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Sonic Radiant - January 2021

Professional Ethics: Making the Right Decision

Professional Ethics: Making the Right Decision
Sarah Hunkele, AuD
June 26, 2017
This article is sponsored by Sonic.

This text course is an edited transcript of a Sonic webinar on AudiologyOnline.

Learning Outcomes 

After this session participants will be able to:
  • Explain what ethics is and what ethics is not
  • Explain various approaches to ethical decision making
  • Name key ethical values
  • Identify a framework for working through ethical dilemmas

Defining Ethics

Albert Schweitzer was once quoted as saying, "Let me give you a definition of ethics: It is good to maintain and further life; it is bad to damage and destroy life." He also said, "A man is truly ethical only when he obeys the compulsion to help all life which he is able to assist, and shrinks from injuring anything that lives." That definition seems simple enough. It's a reasonable and ideal way for us to approach our daily choices. We want to do good and we do not want to do harm. 

What Ethics Is

Ethics is the branch of philosophy that deals with morality. Ethics is a standard of behaviors that guides us in how to act. Ethics is also a set of standards that gives us insight to what we should do, by giving us a view of what is right and what is wrong. These standards that we set forth are typically thought of in terms of rights, obligations, what is the overall benefit to society, what is fair, and/or specific values that we hold close or in high regard. Next, ethics is a continuous effort of studying and refining our own moral beliefs and conduct. Furthermore, it is always looking to ensure that we, and individuals or businesses with whom we interact, measure up to those same high ethical standards. It's truly encompassing the behaviors that surround ethics, what guides us to those certain behaviors and decisions that we might make. 

What Ethics Is Not

Now that we have a solid idea of what ethics is, we need to define what ethics is not. Michael Josephson is quoted as saying, "Ethics is not for wimps. It is not easy being a good person. That's why it is such a lofty goal and an admirable achievement." In defining what something is not, it can also give us valuable insight to the term itself and can help us to begin to clear up our own definitions and questions surrounding what is ethics. 

Not Feelings. Feelings can often deviate from what is ethical. However, feelings can also provide us with insight and information to what is ethical; what should or should not do. For example, we can feel comfortable when doing the right thing, even if it's difficult, but most people feel bad when doing something wrong. However, there are those who can feel good despite doing something wrong. Again, you can see that feelings do not always coincide with what is ethical.

Not Religion. It is important to recognize that if ethics was limited to or even based on our personal religious beliefs, one might then believe that ethics would only apply to the religious, or to those that hold those beliefs. This is most certainly not true. Ethics applies to everyone regardless of religious beliefs. Religions can set high ethical standards and provide personal motivation for certain behaviors and choices, so it can set a good foundation. However, ethics not confined to religion. A person can be moral and ethical, and not religious.

Not Legality. Laws do often incorporate ethical standards, but they can often deviate from what is truly ethical. Laws can easily become ethically corrupt and narrow. Many laws are hard to develop or enforce in various areas because laws don't change dynamically like so many situations that we face. Laws can be slow to address new issues and new problems that may arise in a community or in society as a whole. Again, what is always legal is not always ethical, and vice-versa. We need to understand that the two are not one in the same.

Not Culturally Accepted Norms. When we look at the norms accepted by society, most societies do accept standards for social behavior that we would view as ethical. However, there are times when an entire society can become corrupt. In that case, we would not be able to look at what that society is doing to be able to discern what is ethical. Again, being ethical is not as simple as doing whatever society says is right. If it were that simple, we would just need to look at what our neighbor is doing. This doesn't work for a number of reasons. First, because there is a lot of disagreement in today's society with reference to what is right and what is wrong. This is especially true when looking at many hot topic issues. Finding an agreement or consensus on controversial issues is almost impossible. We've all heard of that concept of when in Rome, do as the Romans do. We cannot adopt that standard when making ethical decisions, or even when justifying a decision that we have made. Just because everyone is doing it does not make it right. 

Not Science. Science can definitely provide a lot of important information to help us make better choices, but science alone cannot tell us what we should do ethically. In essence, science does provide us with explanations for what humans are like; but when we look at ethics, we find that ethics provides reasons or explanations for how we should act as humans. It's important, again, to know that just because something is scientifically possible, does not mean it is ethical.

