Professional ethics applies to a particular profession and focuses on protecting the interests of the individuals served. A professional code of ethics defines shared fundamental principles (based on values) specific to a particular group for practice, research, and education (Chabon & Ulrich, 2006). The code guides professionals' behavior concerning their interactions with clients, colleagues, and employers (Wesley & Buyesse, 2006). It supports self-reflection and public accountability and recognizes individuals as a community of professionals with distinct privileges and obligations. Furthermore, a professional code of ethics involves principles that a specific profession has established to judge the best action to take when facing ethical dilemmas that call for decision-making. 

The relevance of ethics to the daily experience of healthcare professionals is highly acknowledged, and each healthcare association has formulated its code of ethics that is taught as part of professional training. Healthcare professionals (e.g., psychologists, occupational therapists, speech and language therapists) providing direct therapy to children in special education act in a unique situation where ethical dilemmas are examined according to the principles that reflect their values as professionals and establish expectations for their clinical practice. Given that special education is abundant with ethical problems and dilemmas, well-intentioned professionals must learn and apply the relevant ethical standards appropriate to this specific setting. Thus, the question is, how does a multidisciplinary team in special education school resolve cases when a conflict arises between definitions of an ethical dilemma?

Speech and language therapists (SLTs) are employed in various settings, including medical and educational. This study focuses on the unique circumstances associated with providing school-based services in special education and the challenge of applying SLTs' professional code of ethics in special education-based practice.  

During training and development as healthcare professionals throughout their careers, SLTs devote much of their time and effort to assimilating theoretical and technical knowledge with professional and clinical skills. Nevertheless, only a small amount of time is dedicated to considering the substantial ethical implications of what they are learning to do.

Given that SLTs often significantly influence the special education programs and services provided for children with disabilities, the role of SLTs in special education has been insufficiently examined regarding the complex ethical dilemmas they are likely to face. 

The aims of the present study were as follows: 

(1)  to explore how SLTs in special education identify ethical dilemmas and examine the ethical perspectives that influence their decision-making.

(2) to examine whether SLTs’ professional code of ethics provides comprehensive guidance to address ethical dilemmas in special education.

(3) to examine what SLTs claim are the significant sources of ethical dilemmas in special education schools. 

(4) to explore whether and how often SLTs in special education are involved in ethical deliberations with multidisciplinary staff, and whether they recall cases when these lead to competing interests and controversies.  

Using a purposeful sampling method, we invited SLTs employed in Special Education schools to participate in the study. Seventy-three clinicians responded to our request. Of these, 35 clinicians who met the following criteria were chosen to be included in the study: At least three years of experience as SLTs employed in a special education school. Attended a course on professional ethics as part of their academic training. Familiar with the SLTs’ professional code of ethics. A focus group interview was chosen to gather direct thoughts and observations from the SLTs regarding their involvement in ethical dilemmas. Based on a semistructured interview protocol (Morgan, 2002), we conducted five focus group interviews, each lasting approximately 3 hours. All focus group conversations were recorded and transcribed. Using specific questions to guide but not limit their discussions within each focus group, we asked the SLTs to share their views and other information regarding their experiences with ethical dilemmas in special education. In addition, we presented several cases and then used this discussion to begin a dialogue about general ethical issues in special education and strategies for making principled ethical decisions. The data analysis process included reviewing transcripts of the focus group discussions, notating concepts that emerged from the data and related to the study’s aims, identifying categories, and determining relationships among categories to reveal emerging themes (Bogdan & Biklen, 2003).

Most participants needed clarification on the differences between professional ethics and laws, rules, and regulations since they referred to them as interchangeable. Many of the SLTs need help explaining how to identify an ethical dilemma. SLTs are faced with the dilemma of choosing between potentially contradictory obligations. For example, confidentiality, a term in widespread use and familiar to healthcare professionals, is challenging with another familiar concept, teamwork. To respect the issue of confidentiality, not releasing information outside the therapy room may risk undermining the teacher's contribution. Although SLTs are often uncertain about how to proceed when faced with ethical dilemmas, deliberations about ethics in special education are infrequent. The participants raised the issue that some dilemmas are conceptualized as clinical in nature, involving clinical decision-making, but still have ethical implications. For example, when (or how much information) an SLT needs to bring to the notice of parents a suspicion that their child might have some severe additional difficulty that requires assessment and intervention. Using the 'four principles approach' (Beauchamp & Childress, 1994) as a directive guideline to resolve ethical dilemmas poses interpretation challenges in particular cases. For example, failing to provide any service while searching for an SLT expert in a specific area (e.g., autism, cerebral palsy) may not be in the child's best interest and may even result in harm. The participants agreed that SLTs are not prepared enough to cope with ethical dilemmas in special education.

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