Welcome, everyone, to the webinar Ethics in Hearing Health Care, Strategies for Ethical Solutions. We're so glad that you could be here today to learn more about making sound ethical choices and decisions. Our expert presenter today is Suzanne Lindsey Henderson, Senior Educational Specialist at Beltone. Suzanne joined Beltone as an Educational Specialist in May of 2007. As a Senior Educational Specialist, she designs and teaches seminars on products, software, sales, and practice management in the U.S. and Canada, with her main focus being on sales training and improving sales skills. Suzanne brings over 30 years of experience as an audiologist with MiracleHear, AHAA, and Interton. Her background includes training, sales, and business management. Please note that this presentation highlights recognized principles commonly found in the legal arena, but in no way implies nor should be considered as legal advice. It is recommended that you consult your legal counsel for specific advice regarding legal matters that may be pertinent to you. No relationship that represents a potential conflict of interest or special business relationship between the International Hearing Society and Suzanne Lindsey Henderson and Beltone Hearing Care or any of its principals or employees. We're very excited to have Suzanne as our presenter today, but before we get started, we have just a few housekeeping items. Please note that we're recording today's presentation so that we may offer it on demand through the IHS website in the future. This webinar is available for one continuing education credit through the International Hearing Society. We've uploaded the CE quiz to the handout section of the webinar dashboard, and you may download it at any time. You can also find more about receiving continuing education credit at our website, IHSinfo.org. Click on the webinar banner on the homepage or choose webinars from the professional development menu. You'll find the CE quiz along with information on how to submit your quiz for IHS for credit there as well. If you'd like a copy of the slideshow from today's presentation, you can download it from the handout section of the webinar dashboard, or you can access it from the webinar page on the IHS website. Feel free to download the slides now. Tomorrow, you will receive an email with a link to a survey on this webinar. It is brief, and your feedback will help us create valuable content for you moving forward. Today, we'll be covering the following objectives, defining the terms, principles of ethics, and strategies in how they apply to hearing instrument fitting. At the end, we'll move on to a Q&A session. You can send us a question for Suzanne at any time by entering the question on your question box on your webinar dashboard, usually located to the right of your webinar screen. We'll take as many questions as we can in the time we have available. Now I'm going to turn it over to Suzanne, who will guide you through today's presentation. Take it away, Suzanne. Thanks, Ted. Good morning, everyone, and welcome. I'm Suzanne Lindsey Henderson, as Ted said. I've actually been a Senior Educational Specialist with Beltone for the last 10 years, but I've been around the industry for 38 years, so I know a little bit about a lot of things. Today, we're going to be talking about ethics in hearing health care, and I want to start by defining the terms that you hear normally. So we're going to define ethics, morality, the law, bioethics, and ethical deliberation. Now ethics and morality are sometimes used as interchangeable terms. Ethics is a set of moral principles and a code for behavior that govern an individual's actions with other individuals and within society. Morality is what people believe to be right and good, while ethics is a critical reflection about morality. Now is your morality, your moral code, your ethical code different from other people's? Your code of ethics, your personal one, is shaped by all kinds of things. It's shaped by your parents and your family, by your education and your school, by your church, and by a lot of different factors that occur as you're growing up. The law is brought about by tension, agitation, and conflict by dramatic situations. The law is brought about by tension, agitation, and conflict by dramatic situations. Now if you wonder what I mean by tension and agitation and conflict, let me give you an example. I think one of the classic examples of a law brought about by a dramatic situation is the Amber Alert. Previous to the Amber Alert, if you had a missing person, a missing teenager or whatever, you had to wait a certain number of hours or days before the police would start looking, because they assumed it was a runaway. Then Amber Hagerlein was kidnapped and murdered off of her bicycle in the Dallas area. She was nine years old. Her parents and family and neighbors did everything. They went to the local TV stations and radio stations and begged them to broadcast a warning. After that incident, there was a lot of research done, and they found that the ideal time to find a missing child was within three hours of the incident. So therefore, the Amber Alert was brought about by a very dramatic and horrible situation. Laws are societal