Understanding is Key

Why is it so important for us to have a full understanding of the term ethics and what it means to us? There is a large gray area when it comes to ethics. We have to understand what guides our decision-making, what affects our decisions and what is the basis for the decisions that we make? Are there rules that we need to follow, and if so, what are those rules? How do we approach ethics? How do we evaluate and work through professional situations? How do we solve ethical dilemmas in our own lives? 

Although ethics is not specifically legality, I would be remiss not to point out the importance of understanding both the moral and legal implications of any decision we make or action that we take.

  • Legal and Moral: A decision can be legal and moral. This decision would have both no legal implications and it would be an ethically-sound decision; no problem on either front.
  • Legal and Immoral: A decision can be legal and it can also be immoral. A decision such as this would have no legal implications but it would definitely have a questionable ethical basis.
  • Illegal and Immoral: A decision could also be illegal and immoral. This type of a decision would have both legal implications and poor ethical standards attached to the choice.
  • Illegal and Moral: A decision could be illegal and moral. While it may have legal implications and be against the law, you could have a ground to say it is ethically sound and it may simply be the right thing to do.

Ethical Decision Making

Now that we have a firm grasp of what ethics is and what ethics is not, how do we apply this knowledge to inevitable situations in our lives where we need to make tough ethical decisions? Keep in mind that the right choice is not always obvious or clear-cut. Therefore, we need to form a solid foundation for how we decide and why we decide. To guide our decision-making, we can use these theories of ethics: meta-ethics, applied ethics and normative ethics. 

Meta Ethics 

Meta-ethics is the branch of ethics that seeks to understand the nature of ethical properties, statements, attitudes and judgments. Where do our ethical principles come from? What do they mean? Are they social inventions or are they universal truths? Some will say they are guided by the will of God. Meta-ethics looks at the role of reason, the meaning of various ethical terms and how they relate.

Applied Ethics 

Applied ethics looks at how we can achieve moral outcomes in certain situations. More specifically, applied ethics deals with controversial issues such as war, capital punishment, environmental issues and animal rights. 

Normative Ethics 

Normative ethics is the study of ethical action. It is the attempt to provide a general theory that tells us how we ought to live. Normative ethics looks at certain duties that we should follow, and the consequences -- both direct and indirect -- of our behaviors and decisions on others. Within normative ethics, the goal is to arrive at moral standards that regulate right and wrong conduct. The goal is to determine what will lead us to the right decision, and what will lead us to the wrong decision, and the process by which we choose a course of action. For the purposes of this seminar and the situations that we face in our professional careers, we are going to look a little bit deeper at normative ethics. 

Unlike metaethics, normative ethics does not attempt to tell us what moral properties are; and unlike applied ethics, it does not attempt to tell us what specific things have those properties. Normative ethics simply seeks to tell us how we can find out what things have what moral properties, to provide a framework for ethics. 

Many people might view this way of thinking as the golden rule: "Do unto others as you would have them do unto you." However, when I was preparing for this seminar, I found that treating others using the platinum rule is a better way: "Do unto others as they would have done unto them." It's not about what we think is right and good; it's about what is going to be the best for the person at the end of that ethical decision. 

Normative ethics assumes that we can establish a single principle, and that principle is one by which we can judge and guide each ethical choice or action. We can also look at a set of traits or principles that should be the foundation for our ethical decisions. Additionally, there is one key assumption that an ultimate criterion of moral conduct exists, although there is not 100% agreement on what this criterion is. The key is to identify the single principle, the single standard or criterion. How do we find that principle? We know that we might agree "in principle," but we don't all have the same principle in mind. As an individual, we need to determine on what do we base our standards? Then, we can figure out how to apply the standards to ethical decisions. We know we need this single principle. We know we need a criterion by which to judge our actions. We know we have to pinpoint something on which to base the standard; but how do we figure out what our standards are and how we are going to apply them? We have to refer back to the list of things that ethics is not. It is not our feelings, or religion; it's not law, it's not social norms, or what is it? What is ethics? This is where it truly can become very complicated for us. 

