The Ethics of Serving Infants and Their Families

1. The Ethics of Serving Infants and Their Families Les R. Schmeltz, Au.D. NCHAM & Arizona School of Health Sciences Karen Munoz, M.S. NCHAM & Northern Illinois University

2. Faculty Disclosure Information • In the past 12 months, we have not had a significant financial interest or other relationship with the manufacturer(s) or provider(s) of the service(s) that will be discussed in our presentation. • This presentation will not include discussion of pharmaceuticals or devices that have not been approved by the FDA nor will we be discussing unapproved or “off-label” uses of pharmaceuticals or devices

3. Ethics • “Deals with the study and evaluation of human conduct in light of moral principles, which may be viewed as the individual’s standard of conduct or as a body of social obligations and duties”(Institute of Chiropractic Ethics)

4. Ethics • Ethical standards are defined by the associations and organizations to which a professional belongs • It is the responsibility of each member of those groups to abide by the ethical standards of each group

5. Codes of Ethics • American Speech-Language-Hearing Association • American Academy of Audiology • Academy of Dispensing Audiologists • State Speech-Hearing-Language Associations • Other professional groups

6. Codes of Ethics • Principles are statements of the agreed upon standards of ethical practice • Serves to inform patients about what they have a right to expect • Informs other professionals about the kind of cooperation they have a right to expect • Provides guidance for ethics committees to rule on professional misconduct of members

7. Each professional must take individual responsibility to see that ethical standards of practice are followed in all professional activities, in all professional environments and for all persons served

8. Codes of Ethics • “Professionals shall provide professional services and conduct research with honesty and compassion, and shall respect the dignity, worth and rights of those served.” (AAA Code)

9. Codes of Ethics • “Members shall maintain high standards of professional competence in rendering services” (AAA Code) • Education, training and experience • Appropriate credentials/licensure • Use all available referral resources • Appropriate and calibrated equipment • Continuing professional development

10. Codes of Ethics • “Members shall maintain the confidentiality of the information and records of those receiving services or involved in research” (AAA Code)

11. Codes of Ethics • “Members shall provide only services and products that are in the best interest of those served” (AAA Code) • Not exploit persons in the delivery of services • Not charge for services not rendered • No conflict of interest • Informed consent for investigational procedures

12. Codes of Ethics • “Members shall provide accurate information about the nature and management of communicative disorders and about the services and products offered.” (AAA Code)

13. Codes of Ethics • “Members shall comply with the ethical standards of the Academy with regard to public statements or publication. • Members shall honor their responsibilities to the public and to professional colleagues • Members shall uphold the dignity of the profession and freely accept the Academy’s self imposed standards.” (AAA Code)

14. Ethical Scenarios • Each small group will be asked to discuss a scenario and answer the questions posed • One member of the group will report back to the larger group what was discussed • Input and discussion from the entire group as time permits

15. Ethical Scenarios • Questions: • 1. What ethical issues do you think are involved in this case? • 2. What actions do you think were needed? • 3. What action do you think you would take if this happened in your area?

16. Ethical Scenario #1 • Failed 2 OAE Screens at birth • Passed OAE & Tymp at 4 weeks • Retested at 12 months: • Normal Tymps, OAE’s present bilaterally • No measurable responses by ABR • Moderate to severe bilateral hearing loss • Probable Auditory Neuropathy • CI, enrolled in early intervention • Parents concerned about delayed diagnosis

17. Ethical Scenario #2 • Baby identified with moderate to severe bilateral sensori-neural loss at 6 weeks • Amplification at 12 weeks • Audiologist pressured parents into Auditory Verbal Therapy • Parents concerned about not being informed about more communication alternatives

18. Ethical Scenario #3 • Infant failed newborn screening and identified with moderate s/n loss at 3 months • Audiologist recommended ENT evaluation, amplification • Parents decide not to pursue recommendations or services for their child • Audiologist reports child to Dept of Social Services as Child in Need of Assistance

19. Ethical Scenario #4 • Baby referred on 2 inpatient and 1 outpatient OAE screen • ABR at 5 weeks: • Click ABR at 70 dB and 80 dB • Wave V present in both ears per neurologist • “Functional hearing bilaterally” reported • No follow-up recommended

20. Ethical Scenario #5 • Baby diagnosed at 3 weeks with severe s/n hearing loss • Hearing aids fitted at 8 weeks • Audiologist adjusted aids using “Quick-fit” in NOAH, then turned gain down “a bit” to avoid overamplification • Parents advised to return in 4 weeks to check on the fitting

21. Ethical Scenario #6 • Baby born at hospital with high annual birth rate in state with mandated screening • Parents refused screening to save money • Hospital did not have policy to address refusal due to inability to pay • Child was identified with moderate s/n hearing loss at 2.5 years of age • Hearing aids and early intervention within one month of diagnosis

22. Questions and Comments