Ethics, Evidence And Clinical Decision Making




Course Type


This course was designed to fill the information void on ethical decision making for individuals with dysphagia. When striving for autonomy and the push for clinical beneficence clash, service providers need sound advice based on current best practice. Participants will learn a comprehensive model of medical ethics that can be successfully applied to their practice to better manage complex cases. Values, morals and professional codes related to a variety of challenging situations that often occur in everyday practice will be examined and discussed. Situations involving informed consent, patient refusal, treatment options including oral vs non-oral feeding, and when and how to terminate services will be addressed. The need to maintain robust and clinically relevant records and specific documentation suggestions to achieve this will also be discussed. Offered for 0.3 ASHA CEUs – 3 contact hours .

Run Time: 3:00:01

Course Overview:

  • Values, Morals & Ethics
  • Bias
  • Medical Ethics
  • Support From Professional Bodies
  • Evidence-Based Practice
  • Caregiver Burden
  • Healthcare Documents

The content of this online CE course does not focus exclusively on any specific proprietary product or service. Presenter financial and non-financial disclosures may be found in the Presenter & Disclosures area.

Course Format:

Video PowerPoint presentation with author narration & downloadable handout.

Course Objectives

  1. Explain differences between values, morals, and ethics.
  2. Identify personal biases.
  3. State medical ethical principles.
  4. Locate relevant professional publications.
  5. Explain the link between ethics and evidence-based practice.
  6. Recognize caregiver stresses.
  7. Compare common legal health documents.


Professional Issues: Contemporary Issues and Trends

Presenter & Disclosures

Paula Leslie, PhD, FRCSLT, CCC-SLP, is a professor and director of the Doctor of Clinical Science in Medical Speech-Language Pathology. She maintains full clinical licenses in the USA and UK where she is a Specialist Adviser to the Royal College of Speech & Language Therapy in swallowing disorders. She provides support to researchers and provides continuing education from grassroots to international level and across the health professions on complex clinical decision making, ethics, and end of life decisions in vulnerable populations. Her honors include the Honors of the Association Southwestern Pennsylvania Speech-Language-Hearing Association, the American Speech-Language-Hearing Association DiCarlo Clinical Achievement Award, the Pennsylvania Speech-Language-Hearing Association Clinical Achievement Award, and Fellow of the Royal College of Speech & Language Therapists (UK).

Speaker Disclosures:

Financial — Paula Leslie is a presenter of online CE courses sponsored by Northern Speech Services; receives royalties.

Nonfinancial — Paula Leslie has no relevant nonfinancial relationships to disclose.

Intended Audience/Accreditation

This program is offered for 0.3 ASHA CEUs (Intermediate Level; Professional Area).

Intended Audience

  • SLP
  • OT
  • SLPA

ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.

ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:
  • Current ASHA Member
  • ASHA Certificate of Clinical Competence (CCC) Holder
  • Licensed by a state or provincial regulatory agency to practice speech-language pathology (SLP) or audiology
  • Credentialed by a state regulatory agency to practice SLP or audiology
  • Credentialed by a national regulatory agency to practice SLP or audiology
  • Engaged in a Clinical Fellowship under the supervision of an individual with their ASHA CCC
  • Currently enrolled in a masters or doctoral program in SLP or audiology

If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.

Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.

Additional accrediting agencies by which Northern Speech is an approved CE provider:

  • California: NSS is approved as a provider of continuing education by the California Speech-Language Pathology & Audiology Board. Provider #PDP4. Online CEU limits may apply; please contact SLPAHADB for current online CEU acceptance policies.
  • Iowa: NSS is approved as a provider of continuing education by the Iowa Board of Speech Pathology and Audiology Examiners. Provider #169.
  • Kansas: NSS is approved as a provider of continuing education by the Kansas Department of Health and Environment. Provider #LTS-S0005.
  • Florida: NSS is approved as a provider of continuing education by the Florida Speech-Language Pathology and Audiology Board. Provider #SPA-026.

Frequently Asked Questions

Customer Support: Please phone 888.337.3866 or email

Course Completion Timeframe:

You have unlimited time to complete our online courses. You may log off and log on as often as you’d like to in order to complete all sections of a course.

However, completion dates are based on Eastern Standard Time. Therefore, if you need your CEUs by a certain date, be sure to complete the course test before 11:59pm EST on that date. For example, if you need CEUs before January 1st, you will need to complete the course test before 11:59pm EST on December 31st.

Content Access:

Access to course materials and content does not expire, even after completing the post test. You may continue to review course material by logging into your NSS account, clicking the My Online Courses tab, and then viewing your desired course.

Certificate of Completion:

On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.

ASHA CE Registry Submission:

During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.