Five Approaches

In addition to the ethical theories, we have multiple approaches to help determine and settle upon that ultimate criterion by which we can judge our actions. The five different approaches are:

  1. Utilitarian
  2. Rights
  3. Fairness/Justice
  4. Common Good
  5. Virtue

Utilitarian. This approach is also known as consequentialism. Figure 1 shows a popular cartoon used to illustrate the Utilitarian approach. This example is known as The Trolley Problem. The trolley tracks split and branch off into two separate directions. To the right, one person is tied to the tracks. To the left, there are five people tied to the tracks. The operator is unable to stop the trolley, and they must choose on which track the trolley will travel. How do they choose? Either way, it's harmful and damage will be done. In essence, they have to decide which is the lesser of two evils. 


The Trolley Problem

Figure 1. The Trolley Problem. By McGeddon (Own work) [CC BY-SA 4.0 (], via Wikimedia Commons.

At the base of the utilitarian approach is the idea that we will choose either to do the most good or to do the least harm. Then we have to look at the possible consequences of trying to increase the good done, while simultaneously reducing the harm by that same exact decision. You can tally the good against the bad. In doing this, the assumption is that if there is more good, then it's ethical. If there is more bad, it is unethical. It seems like a simple, clear cut decision. However, not everyone is going to agree on what is good and what is bad, and we end up in a gray area. 

Rights. With the Rights Approach, the best decision is one that protects and respects the moral rights of those affected. This quote by Immanuel Kant embodies what the rights approach is about: "Always recognize that human individuals are ends, and do not use them as means to your end." With the rights approach, we truly have to recognize that others are an end, and not simply a means to our end. It's a duty-based approach. We have a duty to respect and to protect the rights of others. We have a duty to respect others not only in what we choose, but also in the consequences of the choices that we make. At the heart of this approach are those rights that we have a duty to protect. These rights are varied and debated, but most include several key rights, such as the right to make your own choice regarding what kind of life you want to lead. As an example, I may choose to be a vegetarian. I have that right and people have a duty to respect that right. I'm not hurting anybody by choosing that lifestyle. You have the duty to respect and to protect that right. Other rights include the right to be told the truth, the right to not be hurt or not be injured, and the right to a certain degree of privacy.

Fairness/Justice. The Fairness/Justice approach embodies the idea that we should treat everyone equally, and if we don't, we must be able to defend why. When using this approach, we want to ask ourselves three different questions in the decision-making process: 

  • What is the fair thing to do?
  • What has been done in the past?
  • Are my decisions consistent both with what has been done in the past and with what my choices have been?

As an example, let's say you have two employees who hold the same job, but one is paid a higher wage than the other. On the surface, this seems like it's unfair. However, there could be a difference in education, there could be a difference in experience, there could be a difference in years of tenure with the company. Again, if you can justify and defend why there is an inequality, that is considered ethical. If you treat people unequally with absolutely no defense, the Justice approach holds that it's an unethical decision. 

Common Good. The Common Good Approach holds that we should do whatever is best for and will to contribute most to the common good. A well known example of this approach is Robin Hood. His actions were not always legal (stealing from the rich and giving to the poor), but in the grand scheme of things, they were ethical. He was doing what was in the best interest of the people in the community. It is the common good and our interactions with those around us that are the basis for our ethical decisions. We not only look at the common good of society as a whole, but also how the decisions that we make will affect our interactions with neighbors, coworkers, clients, or whoever it may be. We must have respect and compassion for others and for the conditions that might affect their welfare. We need to take into consideration the consequences of any decision that we make, and thing about what effect it will have, both short-term and long-term. In essence, "life in a community is good and our actions should contribute to that life."

Virtue. The Virtue Approach is the belief that our actions should be consistent with certain values or virtues that we hold in high regard, and that provide for our full development. When we consider any action that we are about to take, we have to ask ourselves a series of questions: 

  • What kind of a person will I be if I do this?
  • If I make this choice, how does that define me?  
  • Is this action consistent with me acting at my best?  

We also have to ask ourselves, "By what criteria are we judging our decisions? What are the virtues that we should be holding in high regard?" A number of these virtues have been identified as ones that are critical in helping to guide our decision-making to keep us at our best selves and to stay true to ourselves through any type of a decision-making process.

