Consider the following scenario:
Davion is an adult with an intellectual disability who displays problem behaviors involving aggression and property destruction. He lives in a residential facility with staff members who help take care of his needs. You are asked to consult on his case by developing an effective intervention plan to address his problem behaviors. After conducting an appropriate functional assessment of all problem behaviors involved, you come up with a couple of possible treatment plans that both have the potential to be effective based on the function of the problem behaviors. You present the choice of interventions to Davion and his support team (that consists of a family member and two staff members of the residential facility).
One of the possible treatment options involves an exclusionary timeout procedure in the calming room of the facility, in addition to functional communication training and the use of token economy procedures. The other possible treatment involves a nonexclusionary timeout procedure in addition to the other treatment components. The two alternative timeout procedures are explained to Davion in a manner that he can understand, and he decides that he would rather spend a few minutes in the calming room after he engages in problem behavior (instead of remaining in the setting where the problem behavior occurred).
The staff, on the other hand, generally dont like to use the calming room because it requires one staff member to monitor that room instead of carrying out their other duties. This increases the workload of the other staff members. Therefore, the staff members on Davions support team say that they would like to use the nonexclusionary timeout procedure.
After hearing the opinions of Davion and the staff, you are unclear what to do. You could decide to emphasize the benefits of one of the timeout procedures over the other in order to bias the decision in that direction, though you know both procedures have the potential to be effective. You also know that you have limited experience using exclusionary timeout to handle behaviors that involve safety concerns (i.e., transferring an adult who is engaging in aggressive behavior from one setting to another). Therefore, you recognize that using the exclusionary timeout option might require further support from another behavior analyst with experience in this procedure.
What should you do? Which procedure should you recommend for implementation?
Please address this scenario by answering the following:
Is this an ethical dilemma? Why or why not?
The four guiding principles of the Ethics Code are (1) benefit others, (2) treat others with compassion, dignity, and respect, (3) behave with integrity, and (4) ensure competence.
Choose two of these principles that you think apply to this scenario. Define the principles and then explain how they relate to your decision-making process about what treatment to recommend. (You do not have to decide which treatment to use, but you simply must discuss how the principles you choose would affect your final decision.)
Ethical Dilemma in Behavioral Intervention for Davion
Introduction
In considering the case of Davion, an adult with intellectual disabilities exhibiting aggressive and destructive behaviors, we encounter a complex ethical dilemma. This scenario presents two potential intervention strategies: exclusionary timeout in a calming room and nonexclusionary timeout. Both strategies come with their own set of advantages and disadvantages, and the decision-making process involves weighing the needs and preferences of Davion against the concerns of the staff at the residential facility.
Is This an Ethical Dilemma?
Yes, this scenario constitutes an ethical dilemma. An ethical dilemma arises when there are competing moral principles that guide decision-making, leading to a situation where one must choose between conflicting actions. In this case, the ethical principles involved include Davion's right to choose an intervention that he prefers, which aligns with his dignity and autonomy, versus the staff's concerns about practicality and workload. This conflict raises questions about how to best support Davion's needs while respecting the limits and well-being of the staff.
Guiding Principles of the Ethics Code
1. Benefit Others
The principle of benefiting others emphasizes the importance of acting in a way that promotes the welfare of individuals receiving support. In this case, Davion's best interests should be at the forefront of any decision made regarding his treatment plan. Implementing a procedure that has been shown to effectively reduce problem behaviors while ensuring safety is critical.
Relation to Decision-Making Process:
In considering which treatment to recommend, I must evaluate how each option serves Davion’s needs. While both procedures may be effective, I would lean toward the exclusionary timeout in the calming room if it aligns better with Davion’s expressed preference and has been shown to reduce aggressive behaviors more effectively than nonexclusionary timeout. However, this choice would need careful consideration of the potential benefits versus the risks involved, particularly regarding safety during aggressive episodes.
2. Treat Others with Compassion, Dignity, and Respect
This principle underscores the importance of treating individuals with kindness and recognizing their inherent worth. For Davion, this means honoring his choice regarding intervention strategies and ensuring that any treatment plan respects his autonomy and preferences.
Relation to Decision-Making Process:
By respecting Davion's choice for exclusionary timeout, I acknowledge his ability to express his needs and preferences, which is essential for promoting his dignity. However, I must also consider how this choice impacts the staff’s capacity to provide care effectively. The staff’s concerns about increased workload are valid; thus, I should engage in a dialogue with them to explore potential solutions that maintain Davion’s dignity while addressing their concerns. Perhaps training additional staff members or adjusting schedules could mitigate their workload issues.
Conclusion
In summary,
the ethical dilemma surrounding Davion’s treatment options highlights the tension between benefiting him as an individual and ensuring that staff can provide care effectively without compromising their own well-being. By prioritizing the principles of benefiting others and treating individuals with compassion, dignity, and respect, I can guide my decision-making process towards a balanced approach that considers both Davion's preferences and the practical realities faced by his support team. Ultimately, collaboration between all parties involved will be crucial in reaching an ethically sound decision that meets Davion's needs while supporting staff efficacy.