Purchase Orders:

Purchase orders are NOT accepted when registering for online courses. Payment must be made online in the form of a credit or debit card payment.

What is an Online Course?

Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.

Receiving CEUs:

Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online.

Registering for an online course:

You may browse all online courses by clicking the Continuing Education tab above, then Online Courses. Once you find a course, click Enroll Now, and you will be asked to either log into your existing Northern Speech account or create a new online account. Once you’ve entered your account information and provided your credit card payment, your course will be immediately available to you.

Accessing your purchased course or returning to a purchased course:

You will be able to access your online course by logging into your Northern Speech account and then clicking the My Online Courses tab on your profile screen. Click the course you would like to start or to resume. From there, proceed through the course sections until you are ready to complete the post test. You do not have to complete your course all at once. You may log on and off as you wish.

Testing requirements:

Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.

Number of CEUs offered:

We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.

State licensing boards and online CEUs:

NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.

Course formats:

Our course formats include: text, audio, video, and PowerPoint with author narration. Each course will note the format on the course description page.

Course handouts:

Most of our online courses provide a link to download the accompanying handout as a PDF file. 

Group discounts:

Groups of 3 or more are eligible for a 20% discount on each registration on most of our online courses. To receive this discount, registrations need to be processed together via the "Group Rates" tab on the Online Course of your choice.

Computer requirements:

For our online courses to function best, we recommend that you update your computer to include the newest version of your Internet browser (Safari, Chrome, Firefox, Edge, Internet Explorer, etc.) and newest version of your computer's operating system. Also a high-speed Internet connection is recommended (cable or DSL). Speakers or headphones will be required for many of our courses as many contain audio components.

Course Cancellation Policy:

A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded. 

Contact Us |


“I like Paula Leslie’s examples from her own experience as well as from research, both within the SLP practice and outside of it. I appreciated the discussion that sometimes it is up to the SLP to open up communication about patients preferences for care; during treatment and end of life decisions.” – N.S. (Apr. 2020)

“The speaker provided clear examples of Autonomy, Beneficence, etc. The speaker’s rate of speech made it easy to follow. Talking about patient motivation and understanding what pt understands or their perspective for framing treatment goals and the use of VALUE concept when working with pt and/or pt family was most helpful.” – J.M. (Mar. 2020)

"The Patient Preference information was most beneficial: this section opened my eyes to the factors that can affect how my clients (and their family members) both understand and follow through with recommended treatments/strategies, etc." – J.D.M. (Feb. 2020)

"I really liked how she provided real-life case scenarios and walked through the ethical decision-making in each case." – H.R. (Jan. 2020)

"This course was excellent as it went through the elements of decision making for ethical practice in a systematic way." –S.H. (Jan. 2020)

"I appreciated the discussions on Advance directives and Living Wills and the resources we can use. Very informative and clarifies our ethical duties and participation in medical care for our patients." – D.N. (Dec. 2019)

"The course helped with how to address patients who dislike recommendations even after education of risks of aspiration." – A.M. (Dec. 2019)

"I gained a clearer understanding of the differences between values/morals/ethics. I liked the valuable information with relate-able examples. It was well organized and administered." – R.C. (Nov. 2019)

"I like the review of what values are and how that impacts our professional work. I am currently working more in the school setting but also do PRN work in an assisted/independent living facility; therefore, I think just the review of ethics in the practice that is no longer routine work is impactful in decision making, understanding, and counseling." – K.L. (Oct. 2019)

"I liked the section on biases, the section on types of studies that are done, the VALUE system way of communicating with families, the patient, and family decision making. I liked the speed of how the presenter presented the materials. She was thoughtful. The resources look very helpful. It was a great course." – T.C. (Oct. 2019)

"I am retired, but this course was very beneficial in every day life and I can use this to help others in any setting. The information was wonderful and well presented. I found much new and needed information." – S.P. (Sept. 2019)

"I really liked all of this and the person talking was excellent and easy to listen to. The caregiver information was especially relevant for me." – J.S. (Aug. 2019)

"I appreciated the practical steps to communicating with families and training in the development of critical thinking skills for complex cases - especially the 'case study' questions. I wish we'd gone into a little more depth about patients refusing therapy as I have run into this issue frequently - particularly with cognition patients (no swallowing or speech/language deficits) and therefore I find myself in a difficult position of encouraging the patient to try therapy vs discharging the patient from therapy secondary to patient request. However, overall this was a great course!" – L.H. (Aug. 2019)

"I liked the life examples that were given throughout the course. The explanation on the difference between ethics, morals, and values was especially helpful." – M.F. (Aug. 2019)

