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The Golden Rule as a Clinical Practice Guide*

The Golden Rule as a Clinical Practice Guide*
Judith F. Duchan, PhD
June 23, 2003
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Everywhere you look, now and throughout history, you will find people evoking The Golden Rule as a guide for how to think and behave toward one another. A common, contemporary way of expressing the rule is "do unto others as you would have them do unto you." The rule is part of many religions and often serves as a guide for ethical practices, being regarded as a fundamental moral imperative.

Amazingly, given its omnipresence, the Golden Rule is not emphasized in the professional practices of speech-language pathologists in the United States. There is, for example, neither a tacit or explicit expression of the Golden Rule in the statement of ethical practices of the American Speech-Language-and Hearing Association. ASHA's Code of Ethics does say that "Individuals shall honor their responsibility to hold paramount the welfare of persons they serve professionally." But this statement does not encourage professionals to assume the point of view of the client. We can treat our clients in ways that they we might not want to be treated, so long as we think it will promote their welfare.

ASHA's ethical statement is presented as given, as something to live by. There is no overarching way to help us make judgments about our particular actions. There is no check on whether our ideas about clients' welfare is consistent with our clients' own ideas, or even whether it is consistent with what we would want to have done if we were in the client's position.

You might ask, "What are we doing that shows we are not abiding by the Golden Rule"?
Here are seven examples of practices that we might not want to experience ourselves:

  1. Our excessively negative and judgmental tone when writing reports, focusing on what clients can't do rather than casting their difficulties in the context of competencies (see Duchan, 1999a for a detailed critique of the negative nature of clinical reports).


  2. Our failure to portray the experience and words of the person with the disability in our reports (e.g., see Middleton, G., Pannbacker, M., Vekovius, G., Sanders, K., Puett, V., 1992, for guidelines for writing reports that leave out the point of view of the client).


  3. Our selection of therapy goals with little input from clients or family members about their needs or desires (see LPAA Project Group, 2000 ; Duchan & Byng, in press; and Holburn & Vietze, 2002, arguments for more on this failure to involve clinicians in their own therapy planning.).


  4. Our undue focus on accuracy in our clients' performance, (see Kagan & Gailey.1993 for more on this difficulty).


  5. Our tendency to define functional communication in mundane, utilitarian terms (see Byng & Hewitt, in press, Elman & Bernstein-Ellis, 1995; and Kagan, 1993 for development of this "functional is not enough" position).


  6. Our reliance on evaluation methods that objectify performance (see Duchan & Black, 2001; Kagan & Duchan, in press, for more on the need to examine our clients' subjective experiences).


  7. Our adherence to evidence-based decisions when evaluating our practices without considering the values upon which our decisions are made (see Byng, Cairns, & Duchan, 2002, for a call for the need to examine the values underlying practices).

Judith F. Duchan, PhD



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