Issues in Ethics: Conflicts of Professional Interest
About This Document
Published 2018. This Issues in Ethics statement is a revision of Conflicts of Professional Interest (originally published in 2004 and revised in 2011). It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2016). The Board of Ethics reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.
Issues in Ethics Statements: Definition
From time to time, the Board of Ethics (hereinafter, the "Board") determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics (2016) (hereinafter, the "Code") and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical
Introduction
This Issues in Ethics statement is presented for the guidance of ASHA members and certificate holders in matters relating to conflicts of professional interest.
As we have become increasingly aware of the power of external factors to influence interpretation and reasoning—and the possibility that these external factors may undermine objectivity—all of the professions have begun to pay more attention to conflicts of interest. Principle of Ethics III, Rule of Ethics B, of the Code specifically prohibits conflicts of professional interest. "Individuals shall avoid engaging in conflicts of interest whereby personal, financial, or other considerations have the potential to influence or compromise professional judgment and objectivity."
The Board defines conflict of interest as an opposition between the private interests and the official or professional responsibilities of a person in a position of trust, power, and/or authority. Such conflicts may result in a situation in which personal, financial, and/or nonfinancial considerations have the potential to influence or compromise professional judgment in clinical service, research, consultation, instruction, administration, or any other professional activity. It is important to note that it is not necessary for such influence or compromise to have occurred before a situation can be identified as a conflict of interest. It is sufficient for the situation to appear to provide the potential for professional judgment to be compromised.
The following information is provided in an attempt to heighten sensitivity, increase awareness, and enhance judgments in those circumstances when conflicts of interest influence, or appear to influence, professional conduct.
Guidance
Principle of Ethics I
"Individuals shall honor their responsibility to hold paramount the persons they serve professionally or who are participants in research and scholarly activities, and they shall treat animals involved in research in a humane manner."
This indicates that professional practice decisions must first and foremost promote the best interests of those who are being served. Normally, there is no conflict between the professional's interest and the interests of those they serve. This is because both the professional and the client typically share the same interests (the clinician and the patient both want the patient to improve as much and as quickly as possible; the teacher and the student both seek the student's intellectual and professional advancement; the researcher and the journal in which research is published both seek to advance understanding). Moreover, professionals are usually quite skilled in keeping their own personal interests and preferences separate from their professional responsibilities.
Principle of Ethics III
"Individuals shall honor their responsibility to the public when advocating for the unmet communication and swallowing needs of the public and shall provide accurate information involving any aspect of the professions."
Principle of Ethics III, Rule B
"Individuals shall avoid engaging in conflicts of interest whereby personal, financial, or other considerations have the potential to influence or compromise professional judgment and objectivity."
Under certain circumstances, it may be difficult for a professional to maintain the separation of personal interest from professional service. These situations often involve professionally related commercial enterprises or financial arrangements in which the individual is involved and personally benefits. Some studies have shown that physicians who are part owners of imaging practices are somewhat more likely than other physicians to refer patients for imaging. But conflicts of interest can also arise when clients, relatives of clients, or contractors offer gifts or incentives that may predispose the professional to favor them. Involvement in the professional assessment (clinical, academic, or administrative) of someone who is a friend can constitute a conflict of interest.
An individual's belief that their professional judgment or objectivity is unaffected by gifts, other economic incentives, or personal ties is not sufficient protection against conflict of interest. This is partly because the influence introduced by personal interests may be subtle, such that the person affected may be unaware of the way in which their judgment has been biased. For this reason, there is inherent motivation in workplace settings to establish policies for employee conduct to minimize professional conflicts of interest.
All ASHA members and certificate holders have a duty to conduct themselves in such a way as to preserve and protect the public's trust and confidence in the professions. By becoming involved in a situation that has the potential to compromise independent judgment or objectivity, an audiologist, speech-language pathologist, or speech, language, and hearing scientist diminishes the public's trust and confidence in the professions at large. Even the appearance of a conflict of interest can be damaging to professional relationships and to the public perception of the professions.
Discussion
Conflicts of interest can occur in teaching, research, and clinical practice, and they may be obvious or subtle. No Principle or Rule of either the Code or the Issues in Ethics statement can address all of the forms that such conflicts can take. This Issues in Ethics statement gives guidance in identifying conflicts of interest and suggests what should be done when a conflict is identified.
Identifying Conflicts of Interest
Many conflicts of interest involve commercial interests or financial arrangements. Policies and procedures in workplace settings should be evaluated to safeguard against biases or preferences being introduced into professional judgments. If a professional is offered, or receives, gifts or incentives—even something as minor as a free lunch—conflict of interest may be suspected.
Personal and family relationships complicate the ability to recognize potential conflicts of interest. Preferential treatment in referrals, in the evaluation of employees, or in the assessments of students and fellow faculty members should be avoided.
What to Do About Conflicts of Interest
When faced with a potential conflict of interest, there are three appropriate responses: avoid, disclose, and recuse.
It is best to avoid situations that could result in conflicts of interest whenever possible. In commercial and financial matters, avoidance does not mean that absolutely no nonwage benefits may be accepted. It does mean that some are prohibited and that all should be carefully scrutinized. Audiologists, speech-language pathologists, and speech, language, and hearing scientists should not accept gifts or benefits unless it can be clearly demonstrated that such gifts or benefits
- primarily contribute to the welfare of persons served professionally;
- do not reasonably appear to bias professional judgment;
- enhance one's professional knowledge and skills; and/or
- do not diminish the dignity or autonomy of the professions.
Disclosure is essentially a self-initiated action, with the intent to be honest and complete, to provide personal and professional information in order to remain ethically compliant with the Code. The act of disclosure is a process of transparency. Foundational to proper, professional, and ethical conduct is the intent to be honest, accurate, and complete. Disclosure of both financial and nonfinancial relationships is inherent in assumed ethical conduct. Many clinical, research, and teaching scenarios can potentially foster a natural tension between professional obligation and personal preference/gain. Misrepresentation by both errors of omission and commission can create ethical violations.
Recusal is the action of withdrawing from situations when one's participation creates bias that could adversely influence the decision. As an example, when one sits on a committee or board that makes decisions about the advancement of others or about the distribution of resources and benefits to others, a conflict of interest may require that the professional recuse themselves. Recusal may occur because of the professional's financial interests in or personal ties to one or more of the parties. By disclosing the nature of the association and by stepping out of the decision-making process, the professional ensures that any personal preferences or biases they may have will not unfairly influence the deliberations.
Summary
Individuals must carefully consider all circumstances surrounding the offer of a gift or an incentive, including the purpose of the donor, how the transaction may be viewed by impartial observers, and the potential impact on the practice of the professions. Individuals must also be aware of ways in which their personal and family relationships, and other close personal associations, may potentially bias their judgments. Preservation of the highest ethical standards is vital to the conduct of independent judgment and professional practice by audiologists, speech-language pathologists, and speech, language, and hearing scientists. Conflicts of interest erode the public's trust and must be avoided whenever possible. When they cannot be avoided, they must be managed with transparency.