"One of the things I particularly liked was the inclusion of literature and perspectives from APTA and AOTA. Every area was clearly discussed and in a very interesting and engaging manner." – P.F. (July 2019)

"Paula Leslie was easy to follow and listen to. The discussion on the importance of patient preference was especially beneficial." – K.H. (May 2019)

"Presenter gave lots of scenarios and anecdotes to help with understanding. The discussion on caregiver burden was most beneficial." – L.B. (Apr. 2019)

"I liked the presenter's voice and style of presenting. It was easy to attend. I liked that I could take this in the comfort of my home without traveling. I was challenged to think in some ways that were not presented in the past at Ethical Topic Trainings I had attended. It was concise and well presented." – D.S. (Feb. 2019)

"Interesting course with great examples and wonderfully knowledgeable presenter. The portion on caregiver burden and information on healthcare documents was most helpful." – M.W. (Jan. 2019)

"I liked that she discussed the legal documents for end of life decision making and how they impact clinical decision making and the role of the clinician." – M.J. (Jan. 2019)

"The VALUE scale was very helpful. The paper which described patients' end of life wishes/preferences was especially beneficial. Dr. Leslie was very good at encouraging us as clinicians to view our recommendations through the patient's eyes (as well as the caregivers) and to not just include them in the discussion of the recommendations but to include them as PART of the recomendations." – T.C. (Dec. 2018)

"It was a good refresher in ethical decision making and it made me realize I should place patient autonomy and patient/family values higher on my radar when it comes to diet modifications. This course was easy to follow. Paula Leslie has a pleasant and calming voice, but was still engaging and she didn't make me want to fall asleep." – A.L. (Dec. 2018)

"Everything was beneficial! I like how she reinforced including patient and family wishes into our practice/treatment. Her resources and thorough coverage of the topic. She did a great job!" – V.D. (Nov. 2018)

"I liked that the material was presented with relevant commentary and explanation from the presenter." – M.R. (Oct. 2018)

"In general, it was helpful to go over just how to communicate some of these tougher decisions with patient's and their families. Also, affirmation that I have been doing well in addressing some tough, ethically challenging cases was beneficial." – B.K. (Sept. 2018)

"It was helpful to review discipline specific governing boards that provide information on ethics." – K.F. (Sept. 2018)

"I appreciated the specific review of living wills, advanced directives, surrogate decision makers, and DNR was extremely helpful as this has not been a topic thoroughly explained to me in the past. I liked that the presenter provided concrete information and guidelines along with case presentations for interpretation of ethical guidelines." – A.A. (Aug. 2018)

"I liked the way in which the instructor presented the information - especially the information regarding shared decision making." – C.S. (June 2018)

"I really liked the parts about shared decision making and the ease of reading material was helpful." – J.M. (May 2018)

"The practice questions related to patient decision making and 'non-compliance' bias I found interesting.  The course was presented well and is very applicable to my work environment." – K.O. (May 2018)

"I liked the very thorough discussion and relatedness of the principles to real life situations." – D.B. (Apr. 2018)

"I enjoyed the portion of personal bias and motivation and how it can be reflected in our treatment processes. It encouraged me to take a step back and re-evaluate myself before every treatment plan with a patient. I enjoyed the topic and thought-provoking ideas. I feel the course was excellent!" – G.H. (Feb. 2018)

"The information about advanced directives etc. was most helpful. I liked that the course was clear and concise." – C.K. (Dec. 2017)

"The discussion on compliance/noncompliance with treatment was really useful. I like that the presenter hit on some areas I didn't think about before." – K.L. (Dec. 2017)

"Engaging presentation on sometimes dry content. I especially enjoyed the discussions on autonomy vs paternalistic concepts and legal documents." – L.D. (Nov. 2017)

"Good speaker. She was very thorough and covered topics in a way that will be useful in clinical practice." – S.L. (Nov. 2017)

"I appreciated the discussion on dealing with the families and following their wishes for better ethical practice. I like that the course provided information that relates to working with patients and provided important references." – R.H. (Oct. 2017)

"I like that this course can apply to almost all clients rather than a limited population or setting." – J.O. (Sept. 2017)

"The discussion of clinical examples balancing ethical principles of autonomy and beneficence was helpful. I liked the case examples too." – M.C. (Aug. 2017)

"This was my first webinar and the speaker's voice was incredibly pleasing, excellent phrasing, and very easy to listen to. I especially enjoyed the portion on documenting clinical intervention." – J.P. (July 2017)

"I appreciated the discussion on the patient's voice in clinical decisions including end of life and striving to understand the 'unmotivated' patient. I liked the format with narration of topics outlined on screen. I also like the resources offered." – L.S. (June 2017)