Virtues that help us become our best possible self include:

  • Fidelity: The duty to keep promises to those with whom we interact.
  • Reparation: The duty to compensate others when we do harm (e.g., saying "I'm sorry").
  • Gratitude: The duty to thank those who help us.
  • Justice: The duty to recognize merit.
  • Beneficence: The duty to improve the conditions of others; always striving to do better, be better.
  • Self-Improvement: The duty to improve ourselves and to further our own knowledge, never to become complacent, always work to know more, be more.
  • Non-maleficence: The duty to not injure others.

Applying These Approaches

We have addressed the topic of ethics and ethical decision-making. We have introduced multiple ethical theories and a number of different approaches. I just provided a list of virtues that we should follow when facing ethical decisions. Now, we will look at how we go about using this information. How do we put it all together?

There are different ways to go about this, but I will say that simply putting the approaches together presents another set of problems. First, we don't all agree on what the common good is. We don't all agree on what virtues are important. What I hold as important may not be the same as what you hold important. We can often arrive at different answers to the exact same question or the exact same dilemma. We have to ask ourselves, "What is the common good? What is good? What is harm?" Even though each approach may not lead us to the exact same answer, each approach gives us valuable information and most times can lead us to similar answers, which we can then decipher and work through to come to our final decision. Making an ethical choice is not always easy or cut and dried -- there are many gray areas. 

Six Key Values

Regardless of the theory or the ethical approach that we use, or the virtues that we hold true and find to be very important, there are essentially six key underlying values at the heart of nearly every ethical choice that we may have to make. Even if it seems to be a simple choice, and we don't think it will affect many people, if you delve into it and dig deeper, there are so many different values that you have to hold true. These values are going to help guide your decisions. They're going to help clarify the issues and the goals that you have, and they're also going to help identify possible solutions. 

1. Trustworthiness. A person who is trustworthy is reliable, consistent and keeps their promises. In essence, they do what they say they will do. A trustworthy person is honest; they are not deceptive in what they say and what they do. They act with integrity, they are loyal to others even when they aren't around. Trustworthy people are viewed as credible and will in turn maintain a good reputation, which is important from a business aspect. If your patients trust you, if your coworkers trust you, if your community trusts you, you will in turn then have a very good reputation as a professional.

2. Respect. Respect is reciprocal: we must give respect to get respect. To show respect, we have to treat others better than they treat us, which can often be very difficult. Additionally, be open to and tolerant of differences among people. Be considerate and courteous; deal peacefully with anger, disagreement or insults. Use good manners. Remember the platinum rule: treat others how they want to be treated (not how we want to treat them). 

3. Responsibility. As a responsible person, we will be consistent. We will be accountable, we will always think before acting and act with self-discipline. We will do what we're supposed to do and we will know that actions will always create consequences. It may be a little bit further down the line, it may not be an immediate consequence, but actions always create consequences.

4. Fairness. Play by the rules, take turns, share, do not pass blame onto others and accept the consequences of your words and your actions. To be fair, we always have to stay open minded. We have to listen to others -- what they have to say and what they have to contribute. We must be equitable and impartial in our words and actions. John Bercow is quoted as saying, "Fairness is not about statistical equality." This notion goes back to the idea of fairness encompassing equity and impartiality. Equity, not equality. When faced with an ethical decision, we have to focus on being equitable and we will ultimately always be fair. It can be a tough one to figure out at times, but again, equal isn't always fair. We want to make sure that it's equitable.

5. Caring. Show others that you care, and have empathy for them; for what they feel, what they think, what they're going through. Express gratitude for what you have and for those around you. Forgive. Help others in need and be compassionate. Be compassionate not only in how you act and how you think, but in what you do, what you stand for. Again, it's very important when making those ethical decisions to know where your basis is and then use that to help guide those decisions.

6. Citizenship. Being a good citizen can mean different things to different people. Essentially, it means that we do our share, we cooperate with others. We share information, and we also seek to receive new information so we stay informed about what is occurring in our surroundings and our community. A good citizen is a good neighbor; they protect the environment, they obey the law, and at the end of the day, they seek the common good. 

Path for Ethical Decisions

How do we incorporate all of these different components into our ethical decision-making? Furthermore, how do we begin to make a choice when there are so many different factors to consider? There are multiple approaches that we can use and the need to keep certain virtues and values close; some that we may agree on, some that we may not. It makes sense that we now need a method; a definitive path that's going to help us and steer us towards an ethically-sound choice.