rules or regulations that we have to observe. Laws protect the welfare and the safety of society. It resolves conflicts. And laws are constantly evolving. Laws have governed the practice of medicine for over 100 years. And all of you sitting out there listening to me today are, of course, governed by the laws that affect audiologists and hearing instrument practitioners. You had to study and learn the business. You had to, in some states, be an apprentice. You had to take an exam. And now, you have to earn continuing education hours so that you can continue to be licensed to practice. So I want to play a couple of little games. Is it legal, moral, and ethical? And we're going to use polls just to see what you have to say about these scenarios. Scenario one is a poorly fit user. And scenario two is just something that I pulled from the national news. And with everything that's going on, it was very easy to pick out an ethical dilemma from the national news these days. So our poorly fit user in scenario one. A woman walks into your office. She's wearing a set of digital hearing aids. And she's complaining that they really don't work very well. They were fit by the hearing instrument specialist who worked in your office previously. When you talk to the patient, you discover that the hearing instruments are less than a year old. They're entry level, two channel digital hearing instruments with basic noise reduction, anti-feedback, and omni mics. They're full shell ITEs. When you look at the test results, you discover ear and bone conduction, but there was no speech testing done. The woman is very disappointed because she says that the dispenser said that this was top technology. And she paid what amounted to her life savings in getting these. We're going to do some polls about was what the other dispenser did legal? Was it moral? And was it ethical? So for the first audience poll, I want you to take a vote. I want you to tell me if you think what the hearing instrument specialist did was moral and ethical. Okay, so I'm actually not seeing the poll come up. So Ted, could you tell me the results? The majority, Suzanne, said that it was not ethical. Okay, so the majority of you said that it was not ethical. So let me just give you some food for thought. Let me go back to the case history. One of the things we all know if you've been practicing more than just a few months is that patients always or most of the time hear what they want to hear. So did that dispenser really tell her that this was top technology? The other thing I think that we have to think about is what was her life savings? So next question is, was what the hearing instrument specialist did legal? So vote yes or no. Okay, Ted, what did the poll say? Suzanne, we had 78% that said yes and 22% that said no. Okay, thank you, Ted. For those of you who said no, I hope that you were thinking about the lack of speech results. In most states, it is required that you do a full evaluation and that includes speech testing. PO2, I picked something for the national news, hopefully not something that would cause too much of a ruckus. So let's talk about Ms. Clinton, Secretary Clinton, who is a Democratic candidate for president. When she was Secretary of State, she used a personal email server rather than a government email server and allegedly sent out classified information over that website. She also has a chief of staff with four jobs, all of them paid jobs. So I want you to vote, is having your own server while working as Secretary of State legal? Okay, Ted, does the audience say that it's legal? Suzanne, 68% said yes, 32% said no. Okay. Actually, according to government regulations, it is illegal. You are bound to use the government servers and you are bound not to send classified information out over a private server. Do you think that what Secretary Clinton did was moral and ethical? Okay, Ted, what did they think? Moral and ethical? A resounding 93% said no. No, not moral and ethical. So that's very interesting. I'm not going to tell you what I think. Like I said, everyone has their own ethical code. So let's move on to bioethics. Bioethics refers to the moral issues and problems that have arisen as a result of modern medicine and medical research. And actually, just for bioethics trivia, the very first law related to bioethics was that you could not do research on a person unless you had their informed consent. But with the huge, huge explosion in research, there's bound to be constant problems with issues in bioethics these days. A lot of times issues in bioethics are life and death. And ethical and bioethical principles can be personal, organizational, institutional, or actually global. When you compare the law and ethics and bioethics, they're each different, but they're all related. Laws are mandatory. You have to, as a citizen, adhere to the law. Or comply with the law. And risk civil or criminal liability whether you like the law or not. Ethics relates to morals and it helps us organize complex information and competing values. So an ethical dilemma, and we all have these on a daily basis, is a value conflict. In an ethical dilemma, there's no clear consensus as to the right thing to do. It's a conflict between moral