"Involving the patient and their family in order to best help with clinical decision making was the best discussion. Good handout." – A.G. (May 2017)

"I found the healthcare documents and case questions most beneficial. I liked the presenter's everyday application of ethics, evidence and clinical decision making." – A.R. (Apr. 2017)

"The speaker was well organized and had a good power point presentation. She used very appropriate examples." – O.R. (Feb. 2017)

"I enjoyed her going over the difference between values, morals, and ethics as well as the info on living wills and advanced directives along with SLP role in topic." – T.R. (Jan. 2017)

"I appreciated the differences in legalities based on the location of the patient." – C.B. (Dec. 2016)

"Paula is an excellent educator on these topics and a great advocate for patient's rights." – J.B. (Dec. 2016)

"I like that it covered a number of different medical situations / case studies and research." – C.M. (Dec. 2016)

"I enjoyed the conversations on end of life, caregiver burden, and explanations of advance directives/living will. I liked how practical examples were given and used throughout." – R.M. (Dec. 2016)

"Thank you, Paula, for a surprisingly good course! I have just completed your Northern Speech Services offering on "Ethics, Evidence and Clinical Decision Making." I will admit that I just need to do a course, ANY course that fulfilled my State's requirement for 3 hours of ethics related specifically to my field. But having previously done other courses through Northern Speech and found them to be of a higher standard than some other companies' offerings, I chose yours. What a surprise then, to discover it was being presented by a fellow Brit from The North! Anyway I just wanted to say that I appreciated the relevance of your content and you not subjecting us to endless ramblings about your own research. Your section on "eminence based" rather than "evidence based" practice certainly made me smile and helped to explain why the course was well paced and bursting with relevant info. I also appreciated your use of the glottal stop. :) Very best wishes and many thanks for turning what could have been 3 hours of dry, "eminence based" stodge into something really rather refreshing." – S.S. (Nov. 2016)

"I enjoyed the audio. It was conversational and not just reading slides." – D.H. (Nov. 2016)

"The entire course was good. I found the information on caregiver/patient perspective very helpful." – S.V. (Nov. 2016)

"Excellent course on ethics and EBP. Enjoyed how she consistently showed the connection between EBP and ethical care. The presenter did a fabulous job educating clinical knowledge." – M.B. (Nov. 2016)

"I loved the accent. Nice presentation and good information. Maybe more issues that relate to children could be covered as that is my main setting, but having had a husband die from leukemia, I was able to relate to the end of the lecture from having been there." – B.M. (Oct. 2016)

"Reiterating the importance of talking with families and understanding the emotions they are feeling was most beneficial. I also appreciated differentiating between the various advanced directives." – M.B. (Oct. 2016)

"I liked the discussion of caregiver vs patient perspective and what that means for a clinician. The discussion on cultural perspectives relating to ethical decision making was really helpful." – V.S. (Sept. 2016)

"It was helpful to learn about the specific documents that underlie our profession's code of conduct. The speaker was very fluid and concise in her language and discourse." – G.R. (Aug. 2016)

"I loved that I am able to do it in the comfort of my own home/office. I am a very busy SLP and mommy, and sometimes coordinating childcare for continuing education is difficult. A great course!!" – L.H. (July 2016)

"Well organized and easy to follow; good slides and resource info." – J.H. (June 2016)

"All content presented will be useful, particularly the breakdown of ethical principles. This was well-organized. Presenter was engaging & knowledgeable. The references provided will be useful in providing pt care." – R.K. (Apr. 2016)

"It was a wealth of information regarding decisions to be made by more severely challenged individuals." – C.M. (Feb. 2016)

"The coverage on end of life care was most useful. I enjoyed the case studies." – J.D.R. (Feb. 2016)

"I appreciated the discussion on including the family." – K.R. (Feb. 2016)

"The link between ethics and EBP was very helpful. I like that the course was easy to follow." – C.B. (Feb. 2016)

"I liked the legal health documents and dealing with stressed caregivers." – S.M. (Feb. 2016)

"I enjoyed the review of evaluation research literature." – C.C. (Feb. 2016)

"The discussion on advanced directives and living wills was really beneficial." – A.S. (Jan. 2016)

"It was very well explained. I especially appreciated the professional code of ethics." – R.C. (Jan. 2016)

"I liked the discussion of real-life scenarios." – P.K. (Jan. 2016)

"I enjoyed the discussion regarding patient care at the end of their life." – C.B. (Jan. 2016)

"I liked exploring the different dynamics of Ethics." – J.O. (Jan. 2016)

"The discussion re: shared decision making and the stress placed on the caregiver when making decisions for the patient and the often unrealized stress placed upon them when providing the primary care was very useful." – H.D. (Jan. 2016)