Professionalism in the context of providing elective services: reflecting on bias

ABSTRACT

We examine the provision of elective pronunciation services, such as intelligibility enhancement, to non-native speakers by speech language pathologists (SLPs). Practices associated with the ‘modification’ of non-native accent raise significant professionalism questions about bias for SLPs and healthcare professionals. These questions arise partly due to the socio-cultural context in which SLPs practice and their clients live, and the relational nature of communication. We argue that due to the ambiguity inherent in accent modification practices, SLPs must weigh a variety of considerations before determining the circumstances in which such services are professionally acceptable. Our argument is rooted in consideration of the complex nature of professionalism related to communication. After surveying potentially relevant models from other healthcare professions and finding them wanting, we support our position in light of current literature on topics such as accounts of functionality. We conclude by generalizing our anti-bias recommendations to interprofessional healthcare professionalism.

KEYWORDS:

• Speech language pathology
• professional ethics
• professionalism
• implicit bias

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

Both authors contributed to the conceptualization of manuscript, literature review and writing of the manuscript. Both authors have read and approved of the final manuscript.

Data availability

There is no data set associated with this submission.

Notes

1 The term ‘native speaker’ has also been criticized as suggesting that intelligible English is spoken only by monolingual White individuals [3,4], but an acceptable alternative has not been suggested in this context.

2 One might object to this line of argument and suggest that modified accents can allow for similar success, as, in theory, they address the intelligibility concern we discuss. However, we do not argue that this is not an option, but rather that it is not an ethically acceptable one: this is due, generally, to the fact of mutuality in communication, and, professionally for SLPs, to their altruistic calling and their medical-scientific account of pathology.

3 One resource for doing so is the Harvard Implicit Association Test [23] available at https://implicit.harvard.edu/implicit/takeatest.html.

Additional information

Funding

The authors received grant funding from an Opportunity Meets Innovation Challenge Grant program made to Seton Hall University by the New Jersey State Office of the Secretary of Higher Education.

Notes on contributors

Kathleen F. Nagle

Kathleen Nagle, PhD, CCC-SLP is an associate professor the department of speech language pathology at Seton Hall University, where she teaches research methods, voice disorders and bioethics. Her research focuses on acoustic and perceptual outcomes for different and disordered speech and voice.

Bryan Pilkington

Bryan Pilkington, PhD is a professor of medical sciences at the Hackensack Meridian School of Medicine. His research focuses on questions in bioethics and moral and political philosophy.