obligations that are difficult to reconcile and require moral reasoning. So there are also situations necessitating a choice between two equal and sometimes usually undesirable alternatives. So those situations where you're darned if you do and darned if you don't. Some ethical questions that have come to light in the news and over the air. Should a person have a right to refuse immunizations for his or her child? So if you're a parent who has belief that inoculations can cause autism or other diseases, should you have the right to say, no, I'm not immunizing my child? On the other side of that, for the school system, if a parent refuses to immunize their child, should that child be allowed to attend school and jeopardize the other children and the staff at the school? Does public safety supersede an individual's right? Should children with serious birth defects be kept alive for any reason? Should terrorists be tortured to gain information, possibly saving hundreds or even thousands of lives? Should health care workers be required to receive vaccinations like the H1N1? And who should get the finite number of organs for transplantation? So there are ways of looking at ethics that are action strategies. And there are ways of looking at ethics that they all answer the same question, but they look at things, at the consequences differently. The first one is deontology. Then there's consequentialism, virtue ethics or intuition, rights ethics. Deontology, non-consequentialism, is derived from the Greek word dion, meaning duty. It considers that some acts are right or wrong independent of their consequences. So if you were a deontologist, you look to your obligation, what is ethical, and answers the question, what should I do and why should I do it? So an example of a deontologist would be Zelda. She's a nurse practitioner. She believes she has a duty to give cardiac patients detailed information on the pathology involved in their condition. Now, she wants to give them detailed information even though the client has indicated that they're not ready or may be terrified to hear the information causing the patient distress. Consequentialism, also called teleological consequentialism, comes from the Greek word telos, meaning end or consequence. Actions are determined and justified by the consequence of the act. So consequentialists consider all the consequences of what they're about to do prior to deciding a right action. Again, this answers the question, what should I do and why should I do it? So a consequentialist in Zelda's position would have respected the wishes of her patients. She would have given them only the information which would have been a benefit to them and not cause them undue stress. She would have been motivated by her desire to do good, beneficence, rather than her sense of duty. So this is a total opposite of deontology. Utilitarian ethics considers the greatest good for the largest number of people. All of these answer the questions, what should I do and why should I do it? Intuitionism resolves ethical dilemmas by appealing to one's intuition. So it means that you have a gut feeling of knowing what is right in this particular situation. Rights, now this is an American theory. It resolves ethical dilemmas by first determining what rights or moral claims are involved and take precedence. So if you look at the debate over abortion, the personal side of rights is mom versus the fetus or child, and society's rights, which would be pro-life or pro-choice. Virtue ethics, contrary to other ethical theories, virtue ethics tells us what kind of person one ought to be, rather than what they do. So the focus in virtue ethics is on the character or goodness of the person. We all want to ask two questions when faced with a dilemma, and that is, what should I do, and the motivation behind it is, why should I do that? There are a lot of other things involved in ethics, and one is an argument about identity. Premise one in the identity argument is what is understood to be morally right depends on one's identity as a moral person. Premise two is that one's race, ethnicity, and culture is central to one's identity as a moral person. So what is understood to be morally right by an individual depends, at least in part, on the person's race, ethnicity, and culture. Remember that I said earlier that a lot of our personal moral code is determined by any number of things, our culture, our education, our family. A lot of it comes, I think, from our parents and our school, and also from our church. So what do we mean by race, ethnicity, and culture? For race, genetically there's one race, which is the human race, but society makes judgments about the variety of biological characteristics. So eventually biological characteristics are seen as socially constructed, which could lead to stereotyping. Ethnicity is a person's identification with a particular cultural group to which they are biologically related. Culture is a set of beliefs, values, and traditions that are transmitted socially from one generation to another, so it defines a group's norms or a community's identity. Cultural differences could include the way one group values the family over the individual. Everything is about the family. Some