Do no harm—An ethical dilemma and one possible way out.

Abstract

When analysis services are provided to individuals, families, and organizations, analyst and individual, family, and organization enter a client-agent relationship that carries with it certain responsibilities. These responsibilities relate to, but are not yet a part of body of science and technology that inform agent's decisions and are provided as guidelines for responsible conduct. The Behavior Analyst Certification Board, Inc., has adopted such guidelines for responsible conduct for analysts. This code provides that can lead analysts to answers to practical questions about their work. These rules govern analyst's scope of practice, business practices, and limits on makeup of client-agent relationship. In general, guidelines require analyst to hold client's welfare paramount in all matters and to be law-abiding, truthful, and fair. Among specific items provided are several that are intended to help analyst to do no harm when faced with various dilemmas. One such predicament occurs when analysis services are necessary and requested in a high-risk case and only available analyst is under-qualified. In this case, simply doing nothing will leave client at risk. In what follows, BACB guidelines for responsible conduct are applied to this all too common dilemma in order to demonstrate utility of guidelines and how they lead to possible ways out. The Guidelines for responsible Conduct are quite explicit on matter of qualifications. Clients have a right to effective treatment (i.e., based on research literature and adapted to individual client). In support of this general notion, guidelines state behavior analysts provide services, teach, and conduct research only within boundaries of their competence, based on their education, training, supervised experience, or appropriate professional Further, behavior analysts provide services, teach, or conduct research in new (emphasis added) areas or involving new techniques only after first undertaking appropriate study, training, supervision, and/or consultation from persons who are competent in those areas or And, behavior analysts do not promote use of behavioral assessment techniques by unqualified persons, i.e., those who are unsupervised by experienced professionals and have not demonstrated valid and reliable assessment skills. Again, the analyst accepts as clients only those individuals or entities (agencies, firms, etc.) whose problems or requested service are commensurate with analyst's education, training, and experience. In lieu of these conditions, analyst must function under supervision of or in consultation with a analyst whose credentials permit working with such problems or services. Clearly, an under-qualified analyst cannot ethically or responsibly proceed, but as mentioned above, to withdraw would leave client at risk--to do nothing is, in effect, to do harm. The statements from guidelines provided above suggest that under-qualified analyst may proceed with consultation. This approach works but only just so far. If techniques to be used with client require extensive practice under direct supervision, then consultation alone will typically not be enough to ensure competent use of those techniques. In this instance analyst still faces a problem. And again guidelines offer a way out- ... analysts arrange for appropriate consultations ... based principally on best interests of their clients, with appropriate consent (emphasis added). The best interests of client are paramount. The analyst is guided to ask client to make decision (consent is, of course, to be obtained in all cases, but has a particularly important part to play in this instance). …