**4. Discussion**

The purpose of this study was to investigate which of the many possible roles of speech professionals are mentioned in conjunction with neuro-advancements in academic literature and Canadian newspapers, and how speech-related fields are engaged with in relation to various neuro-advancements in the same literature. The role of user of neuro-advancements in one's clinical service provision was the role found the most. Other roles, such as educator and advocate, were much less frequently mentioned, and the role of influencer of ethics, governance and policy discourses of neuro-advancements was missing. The findings sugges<sup>t</sup> a narrow and problematic role narrative of speech-related professionals in relation to neuro-advancements. In the remainder of this section we first engage with our problematic findings through the lens of neuroethics and neurotechnology governance discussions and then look at our findings through the lens of lifelong learning.

#### *4.1. Neuroethics and Neurotechnology Governance Discussions: Role of Speech-Related Professionals*

Stakeholder engagemen<sup>t</sup> is one focus of discussions within neuroethics and neuro-technology governance discourses [4–6]. It is seen as important to bring stakeholders together to "provide relevant perspectives and broadly considered insights" [5] (p. 6) and to build recognition of the importance of ethical issues into the training of all of those involved in utilizing neurotechnologies [5]. Speech-related professionals use neuro-advancements in their practice. Speech-related professionals have been engaged with some neuro-related products for quite some time such as CIs and some neuro-related products that are just emerging such as speech supporting brain computer interfaces and deep brain stimulation. The use of such emerging products will increasingly become part of the scope of practice of speech-related professionals. Furthermore, there are some neuro-advancements in which the use might not become part of the scope of practice of speech-related professionals directly but still might impact the clients of speech-related professionals. As such, speech-related professionals have a stake in how neuro-advancements are discussed, including in the ethics and governance discourses. Therefore, it is problematic that not one academic abstract or newspaper article in the literature we investigated engaged with the role of speech-related professionals as influencers of and knowledge producers for policy, ethics or governance activities related to neuro-advancements.

Sherwin stated that "we [ethicists] lack the appropriate intellectual tools for promoting deep moral change in our society" [106] (p. 80). Involving people is part of promoting change in society. That the role of speech-related professionals being influencers and knowledge contributors to neuroethics and neurotechnology governance discussions is not present in the literature we investigated suggests that speech-related professionals are not seen as potential and needed change agents in society or in need to change as part of being members of society.

According to an OECD report, one of the key objectives of the BNCT project "Neurotechnology and Society" is to "pool ideas, norms, and approaches for achieving more responsible innovation in neurotechnology for health-related applications through a step-wise process of dialogue involving researchers, innovators, policy makers, health care professionals, and the publics" [5] (p. 9). Speech-related professionals are also health care professionals but are not mentioned in the document explicitly. According to SAC, the expectations in a practitioner's role are to ge<sup>t</sup> involved in producing research and to become knowledge producers themselves [13]. As such, one would have expected some mentioning of and engagemen<sup>t</sup> with that role in relation to neuro-advancements, neuroethics and neuro-governance.

According to the SAC Code of Ethics [107], respect for autonomy, beneficence, non-maleficence, and justice are the main principles to be upheld. More specifically, respect for autonomy refers to the practitioners "enabling individuals to make informed choices"; beneficence refers to "balancing the benefits of intervention against the risks and costs"; non-maleficence refers to "avoiding the causation of harm"; and justice refers to "ensuring clients in similar situations are treated in a similar manner" [107]. Such wordings as those present in the SAC code of ethics sugges<sup>t</sup> that speech-related professionals should be involved in neuroethics and neuro-governance discussions. That the role of speech-related professionals includes advocacy on behalf of their clients [13,14], promotion, education and research [13] also suggests that the gap found in this study should be filled.

How newspapers portray speech-related professions and the role of speech-related professionals may influence an individual's perception of the field and its professionals. The study findings sugges<sup>t</sup> that the readers do not obtain any idea that being influencers of ethics and governance discourses is one role of speech-related professionals. Furthermore, when the role of educator is mentioned, the topic of education was on the clinical services and the topic of hearing and not on ethics or governance issues. The academic literature also did not discuss the role of the speech-related professionals as educators and influencers of ethics and governance issues.