cultures expect the family to support their elderly relatives in their self-care. Some value the institutions that are sensitive to their cultural needs. One of the dangers of any type of study of ethics that everyone talks about is the danger of stereotyping. And stereotyping are oversimplifications to conceptions or images of what a particular group or person should look like, or how they should act by disregarding each person's uniqueness. They represent the end point of one's understanding that all groups should fit into the same pattern or mold. I think the example of generalizations or stereotyping that has really hit me in the face as an educational specialist over the last couple of years in our industry is the generalizations and stereotypes that we make about the technical skills of our patients. Because now we have hearing instruments that wirelessly stream. We have hearing instruments that you can pair to a smartphone or an iPad or an iPod. And our conception of our patients is this person can't even program their VCR. So why would I ever show them something that pairs to an iPhone and streams and does all of these things? So part of my job over the last couple of years in introducing these types of products is to educate hearing instrument specialists on what the real world looks like as far as technical skills of our senior population and also our boomer population. When you stereotype, it means that everybody in that group is the same. So it doesn't encourage you to explore the individual or how they assimilate into the majority group. Generalizations are statements that we make that represent common trends in a group. But they're made with the understanding that further information needs to be gathered to verify that it applies to a particular person. It represents a starting point. It's used by anthropologists whenever they see a broad pattern of similarities among groups of people. When you apply those generalizations to a specific client, like our generalization about technology skills, it may lead to you inaccurately helping that patient to choose the right hearing instrument and the right accessories for their loss and their lifestyle. There are also some organizational ideas and actions that are involved in ethics and morality. One of them is groupthink. Everyone in the group gets together and they decide to do something. And even though you think that it might be foolish or dangerous, you're going along with the pack. Social relativism is thinking to yourself, I can do this because everybody else does it. And that's things like cheating and taking office supplies and conducting personal business at work. My guess is these days that one of the big issues for big corporations is the conducting personal business at work, with people watching sports events on their computers and shopping for Christmas and doing all kinds of things, instant messaging and all kinds of things that they really shouldn't be doing at work. What are ethical principles and how do they help us with making our decisions? Conflict is inevitable. There is no life without conflict. But ethical principles provide the framework or tools which may help you or may help society to resolve conflict in a fair, just, and moral manner. So the first ethical principle is autonomy and freedom. The second is veracity. Next is privacy and confidentiality, beneficence or non-maleficence, fidelity, and justice. So let's talk about each of those just a little bit individually. Autonomy is the right to participate in and decide on a course of action without undue influence. So it is your right to be able to participate in a decision but decide on a course of action without people pressuring you. Self-determination. It's the freedom to act independently. So individual actions are directed toward goals that are yours. Veracity. Really, really simple. The duty to tell the truth. So truth-telling or honesty. I know sometimes in our practices that we have to tell patients things that they really don't want to hear. But I always found in my practice that it was better just to be honest and tell them the truth. Privacy and confidentiality. Using privileged knowledge. Respecting the self of others. And we deal with privacy acts every day in our offices with HIPAA. Beneficence. Non-maleficence. And boy are those mouthfuls of words. It's the principle and obligation of doing good and avoiding harm. The principle counsels a provider to relate to clients in a way that is in the best interest of the client or patient and not the provider. One of the things that comes to mind with beneficence is the Hippocratic Oath, which is first, do no harm. Finality. Strict observance of promises or duties. This principle, as well as other principles, should be honored by both the client and the provider. So if you make a promise to a patient, this is real easy, keep the promise. Justice. The principle that deals with fairness, equity, and quality and provides for an individual to claim that to which they're entitled. Now basically two subsets of justice. One is comparative justice, and that's having a criteria. And that means you determine who qualifies, for example, for one available kidney. A 55 male with three children versus a 