Fortunately, there is a very well-documented path for making ethical decisions. This path was introduced by the Josephson Institute of Ethics. Ethical decisions can be tough. We're often asked to choose between many competing options. Sometimes every option seems to have somewhat of a negative outcome; sometimes they all have a positive outcome. How do we choose? Choices are not always clear. The most important thing is that we realize that following this path and following a step-by-step method will help to guide and direct our ethical decisions. We need to determine the goals. What are the consequences? What can I do with this long-term versus short term? The steps on the path are a tool for guiding us so that we can come to an ethical decision.

The steps on the path for ethical decisions are:

  • Stop and Think
  • Clarify Goals
  • Get the facts
  • Evaluate alternatives
  • Consider consequences
  • Decide and test

Stop and Think

In real life, we won't have a big sign that pops up in front of us telling us to stop and think. However, when faced with ethical dilemmas, we need to remember to take a moment to pause, and become thoughtful about the issue. This gives us time to recognize and assess the issue at hand. It also prevents us from making a rash decision that we might later regret. When faced with difficult decisions, a lot of people recommend taking a few minutes to remove yourself from the situation to stop and breathe. This helps us to become thoughtful about the issue, thoughtful about the decision that we're faced with, and then it gives us a chance to move forward.

Clarify Goals

When we get to the goal clarification step, we have to look at our short-term and long-term goals. During this step, we must remember not to allow fulfilling immediate wants to outweigh achieving long-term goals. It's like building up a savings account. We might think about spending a relaxing weekend at the beach, which would cost $500. We might think that we need a break and that short-term, this is what we need right now. Further on down the line, however, is that beach weekend going to help me reach my goal of saving the money and having the extra funds available for something else? Identifying our goals is an important step to determine the end result that we want to achieve. 

Get the Facts

So far, we have taken the time to stop and think and we have determined our end goal; now we have to get the facts. This is not always as easy as it seems. We can't just accept the information that we are given or that we find. We also need to determine any information that we're missing; in other words, what do we not know? This is tough because we don't know what we don't know. Again, we have to open up our view and be accepting of information that we don't have readily available. We have to prepare ourselves to receive more information. However, once we receive more information, we must verify that information. Consider the source: who is giving us this information? How reliable are they? What are their motives? Why are they giving us this information? Is there an ulterior motive behind it, or are they genuinely presenting us with more information to make a sound, ethical choice?

While obtaining the facts, we have to use our best judgment. Be open to information but also be smart. Don't become complacent. Don't just look at the surface; dig deeper, especially when making tough, ethical decisions. Even though we might not have ulterior motives, people that we encounter, in both business and personal affairs, might have ulterior motives. 

Evaluate Alternatives

The fourth step is to evaluate alternative options and/or actions. Once we have identified our end goal, and we have evaluated all of the facts, we want to make a list of choices that are going to help us reach our goal. If we are struggling, this is a great time to talk to someone so that they can possibly help us see things from a different perspective. Sometimes just talking to a coworker or a trusted colleague can open up a viewpoint that we may not have even considered. It is very important to be open, not only to information, but to other people's perspectives and other people's opinions.

Consider Consequences

Once we have our list of potential actions, we absolutely must consider each and every consequence of every option or action that we are considering. We have to look at our options and ask if any of them will go against our ethical standards, and immediately eliminate any that might. If there is even a question that we feel a decision would be unethical, eliminate it, find another option. We need to consider everyone and anything that our decision is going to affect and how is it going to affect them. Again, not only short-term but also long-term, look at the overlying result of our action or our decision. This is very important to remember, we are free to choose, but we are not free from the consequence of our choice. We see that a lot with ethical dilemmas. We make our decision and we don't have a full understanding of the overreaching impact of that decision, not only to ourselves or to our business, but to those who are inadvertently or directly affected by it. 

Decide and Test

Now is the time to decide on the option that we want to move forward with. If at this point we are still unsure or on the fence, talk with a trusted friend or colleague. Or, think of someone that we regard as having high moral standards and ask ourselves what they might do in this situation. We also need to consider that if others knew of our decision, would we be proud of it? Am I willing to put my name on it, or am I going to want to shy away from that decision and hide behind it? If it makes us proud, if it's something that we don't mind everyone knowing that we've done, it's an ethically-sound decision. In the end, we want to follow the golden rule. 