## *4.2. Lifelong Learning and Professional Development*

Building clinician expertise for SLPs and audiologists including professional development [35] and lifelong learning fits with the scope of evidence-based practice [35]. A commitment to lifelong learning is expected [12,38], and SLPs and audiologists should be given the opportunity to update their knowledge and skills [34], including skills for working in an interdisciplinary environment [36]. An interdisciplinary competency framework was developed that is seen to enable the person to identify whether they need to update their competencies in order to be able to work in an interdisciplinary way [36]. Continual learning, lifelong learning and professional development for SLPs and audiologists enables the professionals to provide safe and competent care [13,16,33] and to advocate on behalf of their clients [13,14]. It is also noted that audiologists should have the skill to make use of ethics literature [39].

However, according to the literature we investigated, lifelong learning and professional development of speech-related professionals was not present as a topic in relation to neuro-advancements, neuroethics or neuro-governance. This gap in the literature should be filled. Indeed, the findings could be seen to be empirical evidence supporting claims that lifelong learning procedures are not e ffective [35]. The findings also fit with studies that focused on certain groups of health professionals (not speech-related professional) and that concluded that there is a need for better knowledge of health professionals on ethics issues [108,109]. Our findings sugges<sup>t</sup> that discussions of how to make use of lifelong learning mechanisms to increase skills and knowledge needed to contribute and influence neuroethics and neuro-governance discourses have not even started. Work is needed in this area especially given that the existing system is seen as not working [35]. Others have suggested that lifelong learning is needed to be able to discuss social and technological changes [110]. Given the constant change in neuro-advancements, lifelong learning is needed as a mechanism to be up to date not only on the neuro-advancements but also on their impact, if speech-related professionals are to fulfill their roles of providing safe and competent care [13] and to advocate on behalf of their clients [13,14].

## **5. Conclusions and Future Research**

The findings from this study sugges<sup>t</sup> that the role narrative of speech-related practitioners linked to neuro-advancements focuses on clinical practices such as the assessment, therapy, and rehabilitation of clients and not on influencer of and knowledge contributor to neuroethics and neuro-governance discussions. Lifelong learning and professional development are not discussed as tools to obtain the skills and knowledge to contribute in a meaningful way to neuroethics and neuro-governance discourses. The findings of the study are problematic given the role understanding of speech-related professionals [12,13] and the focus of neuroethics and neuro-governance on stakeholder engagement. Given the results of the study, future research could be conducted in two main areas. One area could investigate in detail the views of speech-related professionals on their role in relation to and outside of neuro-advancements in order to obtain a better understanding whether our role narrative findings reflect the role understanding of speech-related professionals or not. More concretely, such research could obtain the views of speech-related professionals on specific roles such as being influencers of neuro-advancement discourses including ethics, policy, and governance discussions and being educators of the public on neuro-advancements including ethics and governance aspects of neuro-advancements. Linked to this focus, speech-related professionals could be asked about their views of the importance of neuroethics and neuro-governance and their own involvement in neuroethics and neuro-governance discussions. A second focus of research given our findings could be on the utility of lifelong learning to empower speech-related professionals in fulfilling all of their potential roles. More concretely, such research could obtain the views of speech-related professionals on whether lifelong learning and professional development could and should be used to (a) give them the knowledge and skills needed so they can in a meaningful way contribute to the neuro-advancement discourses including ethics, policy, and governance discussions, and (b) increase

their role of being educators of the public on neuro-advancements including ethics and governance aspects of neuro-advancements. Furthermore, an analysis of the current lifelong learning programs for the speech-related field with a focus on which roles they enable might be warranted.

**Author Contributions:** Conceptualization, G.W. and V.V.; methodology, G.W. and V.V.; formal analysis, G.W. and V.V.; investigation, G.W. and V.V.; data curation G.W. and V.V.; writing—original draft preparation V.V.; writing—review and editing, G.W. and V.V.; supervision, G.W.; project administration, G.W.; funding acquisition, G.W.

**Funding:** This research was funded by Government of Canada, Canadian Institutes of Health Research, Institute of Neurosciences, Mental Health and Addiction ERN 155204 in cooperation with ERA-NET NEURON JTC 2017.

**Conflicts of Interest:** The authors declare no conflict of interest.