13-year-old girl. And that's all determined who gets the organ with a preset criteria and outcome. Comparative justice would be that that same kidney goes to a patient by distributing those kidneys using a lottery system. Let's talk about another ethical dilemma, and I always like to do this one. It's called deciding people's fate. You're on a sinking ship, and there's only one lifeboat available. Located on the side of the lifeboat is a sign which reads, maximum occupancy, eight persons. This boat will sink if it's over-occupied. Standing on the deck of that boat and waiting to board are nine adults and one child. So you must decide who dies. The people on deck are you, a young mother and her infant son, a 75-year-old retired physician, his 68-year-old wife, a 17-year-old pregnant girl. This counts as one person, by the way. A professional athlete, a member of the clergy, a middle-aged school teacher, and her husband, a banker. So we're going to use the audience polls again. Who do you think should get on the lifeboat first? The young mother with her infant, the pastor, or the professional athlete? And I'll give you a few minutes to vote. Okay, Ted, it's still not coming up, so tell me what it was. Well, Suzanne, we had 95% that said the young mother with the infant. Okay. The next would be the professional athlete and then the pastor after that. Okay. So most of you decided on the young mother with the infant. Teaching ethics and listening to ethics is always a very uncomfortable situation, but what if you knew, would you have voted differently if you knew that the young mother with her infant was a crack addict and the baby was born addicted? What if you knew that that pastor was a pedophile and had molested young boys in his church? What if you knew that the professional athlete had just been diagnosed with Lou Gehrig's disease? So all of that gives you some thoughts about your decision. Another audience poll is who would be second? Would it be you, the retired physician and his wife, or the teenager who's pregnant? Thank you, Dan. So we have 83% who said the teenager who was pregnant, and then it was almost evenly divided between you and the retired physician and his wife. Okay. Thanks, Dad. Here again, playing devil's advocate, a lot of people are very selfless. I think that all of us want to live to see the next day. So a lot of people in this poll, when I've done it before, have said that they would not put themselves in the boat. The retired physician and his wife, what if he had lost his license for terrible practices with his patient? And the teenager who's pregnant is seriously considering late at night jumping off that boat because she's so distressed about being pregnant and not being able to get on with her life and go to college and so forth. So how do you make all of these ethical principles and ethical ideas work in our business or practice on a day-to-day basis? There's a lot of different decision-making models, but the one called ADPIE, I think is probably the closest to what we do on a daily basis. ADPIE stands for assessment, diagnosis, plan, implementation, and evaluation. So in assessment, ADPIE says that you gather the facts and collect the information from a variety of sources. So that relates to our practice in this way. We bring in a patient with a third party with them, usually a spouse, a child, a friend, and we're going to do a complete evaluation. We're going to do a case history. We're going to look in their ears with an otoscope. So in that way, we're gathering the facts and collecting the information from both the patient and third party on what the best instrument might be for their hearing loss and their lifestyle. Diagnosis, we're going to identify the problem or the issue. So we're going to take all of the things that we found in the assessment and figure out what the problem or issue really is. Planning, we're going to explore alternatives and options. We're going to identify the consequences of actions or non-actions. We're going to analyze the value of what we're doing and then make a decision. And we have to be able to justify that decision to ourselves and to our patient. So exploring the alternatives and options, I'm thinking about things like showing them different styles of hearing instruments that they can choose from. Different options in technology that would best suit their lifestyle and the demands on their hearing. Counseling the patient on the consequences of not taking action or taking action. We all know there's a lot of documented research about auditory deprivation that tells us that if the patient doesn't take action, that their understanding of speech could deteriorate and it reaches the point where the hearing instrument doesn't do nearly as much good if they wait to do something about it. Making a strong recommendation to the patient so they'll move forward. And with justifying that decision, you can relate the features in the hearing instrument to the loss and the challenges they have with hearing in their day-to-day life. Implementation is carrying out your plan. So that is convincing the person to move forward with better hearing. And it's also setting up a schedule of delivery and follow-up so that you make sure that the