Reflect on Outcome

Once we have decided and put our decision to the test, it's important to reflect on the outcome of that choice. When making decisions, we always want to monitor the effect of our decision. If it doesn't turn out the way we like or if it's not giving us the results that we hope for, at times we can reassess and we can change our decision. Sometimes we're not given that opportunity; regardless, even if we can't change the decision, we always have to evaluate our choices because that helps guide our future behaviors. 

Success Story

I would like to share a real-life success story about a person who made an ethical decision that resulted in a positive outcome. In 2009, Captain Chesley Sullenberger was piloting a plane with 155 people aboard. Immediately after takeoff, he struck a flock of Canadian geese, which caused the plane to become disabled. Captain Sullenberger had approximately 30 seconds to make a decision about what he was going to do. In those 30 seconds, he had to think, he had to clarify his goals, and he had to get information to help him meet that goal. He had to evaluate many different options and consider all possible consequences of those decisions. Then he had to decide and he had to test.

Captain Sullenberger's goal was not to save the plane; his goal was to save his passengers and to not risk any further injury to those who were on the ground. There were two different airports nearby, but he was unsure if he would be able to clear the buildings, or even if he would be able to make it to either airport. Also, in choosing to attempt to get to one of the airports, there might have been risk to people on the ground. His choice? To land the airplane on the Hudson River. 

As with any choice, there are always "what ifs." There are always questions that surface after the fact; but, we do the best we can with the information we have at the time. If we use this framework, if we think through our options and we keep our values close, we will nearly always make the right choice. As for Captain Sullenberger, he achieved his goal. There was not one fatality that day. The passengers and crew survived, and there was no injury to those on the ground. 

Important Considerations

In addition to the ethical approaches, methods and steps to guide us, there are also federal and state guidelines, along with the ethical codes of conduct set forth by professional organizations that we are required to follow. Again, the purpose of this course is not to tell you what is and what is not ethical, but to cause you to begin to think about what guides your ethical decisions.

Federal Guidelines

For the purposes of today's course, we are going to briefly touch on some federal guidelines. I encourage anyone who is practicing to conduct further research and become familiar with these guidelines because they are extremely important.

The first federal guideline is the Anti-Kickback Legislation. This legislation states verbatim that it is a "felony to knowingly and willfully solicit or receive any type of remuneration directly or indirectly, overtly or covertly, in cash or kind in return for purchasing, leasing or ordering (or recommending the same) of any good or service that is reimbursable in part or whole under a federal health care program." This applies to Medicare, Medicaid and Tricare. The premise behind this guideline is that by accepting kickbacks, it creates incentives to over-utilize specific goods and services, thereby creating unfair competition with those who are not willing to accept kickbacks. Furthermore, it impinges on patient care. By accepting kickbacks, a practitioner is not truly considering what is best for the patient.

The second important federal regulation to understand is the False Claims Act. This act states that you may not submit fraudulent claims to any entity, including:

  • Billing for services not performed
  • Billing under someone else's provider number
  • Unbundling (breaking a code into the sum of its parts; e.g., billing for separate services when it should be for an overall diagnostic evaluation)
  • Upcoding (e.g., if you were only with the patient for an hour and you charge for two hours)
  • Billing for services known to not be covered and not adding the appropriate modifier
  • Billing for services known to not be medically necessary without the appropriate modifier

Additional federal regulations include the Stark Law, HIPAA, OSHA, and the Federal Trade Commission (FTC), which involves consumer marketing materials. At the heart of it all, know that federal violations can carry criminal penalties. A violation of a federal regulation truly can have far-reaching effects, so you definitely want to make sure that you are in line with what those guidelines stipulate.  

State Guidelines

Each state has its own guidelines; become very familiar with the guidelines in the particular state(s) where you are licensed to practice. State guidelines may dictate your scope of practice. Many will serve to prevent ethical dilemmas that can become legal problems. Know that ignorance is not a defense and if you do violate your state guidelines, you may lose your license.

