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

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. 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 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

Ethics Deals with the study and evaluation of human conduct in light of moral principles, which may be viewed as the individuals standard of conduct or as a body of social obligations and duties (Institute of Chiropractic Ethics) Deals with the study and evaluation of human conduct in light of moral principles, which may be viewed as the individuals standard of conduct or as a body of social obligations and duties (Institute of Chiropractic Ethics)

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

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

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

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

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) 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)

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

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

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

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

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

Ethical Scenarios Each small group will be asked to discuss a scenario and answer the questions posed 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 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 Input and discussion from the entire group as time permits

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

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

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

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

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

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

Ethical Scenario #6 Baby born at hospital with high annual birth rate in state with mandated screening Baby born at hospital with high annual birth rate in state with mandated screening Parents refused screening to save money Parents refused screening to save money Hospital did not have policy to address refusal due to inability to pay 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 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 Hearing aids and early intervention within one month of diagnosis

Questions and Comments