patient is taken care of. And evaluation. What did I learn from what I fit and what I did with this patient? You know, how could I have done better? Would they have been better with a different style or a different technology? Or is there something newer on the market that might have been better? So we do have some time for questions. I'm going to allow you to enter any questions that you have into your question box in the webinar dashboard. And I'll answer as many as I can until our time is up. Thank you, Suzanne. Suzanne, we're so excited that we've had over 150 of your fellow colleagues that have joined us today on this webinar. As Suzanne said, we do have some time for questions. So if you have a question for Suzanne, please enter it in the question box on your webinar dashboard. Suzanne, our first question comes from Susan. And Susan asks, is it okay to offer free movie tickets or another item of lower value to current clients who give us a referral? Okay, is it ethical and moral? Now, when I answer questions, of course, I'm talking about someone who used to fit and dispense hearing aids and who works for a manufacturer. There's been a lot of discussion about ethics in the industry over the last several years. I don't see anything wrong with offering a small gift for referrals to our patients, whether that be movie tickets or dinner for two at a local restaurant or a supply of batteries. I justify that in my moral code that there are too many people out there who need hearing instruments who are not wearing them. And we need as many ways as we possibly can to get those people into our offices and seen. Suzanne, our next question comes from Robert. And Robert says, does the AddPi method, can you use that method for ethical situation solving as well? Yes, you can. AddPi is just one of several ethical frameworks for solving problems. And you can apply it to any situation involving ethics. I used it in this case, because you're all hearing instrument practitioners and audiologists, to apply it to our practices and how we can make the right ethical decision for our patient. Great, thanks, Suzanne. Suzanne, our next question is from Steve. Steve asks, when manufacturer warranty dates are different from those listed on the contract, which is more ethical to follow? Okay, I believe that you must follow the contract. The contract is what you sit down and sign with the patient. You give them a copy, you keep a copy. So what is ever on that document, I believe is the legal warranty date. Great, thank you, Suzanne. Suzanne, the next question comes from John. And John says, he's a practitioner owner and he offers free services for his clients. What if the patient insists on giving him something, regardless of the fact that he doesn't typically charge for that service? I believe that you have to refuse whatever he's offering you as far as compensation for that. I had people all the time saying, oh, let me pay you, I took up your time. If your practice says that you will take care of in-office repairs free, like changing tubing or changing receivers or whatever, or if you offer a complimentary or free exam, I think that's certainly what you have to do. Some people I know out there treat competitive users a bit differently because they go someplace and they buy hearing instruments and then find out that your office is closer or easier to park at, or their practitioner charges for the service that they're offering. Or easier to park at, or their practitioner charges for things and you don't. And I think sometimes they take advantage of us a little bit. I don't know how way back when we got started off with free hearing tests and complimentary hearing tests, but I've always been somewhat against that because I believe it devalues the profession and devalues us. I think there's a tremendous value to our time, but that's the way the industry goes and that's what we all do. Great, thanks, Suzanne. Suzanne, our next question's from Allison. And Allison says, do you think it's ethical to accept trips or gifts from manufacturers? No. And actually, I am an audiologist. The American Academy of Audiology and ASHA agrees with me. I don't like the idea that people accept big gifts to incent them to use that particular manufacturer. I think we should choose our manufacturer by what is best for the practice and best for the patient. Great, thanks, Suzanne. Suzanne, our next question comes from Martin. And Martin would like it if you could list some more examples of stereotyping. Oh, stereotyping, jeez. We talked about the issue with elderly patients with stereotyping and technical skills. I think that there's stereotyping all the time if, I think another example would be a friend of mine, little boy started school not too long ago. And when he came home his first day, he said, mommy, everybody in my class speaks Spanish. Well, the school assumed that because his name was Rodriguez, that he was Spanish speaking and was going to be in a Spanish as a first language grade school class. I think another one that comes up over and over and over again is that using the word Muslim and terrorist in the same sentence is politically incorrect. I don't think we can label all Muslims as terrorists. There are a lot of people