by Mike Metz, PhD
A friend of mine spoke often on ethical and legal behavior. He repeatedly said that if Audiology wished to be considered a true healthcare profession, its practitioners would not base their ethical decisions on some examples found in medicine (and some other professions). He has a right to make such a statement since he is a physician as well as an ethicist.
I am neither a physician nor an ethicist, but comments and comparisons about the ethics of audiologists seem quite apparent.
Obligations of the Profession
Over all is a concept that can be argued but not denied: being a member of a professional group, regardless of belonging to a professional organization, obligates that professional to adhere to the ethical positions of the group. If one walks, talks, and acts like a duck (or physician, or audiologist) one is automatically (as well as professionally and legally) included in that group.
Arguments that deny professional or ethical responsibilities due to non-membership in a professional group are generally not valid. Arguments that condone behavior because some members of another professional group function outside the ethical boundaries of their profession are only examples of questionable behavior and not models for, or representative of, that profession.
Professional and Public Sectors
When adherence to ethical standards reaches a point that the public (or politicians) take issue with what is observed, not only is the public trust threatened, but also a common result may involve legislation or other legal actions to “patch” this breached issue. An example involves the establishment of licensing laws to assure the public that aspects of the professional group are under control.
Generally, it is not good for the profession when someone in the public sector interferes with a professional standard since this typically occurs when the profession does not meet public expectations. The public moves to investigate and modify the behavior, as public judgment of high standards is essential to continued trust in that profession.
Professions that function in the professional arena and might provide examples of past or potential public/political action include the pharmaceutical field and healthcare insurance providers. While these industries are not entirely “professional”, they do depend upon the public trust for financial, political, as well as professional status. When they find themselves under public and/or political (governmental) scrutiny, it quickly becomes apparent that occupying the narrow area between professional and business is difficult. Their “slip-ups” generally cause reduced profits or loss of public trust. Sometimes, both result.
Fields in the professional, public work arena must take a professional stance. Despite advertising statements of “professionalism”, retail fields elect a stance that does not require the public trust. Retailers of all sorts may define their efforts as “professional” but do not meet the definitions in any other than a retail—profit motivated, caveat emptor—manner. Almost everyone seems to understand this position—salespersons and customers alike.
For years, there has been considerable public confusion involving the functional differences between audiologists and device salespeople. Many audiologists have prospered making decisions only on the make, model, and settings of hearing aids and thus have defined themselves in the greater public arena as hearing aid sellers. Audiologists must appear to these consumers as retailers and not healthcare providers, despite graduate training in other areas. Most audiology graduates dispense instruments, as fees for audiology services do not support clinical efforts. It’s difficult to dispute the public observation and resulting confusion.
Audiology will continue to be defined by the actions of our majority, not by our best intentions, any designator, or by any obscure code of behavior. In a recent letter in Audiology Today (Sep/Oct, 2016), James Jerger opined that a return to clinical, therapeutic roots involving activities other than device fitting might be the salvation of audiology. It’s difficult to argue with Dr. Jerger.
The PCAST and PSAP issues may be a force for the rebuilding of audiology. Not in the sense of devices, but in remapping the necessity of investigations into the hearing sense, the explanations of ear disease, and demonstrable benefits of the help to patients that audiology might be capable of delivering.
Our issues are in the process of being resolved on multiple levels and at least one thing is regrettably true. If our profession fails to act like a healthcare entity, the public and political impressions will inevitably lead to a definition of audiology that will largely be outside the healthcare arena. The re-establishing of the practice of audiology in all aspects, including the fitting of devices, could lead to a sustainable, beneficial, and profitable future. Good or bad, the coming ethical position of audiology will likely be different than in the past.
Mike Metz, PhD, has been a practicing audiologist for over 45 years, having taught in several university settings and, in partnership with Bob Sandlin, providing continuing education for audiology and dispensing in California for over 3 decades. Mike owned and operated a private practice in Southern California for over 30 years. He has been professionally active in such areas as electric response testing, hearing conservation, hearing aid dispensing, and legal/ethical issues. He continues to practice in a limited manner in Irvine, California.
feature image from VM Ware