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BOUNDARY ISSUES EXPLAINED The Health Professions Council Standards of conduct, performance and ethics (2008) require us to behave with honesty and integrity at all times (p.14). We are reminded that poor conduct outside of your professional life may still affect someones confidence in you and your profession (p.9). Arguably, our clinical conversations and research literature do not focus sufficiently on moral principles, but they at least touch on the ethics around issues such as prioritisation and evidence-based practice. In this series we think through everyday events which receive much less attention but also need to be on our ethical radar. To do the best for their clients in line with the bioethical principle of beneficence (Beauchamp & Childress, 2001), therapists need access to tools for continuing professional development. I have happily accepted adverts for communication aids, advanced courses, assessments and therapy programmes. After some soul searching I decided to include adverts from recruitment agencies, on the grounds that individual therapists have the autonomy to decide who they will work for. I declined to deal with a company that I boycott in my personal life as this would produce conflict in what is known in virtue ethics as narrative unity (Hodkinson, 2008). But was I right to use my position as a gatekeeper in this way, especially if the products might benefit clients? In any publication there is huge reliance on trust that articles are original and fair representations, that due acknowledgement is given to contributing parties, that claims and references are accurate and that any service user referred to has been properly consulted and involved for their opinion and informed consent. You dont have to be familiar with philosophical theories and ethical principles to recognise this ultimately comes down to common sense and respect for yourself and others. However, when an author writes about a product in which they have a vested interest, or even one they believe in and wish to promote, it is important to be extra vigilant in balancing the ethical risks and benefits (Long & Johnson, 2007). I ensure the author gives away information that is potentially useful to readers whether or not they buy the product. I also make explicit any links between the author and the product, or the product stakeholders and the references. But are such measures enough?
It is standard practice for publishers to send complimentary books and products for review in publications, as the authoritative recommendation of a peer has more impact on sales than a marketers blurb. There is always a risk that the review will be negative, but on balance it is worth taking the chance. It is important that reviewers are independent of the publisher and author and, if in doubt, that they declare any connection. I usually decide which conferences I want to go to and pay my own fee but occasionally I am offered a press pass with the expectation that I will subsequently write about it. Writing and disseminating a conference article can take 20-30 hours, so is this a fair exchange or a potential conflict of interest? To be on the safe side, I have started adding information about the source of funding so readers can interpret what they are reading with that in mind. On one occasion I didnt write up a conference, in spite of its topicality and impressive list of speakers. Perhaps I just spend too much time reading Private Eye or am too prejudiced against the medical model, but the event was very heavily subsidised by a drug company and involved high profile exposure of its product. I felt this muddied the waters to the extent that I would have been endorsing the product by reporting on the event. This decision wasnt easy, but how much harder would it have been if I had not paid my own fee? Ultimately, conference speakers, reviewers, recognised experts and journalists should all be aware of their position of power (Carne, 2010) and the responsibility to use it wisely and avoid being used. Body & McAllister (2009, p.10) believe the profession currently needs as much in the way of ethics debate as it can get. I hope the boundary issues series has played a part in helping you discuss and reflect on where you SLTP will draw the line. Avril Nicoll is editor of Speech & Language Therapy in Practice, email avrilnicoll@speechmag.com.
References Beauchamp, T.L. & Childress, J.F. (2001) Principles of Biomedical Ethics. 5th edn. Oxford: Oxford University Press. Body, R. & McAllister, L. (2009) Ethics in Speech and Language Therapy. Chichester: Wiley-Blackwell. Carne, V. (2010) Just a harmless perk of the job...?, MIDIRS Essence. Available at: http://www.midirs. org/development/MIDIRSEssence.nsf/articles/70F4 55A280AB4A8D802576D4004B4A2F (Accessed: 23 November 2011). Hodkinson, K. (2008) How should a nurse approach truth telling? A virtue ethics perspective, Nursing Philosophy 9, pp.248-256. HPC (2008) Standards of conduct, performance and ethics. London: Health Professions Council. Long, T. & Johnson, M. (2007) Research Ethics in the Real World. London: Churchill Livingstone Elsevier.
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