Clinical Informed Consent and ABA: A Guide for Behavior Analysts
Introduction
Informed consent is a cornerstone of ethical behavior analytic practice. It ensures that clients, caregivers, or legal guardians understand and voluntarily agree to treatment. While informed consent is legally required in medical and psychological fields, its application in Applied Behavior Analysis (ABA) is sometimes unclear.
A recent paper by Abraham Graber & Allison Maguire (2024), published in Behavior Analysis in Practice, highlights the legal and ethical foundations of clinical informed consent and how they apply to ABA. This blog post summarizes their key findings, discusses important legal cases, and provides practical guidance for behavior analysts.
The Foundations of Informed Consent
1. Historical Perspectives
The concept of informed consent emerged from historical ethical violations, leading to important regulations:
- The Nuremberg Code (1947) – Established the need for voluntary participation in medical research.
- The Belmont Report (1979) – Outlined ethical principles for human research, focusing on respect for autonomy, beneficence, and justice.
Over time, the ethical focus shifted from a paternalistic “doctor knows best” model to patient-centered decision-making, emphasizing autonomy in medical and psychological care.
2. The Three Pillars of Informed Consent
For consent to be ethically and legally valid, it must include:
- Disclosure – Providing all relevant information about risks, benefits, and alternatives.
- Competency – Ensuring the person giving consent is capable of understanding and making decisions.
- Voluntariness – Confirming that decisions are made freely, without coercion.
Legal Precedents Shaping Informed Consent
Several court cases have helped define the legal standards of informed consent in healthcare, many of which are relevant to ABA.
1. Schloendorf v. Society of New York Hospital (1914)
- Established that patients must consent to treatment.
- Originated from a case where a patient underwent an unauthorized surgery.
2. DiFilippo v. Preston (1961)
- Introduced the Community Disclosure Standard, requiring professionals to disclose what their peers would typically disclose.
3. Canterbury v. Spence (1972)
- Reinforced patient autonomy by introducing the Reasonable Person Standard.
- Required disclosure of risks that a reasonable person would consider important.
4. Gates v. Jenson (1979)
- Expanded disclosure requirements to include:
- Future health implications.
- Available alternatives.
- Diagnostic challenges and uncertainties.
5. Truman v. Thomas (1980)
- Recognized the importance of discussing the risks of not proceeding with treatment.
- Required providers to inform patients about potential harm from refusing care.
6. Johnson v. Kokemoor (1996)
- Mandated that practitioners disclose:
- Their level of expertise with specific interventions.
- Alternative service providers and their success rates.
Understanding these legal cases helps behavior analysts ensure they meet ethical and legal informed consent requirements.
How These Legal Principles Apply to ABA Practice
1. When Is Informed Consent Required?
Informed consent is necessary:
- For all services where the client or guardian must make an educated decision.
- When implementing individual interventions, not just global treatment plans.
- When changing procedures or introducing new risks.
2. What Should Be Disclosed?
Behavior analysts must provide:
- A detailed description of the intervention.
- Possible benefits and risks, including limitations.
- Alternative treatments or approaches.
- Potential consequences of declining treatment.
3. Ensuring True Understanding and Voluntariness
To confirm that consent is truly informed, behavior analysts should:
- Use clear, simple language appropriate for the recipient.
- Ask questions to assess understanding.
- Offer opportunities to discuss concerns.
- Ensure that the client or guardian does not feel pressured to agree.
Practical Takeaways for Behavior Analysts
1. Update Your Consent Forms
Make sure all consent documents:
- Use plain, jargon-free language.
- Clearly outline risks, benefits, and alternatives.
- Explicitly state that consent is voluntary and can be withdrawn at any time.
2. Improve Communication with Clients and Families
- Explain interventions in understandable terms.
- Encourage questions and open dialogue.
- Discuss not only what will happen if services are received but also what might happen without them.
3. Document the Consent Process
- Keep thorough records of consent discussions.
- If refusals occur, document them along with an explanation.
- Periodically revisit consent, as circumstances may change over time.
Why This Matters: Ethical and Legal Accountability
Behavior analysts must ensure that clients and caregivers fully understand and voluntarily agree to treatment. Failure to obtain informed consent can lead to:
- Ethical violations, jeopardizing professional certification.
- Legal consequences, including lawsuits.
- Harm to client trust and professional credibility.
The legal cases discussed here set clear expectations. ABA professionals should align their consent practices with these legal standards to safeguard both their clients and their own professional responsibilities.
Final Thoughts
Informed consent is more than just a signature on a form—it's an ongoing process of education, communication, and respect for client autonomy. By implementing the principles outlined in Graber & Maguire’s (2024) research, behavior analysts can improve ethical decision-making and uphold best practices in ABA.
For a deeper dive into this topic, read the full study in Behavior Analysis in Practice:
📖 Graber, A., & Maguire, A. (2024). Clinical Informed Consent and ABA
🔗 https://doi.org/10.1007/s40617-023-00902-0
By staying informed, behavior analysts can protect client rights while delivering effective, ethical treatment.
