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

The Ethics of Serving The Ethics of Serving Infants and Their FamiliesInfants and Their Families

Les R. Schmeltz, Au.D.Les R. Schmeltz, Au.D.NCHAM &NCHAM &

Arizona School of Health SciencesArizona School of Health Sciences

Karen Munoz, M.S.Karen Munoz, M.S.NCHAM &NCHAM &

Northern Illinois UniversityNorthern Illinois University

Faculty Disclosure Faculty Disclosure InformationInformation

In the past 12 months, we have not had a In the past 12 months, we have not had a significant financial interest or other significant financial interest or other relationship with the manufacturer(s) or relationship with the manufacturer(s) or provider(s) of the service(s) that will be provider(s) of the service(s) that will be discussed in our presentation.discussed in our presentation.

This presentation will not include discussion of This presentation will not include discussion of pharmaceuticals or devices that have not pharmaceuticals or devices that have not been approved by the FDA nor will we be been approved by the FDA nor will we be discussing unapproved or “off-label” uses of discussing unapproved or “off-label” uses of pharmaceuticals or devicespharmaceuticals or devices

EthicsEthics ““Deals with the study and Deals with the study and

evaluation of human conduct in evaluation of human conduct in light of moral principles, which light of moral principles, which

may be viewed as the may be viewed as the individual’s standard of conduct individual’s standard of conduct or as a body of social obligations or as a body of social obligations

and duties”and duties” (Institute of Chiropractic Ethics)(Institute of Chiropractic Ethics)

EthicsEthics

Ethical standards are defined by the Ethical standards are defined by the associations and organizations to associations and organizations to which a professional belongswhich a professional belongs

It is the responsibility of each It is the responsibility of each member of those groups to abide by member of those groups to abide by the ethical standards of each groupthe ethical standards of each group

Codes of EthicsCodes of Ethics

American Speech-Language-Hearing American Speech-Language-Hearing AssociationAssociation

American Academy of AudiologyAmerican Academy of Audiology Academy of Dispensing AudiologistsAcademy of Dispensing Audiologists State Speech-Hearing-Language State Speech-Hearing-Language

AssociationsAssociations Other professional groupsOther professional groups

Codes of EthicsCodes of Ethics Principles are statements of the agreed Principles are statements of the agreed

upon standards of ethical practice upon standards of ethical practice Serves to inform patients about what they Serves to inform patients about what they

have a right to expecthave a right to expect Informs other professionals about the kind Informs other professionals about the kind

of cooperation they have a right to expectof cooperation they have a right to expect Provides guidance for ethics committees Provides guidance for ethics committees

to rule on professional misconduct of to rule on professional misconduct of membersmembers

Each professional must take Each professional must take individual responsibility to individual responsibility to

see that ethical standards of see that ethical standards of practice are followed in all practice are followed in all

professional activities, in all professional activities, in all professional environments professional environments and for all persons servedand for all persons served


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


““Members shall maintain high Members shall maintain high standards of professional standards of professional competence in rendering services” competence in rendering services” (AAA Code)(AAA Code) Education, training and experienceEducation, training and experience Appropriate credentials/licensureAppropriate credentials/licensure Use all available referral resourcesUse all available referral resources Appropriate and calibrated equipmentAppropriate and calibrated equipment Continuing professional developmentContinuing professional development


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

Codes of EthicsCodes of Ethics ““Members shall provide only services Members shall provide only services

and products that are in the best and products that are in the best interest of those served” (AAA Code)interest of those served” (AAA Code) Not exploit persons in the delivery of Not exploit persons in the delivery of

servicesservices Not charge for services not renderedNot charge for services not rendered No conflict of interestNo conflict of interest Informed consent for investigational Informed consent for investigational

proceduresprocedures


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


““Members shall comply with the ethical Members shall comply with the ethical standards of the Academy with regard to standards of the Academy with regard to public statements or publication.public statements or publication.

