cases.

Consider forming or joining an ethics discussion group where practitioners meet regularly to analyze challenging scenarios using proper anonymization protocols. Include professionals from related disciplines—occupational therapists, social workers, bioethicists, or hospital ethics committee members—to gain cross-disciplinary perspectives that enrich your reasoning. Establish regular reflection practices that make ethical thinking a habit rather than a reactive response. Schedule dedicated time—weekly or monthly—to review challenging cases and examine your decision-making process. Keep an ethical reflection journal where you document dilemmas you've faced, the frameworks you applied, and what you learned from the outcome. Practice applying ethical principles to low-stakes situations so these thought patterns become automatic when high-stakes decisions arise. Be honest with yourself about personal limitations, unconscious biases, or workplace pressures that might influence your judgment.

Create accountability systems that support your growth. Establish regular check-ins with a mentor who can provide guidance on ethical challenges specific to your practice setting. Participate in peer review arrangements where colleagues offer constructive feedback on your documentation, clinical reasoning, and ethical decision-making. Set environmental cues—such as posting ethical principles in your workspace or adding ethics prompts to your documentation templates—that remind you to pause and reflect before finalizing important decisions. When you build these systems proactively, you create a safety net for navigating ethical complexity. Rather than facing difficult decisions in isolation or under pressure, you'll have knowledge, support structures, and reflective habits that guide you toward thoughtful, defensible choices that prioritize patient welfare.

The Ripple Effects of Ethical Practice

Ethical practice is built on mindset, reflection, and action. Your individual commitment to these principles contributes directly to the profession's collective credibility and public trust. As technology evolves—from AI-assisted documentation to virtual reality therapy tools—and as regulations adapt to the expansion of telehealth and interstate licensure compacts, you will face ethical questions that today's codes cannot fully anticipate.

Patient populations will become increasingly diverse, presenting cultural and linguistic complexities that challenge traditional approaches. Your foundation in ethical reasoning and commitment to continuous learning will enable you to navigate these emerging challenges while upholding the core principles of beneficence, non-maleficence, veracity, and autonomy. The ethical decisions you make today shape not only your patients' outcomes but the future of speech-language pathology itself.

References

Available as a separate handout.