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

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