out there that are good, peace loving, wonderful Muslims. And there are a few, just like there are with the other religions that are terrorists. Great, thank you, Suzanne. Suzanne, our next question is from Linda. She says, in my office, I offer complimentary tests. Does this mean I can't charge a competitive user for repairs or reprogramming? Do you know, Linda, I came up against that a lot. I had someone down the street who advertised very heavily. He sold hearing aids at a lower cost than what I did. But when you went in for reprogramming or for repairs or tubing changes or whatever, he would charge that. I spent my first few years taking care of those patients who found out I didn't charge. And then one of them came back in for a tubing change and he had on brand new hearing aids from my competitor again. So it made me rethink my policies. I don't think that there's anything wrong with charging a competitive user for repairs or reprogramming. I don't have any problem with that at all. I do think you should have a set price list so that you're not just charging whatever comes to the top of mind. But as long as you do that, I think you're gonna be fine. Thanks, Suzanne. Then our next question is from Julie. Julie asks, do you think it is ethical to require the patient to bring a third party with them to the office? Yes, I do. I don't like the word required very much. I don't think, I think that your chances of moving the patient forward, let me put it this way, are much better with a third party there. Do I think you should absolutely say I'm not going to test you without a third party? No. I believe that they're coming into our office and they're getting dressed and parking and coming in for a purpose. They took the time to do that. I think that we owe them a test and a consultation. So required immoral, jeez, I don't have, I don't have a straight answer. I don't like that some offices say you must have one or they won't test you. How's that? Great, thanks, Suzanne. Suzanne, our next question is from Sheila. And Sheila would actually like to know your thoughts on unbundling services in terms of ethics. Unbundling services. That has been a big topic over the last couple of years. Well, I certainly see pros and cons to both sides. I think if we unbundle the cost of the hearing instrument and have different prices for different features and different styles and all of those things and show them to the patient, that a lot of them are going to choose not to add features that they really need to the product. Actually, as you all probably know, Belltone does bundle their price. Our follow-up care is included under our Bellcare. And the cost of the hearing aid, what the patient sees is actually the cost of that hearing aid with all of the options and features included. I don't know if there's moral or ethics or legality involved in either way. I think you have to evaluate what works best for your practice. If your morals insist to you that the patient should know every little piece of what they're being charged for, then go ahead. If not, I think it's easier for the patient to get absolutely the right thing for them when things are bundled. Great, thanks, Suzanne. Suzanne, our last and final question comes from Brian. Brian, do you think that it's ethical that an audiologist would tell a patient that hearing specialists are not as qualified because they have less education and or training? Oh, jeez, nothing like throwing me a bomb right at the end of this. I do think that's unethical. I think that hearing instrument specialists are extremely well-qualified and trained to fit hearing instruments. I think that they do a fabulous job. I don't think there'd be nearly as many people fit if there weren't great hearing instrument specialists out there. Are hearing instrument specialists qualified to do balance testing? No. Are they qualified to do tests about sight of lesion? No. But if they are staying within their scope of practice, I think that they are very well-qualified to sell instruments, and I think it's unethical of anyone to tell someone that they're not as qualified as far as hearing aids go. Now, since I'm an audiologist, I'm gonna get 100 nasty grants to my email about that, but that is the way I feel, so, okay. Great, thank you, Suzanne. Suzanne, I wanna thank you for an excellent presentation today, and I wanna thank everyone for joining us today on the IHS webinar, Ethics in Hearing Healthcare, Strategies for Ethical Solutions. If you'd like to get in contact with Suzanne, you may email her at shenderson at belltone.com. For more information about receiving a continuing education credit for this webinar, visit the IHS website at ihsinfo.org, click on the webinar banner, or find more information on the webinar tab under Professional Development. IHS members receive a substantial discount on CE credits, so if you're not already an IHS member, you will find more info at ihsinfo.org. Please keep an eye out for the feedback survey that you'll receive tomorrow via email. 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ethics

hearing healthcare

Suzanne Lindsey Henderson

ethical decisions

ethics definition

bioethics

ethical deliberation

principles of ethics

case studies