Professional Organizations

Within the audiology discipline, there are three main professional organizations, each with their own code of ethics and guidelines. Across these three organizations, the principles are very similar but they are worded differently. In the interest of time, I will not go into detail about all of them. Just know that if you are a member of any/all of these groups, you should familiarize yourself with their ethical standards and recommendations. 

The American Academy of Audiology (AAA) Code of Ethics.  Contents:

Preamble contains statement of purpose
Principle I: honesty, integrity and respect
Principle II: professional competence
Principle III: confidentiality
Principle IV: necessary services
Principle V: dissemination of information
Principle VI: truthfulness in publication
Principle VII: professional cooperation
Principle VIII: dignity of the profession

The American Speech-Language Hearing Association (ASHA) Code of Ethics. Contents:

Preamble contains statement of purpose
Principle I: welfare of patients (competence, truthfulness, honesty)
Principle II: professional performance (continuing education and supervision)
Principle III: disclosure of information (dissemination of information, conflict of interest, fraud, truthfulness and honesty)
Principle IV: professional cooperation (referrals, scope of practice, collaboration)

The Academy of Doctors of Audiology (ADA) Ethical Practice Guidelines. Contents:

Preamble contains the purpose and overview
Principle I: welfare of persons served
Principle II: professional competence
Principle III: professional demeanor
Principle IV: accuracy of information
Principle V: professional conduct
Principle VI: maintain standards

Common Ethical Dilemmas

As a professional, ethical dilemmas are inevitable. In a study performed at West Virginia University, a number of issues were identified as common ethical dilemmas that hearing care professionals might face (Callahan et al., 2011). I selected three situations that I felt were most relevant: pay source/funding, Quid Pro Quo, and workplace interactions.

Pay/Source Funding. Within this study, pay source/funding looked at Medicare and Medicaid compliance and reimbursement. They addressed the fact that lack of coverage may reduce care and result in inadequate amplification or a financial loss for the business. You have to accept the reimbursement; but then what do you do with that reimbursement to get the patient what they truly need? It's a delicate and difficult balance at times. There are frequent updates in policy that practices may not immediately be aware of, so you always have to stay on top of the changes. Unfortunately for some, reimbursement rates can dictate test battery or the amplification choice, both with public and private health insurance.

Quid Pro Quo. Latin meaning "this for that." It is defined as a favor or advantage granted or expected in return for something. With these dilemmas, there is often a compliance issue with federal or state regulatory guidelines. You have to ensure that you have sound business practices. You have to ensure that you're able to back up what you're doing and why you're doing it, and always be aware of potential conflicts of interest.

Workplace Interactions. This may involve dishonesty among coworkers, unethical practices, noncompliance with recommendations and perhaps inadequate counseling of patients. Additionally, practices may be misusing their audio techs, interns or students, by having them complete tasks that, especially by state guidelines, they're not supposed to perform due to scope of practice. A big hot topic is commissions, pressure to sell. What are you recommending to the patient? Is it the correct product? Are you basing it on what they need, not what you are being pushed or encouraged to sell?  

Final Thoughts

The topic of ethics is not easily defined or applied in tough situations; but it is a topic that we always have to mindful of when making choices or decisions in day-to-day practice. Be aware of the approach that you use, the virtues that you hold important and stay true to them, because they will inevitably come into play when making difficult ethical decisions. Again, my intent is not to tell you what to decide, but rather to give you the tools to form your own sound ethical decisions. Please contact me if you have any questions. Thank you so much for your attendance today.


Callahan, A.J., Lass, N.J., Richards, K.L., Yost, A.B., Porter, K.S., Schrock, J.J., & Vetica, M.D.  Ethical dilemmas in audiology. Contemporary Issues in Communication Science and Disorders, 38, 76–86.


Rank, S. (2017, June). Professional ethics: making the right decision. AudiologyOnline, Article 20411.  Retrieved from

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sarah hunkele

Sarah Hunkele, AuD

Sarah is part of the Global Support team at Sonic and is responsible for providing audiology support and training as well as CE administration.  She received her Master’s degree in Audiology from Northwestern University and her Au.D. from Salus University.  Sarah has worked in a number of clinical settings including hospitals, ENT offices, and private practice. She has also worked as a facilitator for the state of Georgia Newborn Hearing Screening Program and assisted in the education of various groups regarding audiology practices and protocols

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