What Makes Something an Ethical Dilemma?
An ethical dilemma is distinct from a straightforward ethical violation. In a violation, the correct course of action is clear (for example, you discover a colleague is fabricating data). In a dilemma, two or more ethical principles are in tension, and following one may require compromising another. These situations require careful analysis and thoughtful decision-making.
Common ethical dilemmas in behavior analysis include conflicts between what is best for the client and what the organization or funder demands, situations where a caregiver's wishes conflict with evidence-based practice, scenarios where maintaining confidentiality conflicts with the duty to protect, and cases where resource limitations prevent the delivery of optimal services.
A Step-by-Step Decision-Making Framework
When facing an ethical dilemma, a structured approach can help you make a well-reasoned decision. Consider using the following framework:
Step 1: Identify the Ethical Issues
Clearly define what makes this situation an ethical dilemma. Which specific ethics code standards are relevant? Which core principles are in tension? Write down the competing obligations to make the conflict explicit.
Step 2: Gather All Relevant Information
Before making a decision, ensure you have all the facts. This may include reviewing the client's records, speaking with the involved parties, consulting the ethics code, and researching any applicable laws or regulations. Avoid making decisions based on incomplete information.
Step 3: Identify All Possible Courses of Action
Brainstorm multiple options, not just the two that seem most obvious. Creative problem-solving sometimes reveals a path that satisfies competing obligations better than either extreme option. Consider the potential consequences of each option for all parties involved.
Step 4: Consult
Ethical dilemmas should rarely be resolved in isolation. Seek input from trusted colleagues, supervisors, or ethics committees. The perspective of someone not directly involved in the situation can illuminate considerations you may have missed. If the situation involves legal questions, consult with an attorney.
Step 5: Evaluate and Decide
Weigh the potential outcomes of each option against the core principles of the ethics code. Prioritize the welfare of the client, but also consider the impact on other stakeholders. Choose the course of action that best balances the competing obligations while minimizing harm.
Step 6: Document Your Process
Record the dilemma, the options you considered, the consultations you sought, and the reasoning behind your decision. This documentation demonstrates that you approached the situation thoughtfully and in good faith, which is important both ethically and legally.
Step 7: Implement and Monitor
Carry out your decision and monitor the outcomes. Be prepared to adjust your approach if the situation changes or if unintended consequences arise. Ethical decision-making is not always a one-time event; some dilemmas require ongoing attention.
Real-World Ethical Dilemma Examples
Example 1: Organizational Pressure to Increase Hours
A BCBA determines that a client is making good progress and recommends reducing service hours from 30 to 20 per week. The clinical director pressures the BCBA to maintain the higher hours because the organization needs the revenue. The BCBA faces a conflict between client welfare (reducing unnecessary services) and professional obligations to the employer.
Analysis: The core principle of benefiting others takes priority. The BCBA should document the clinical rationale for the reduction, present the data to the clinical director, and advocate for the recommendation. If the organization refuses to accept the clinically appropriate recommendation, the BCBA should escalate the concern and, if necessary, consider whether they can continue working for an organization that prioritizes revenue over client welfare.
Example 2: Caregiver Disagreement with Treatment
A BCBA recommends a function-based intervention that includes planned ignoring of attention-maintained problem behavior. The child's grandmother, who is the primary caregiver, refuses to implement the procedure because she believes it is harmful to ignore a child. The BCBA faces a conflict between evidence-based practice and respecting the caregiver's values and autonomy.
Analysis: This situation calls for cultural humility and collaboration. Rather than insisting on the planned ignoring procedure, the BCBA should explore the grandmother's concerns, explain the rationale in accessible language, and investigate alternative intervention strategies that address the same function while respecting the caregiver's values. The goal is to find an approach that is both effective and acceptable to the family.
Example 3: Confidentiality vs. Safety
During a parent training session, a mother discloses that she sometimes locks her child in a closet when his behavior becomes unmanageable. The BCBA must balance confidentiality with the duty to protect the child from harm.
Analysis: The safety of the child takes precedence over confidentiality. The BCBA has a mandatory reporting obligation and must file a report with the appropriate child protective services agency. The BCBA should also provide the mother with support and resources for managing challenging behavior safely, while documenting the disclosure and the actions taken.
Ethics Dilemmas on the BCBA Exam
The BCBA exam frequently presents ethical dilemma scenarios. When answering these questions, always start by identifying the core principles at stake, then look for the answer that prioritizes client welfare while also considering the input of stakeholders, consulting with others, and documenting the process. Avoid answer choices that suggest ignoring the dilemma or taking unilateral action without consultation.
Conclusion
Ethical dilemmas are an inevitable part of professional practice in behavior analysis. By using a structured decision-making framework, seeking consultation, and prioritizing client welfare, you can navigate these challenging situations with integrity and professionalism. The process you follow is just as important as the decision you reach.