Members shall honor their responsibilities to Members shall honor their responsibilities to the public and to professional colleaguesthe public and to professional colleagues

Members shall uphold the dignity of the Members shall uphold the dignity of the profession and freely accept the Academy’s profession and freely accept the Academy’s self imposed standards.” (AAA Code)self imposed standards.” (AAA Code)

Ethical ScenariosEthical Scenarios

Each small group will be asked to Each small group will be asked to discuss a scenario and answer the discuss a scenario and answer the questions posedquestions posed

One member of the group will report One member of the group will report back to the larger group what was back to the larger group what was discusseddiscussed

Input and discussion from the entire Input and discussion from the entire group as time permitsgroup as time permits

Ethical ScenariosEthical Scenarios

Questions:Questions: 1. What ethical issues do you think are 1. What ethical issues do you think are

involved in this case?involved in this case?

2. What actions do you think were needed?2. What actions do you think were needed?

3. What action do you think you would take 3. What action do you think you would take if if this happened in your area?this happened in your area?

Ethical Scenario #1Ethical Scenario #1 Failed 2 OAE Screens at birthFailed 2 OAE Screens at birth Passed OAE & Tymp at 4 weeksPassed OAE & Tymp at 4 weeks Retested at 12 months:Retested at 12 months:

Normal Tymps, OAE’s present bilaterallyNormal Tymps, OAE’s present bilaterally No measurable responses by ABRNo measurable responses by ABR Moderate to severe bilateral hearing lossModerate to severe bilateral hearing loss

Probable Auditory NeuropathyProbable Auditory Neuropathy CI, enrolled in early interventionCI, enrolled in early intervention Parents concerned about delayed Parents concerned about delayed

diagnosisdiagnosis

Ethical Scenario #2Ethical Scenario #2

Baby identified with moderate to severe Baby identified with moderate to severe bilateral sensori-neural loss at 6 weeksbilateral sensori-neural loss at 6 weeks

Amplification at 12 weeksAmplification at 12 weeks Audiologist pressured parents into Audiologist pressured parents into

Auditory Verbal TherapyAuditory Verbal Therapy Parents concerned about not being Parents concerned about not being

informed about more communication informed about more communication alternativesalternatives


Infant failed newborn screening and Infant failed newborn screening and identified with moderate s/n loss at 3 monthsidentified with moderate s/n loss at 3 months

Audiologist recommended ENT evaluation, Audiologist recommended ENT evaluation, amplificationamplification

Parents decide not to pursue Parents decide not to pursue recommendations or services for their childrecommendations or services for their child

Audiologist reports child to Dept of Social Audiologist reports child to Dept of Social Services as Child in Need of AssistanceServices as Child in Need of Assistance


Baby referred on 2 inpatient and 1 Baby referred on 2 inpatient and 1 outpatient OAE screenoutpatient OAE screen

ABR at 5 weeks:ABR at 5 weeks: Click ABR at 70 dB and 80 dBClick ABR at 70 dB and 80 dB Wave V present in both ears per Wave V present in both ears per

neurologistneurologist ““Functional hearing bilaterally” reportedFunctional hearing bilaterally” reported

No follow-up recommendedNo follow-up recommended

Ethical Scenario #5Ethical Scenario #5 Baby diagnosed at 3 weeks with Baby diagnosed at 3 weeks with

severe s/n hearing losssevere s/n hearing loss Hearing aids fitted at 8 weeks Hearing aids fitted at 8 weeks Audiologist adjusted aids using “Quick-Audiologist adjusted aids using “Quick-

fit” in NOAH, then turned gain down “a fit” in NOAH, then turned gain down “a bit” to avoid overamplificationbit” to avoid overamplification

Parents advised to return in 4 weeks to Parents advised to return in 4 weeks to check on the fittingcheck on the fitting

Ethical Scenario #6Ethical Scenario #6 Baby born at hospital with high annual Baby born at hospital with high annual

birth rate in state with mandated screeningbirth rate in state with mandated screening Parents refused screening to save moneyParents refused screening to save money Hospital did not have policy to address Hospital did not have policy to address

refusal due to inability to payrefusal due to inability to pay Child was identified with moderate s/n Child was identified with moderate s/n

hearing loss at 2.5 years of agehearing loss at 2.5 years of age Hearing aids and early intervention within Hearing aids and early intervention within

one month of diagnosisone month of diagnosis

Questions and CommentsQuestions and Comments

Documents

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