While on a two-week vacation, you discover a group of deaf children at a South American orphanage in a remote rural community. The community barely offers a basic education to the local children, and, upon asking, you find out that deaf education has NOT been established within the province. As a hearing healthcare practitioner who lives in a developed country, you are conflicted in your decision to advocate for cochlear implants, hearing aids, or manual communication.
This article is the second in a two-part series. The first article discussed how ethical dilemmas can arise when providers practice outside of licensing borders, giving the example of a large quantity of hearing aids dispensed by a humanitarian team without a plan for long-term follow-up of patients.
This article continues the conversation with another example. In the scenario presented in the introduction, there are some subtle nuances: the children are in a remote and unserved rural region where basic education is pretty limited in the best of circumstances. Often a humanitarian hearing healthcare professional has an urgent desire to implement positive and immediate results, even if that may entail transporting children to a developed region for surgery or hearing aids.
Once the initial impulse to “fix” a problem passes, it becomes imperative for the humanitarian to ponder the relational ethics of the situation. Since the humanitarian in this scenario is not native to the South American country in question, the top priority should be building relationships with the community leaders, both at the local and provincial levels, and with healthcare professionals.
If deaf education is unavailable and medical services unknown in the area, how will a cochlear implant or hearing aid be repaired, replaced, adjusted, or serviced? More importantly, we know that cochlear implants and hearing aids by themselves are inadequate for the achievement of optimal education and communication advantages. However, when the technology is paired with appropriate speech therapy/aural habilitation, the wearer has a greater chance of reaping a benefit.
The humanitarian could engage in conversation with local leaders, such as the ministers of health and education, and healthcare professionals about their vision or plan to establish an educational experience for deaf and hard of hearing children. Of course, with appropriate interaction between humanitarian and local leaders, a long-term strategic plan may develop that increases hearing healthcare access, which may eventually result in the provision of cochlear implantation as well as hearing aid fitting.
In scenarios like this, there is no question that the local professional would be held to a high standard of expectations clearly depicted by scope of practice within their own home community guidelines. Unfortunately, when away from home, much of a humanitarian's practice becomes dependent upon self-imposed behavior, as most professional societies and organizations do not address the ethics of humanitarian hearing healthcare.
ISA CODE OF ETHICS
The International Society of Audiology (ISA) created a code of ethics to formalize standards of professional behavior for its members. The following three principles are stated in the ISA document:
- Professional competence pertains to members practicing within their own scope of training, having experience representative of prevailing standards of practice, and participating in a regular program of continuing education.
- Member-client relationship suggests that members hold the welfare of the client paramount by treating clients with respect, honesty, and conscientiousness, while maintaining client privacy and confidentiality.
- Any conflict of interest should be avoided. Members are encouraged to represent themselves and their credentials to the public in a truthful and honest fashion, as well as communicate with other healthcare professionals in order to provide the best possible care to clients.
Though the ISA code of ethics is currently in draft form, a humanitarian hearing healthcare professional can easily find clear guidance when faced with ethical dilemmas. By aspiring to hold the clients/patients in the utmost regard, as well as by representing the profession with integrity, one has a far better chance of building valued interactions and friendships on a foundation of mutual respect.
With time, one can hope that professional societies and organizations will encourage their members to adhere to best-practice guidelines regardless of whether practitioners find themselves working in a developing country. After all, the world needs our best!
Some may say that when considering the knowing (ethics) and doing (morality) of the manner in which a humanitarian hearing healthcare professional interacts with clients and professionals at the work site, the answer is pretty simple. When struggling with decisions of what we personally would like to achieve, one is well-advised to ask: Is this what is best for the profession? Is this what is best for the client/patient?
“Moral excellence comes about as a result of habit.”
Reprinted with permission from ENT & audiology news: Clark JL. Should humanitarian hearing healthcare providers be concerned about ethical practices? 2011;20(2):60-62.
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Audiology Without Borders
Our Audiology Without Borders column, featured each month in the HJ eNewsletter, highlights humanitarian hearing healthcare programs.
The column is edited by active humanitarians Jackie Clark, PhD, and King Chung, PhD. Dr. Clark is a clinical associate professor at the University of Texas at Dallas and a research scholar at University of the Witwatersrand in Johannesburg; and Dr. Chung is an associate professor of audiology at Northern Illinois University in DeKalb.
Let us know about your humanitarian program! Send the details to HJ@wolterskluwer.com—manuscripts should be about 1,000 words, and photographs are also welcome (300 dpi in jpg, tif, or gif format).
Read past Audiology Without Borders columns in a special collection at http://bit.ly/HJAudWB.
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