Ethical Dilemma

Recently, Tom Freeman, MS, BCBA, LBA-NY, LBA-MA, and current senior vice-president of ABA Technologies, Inc., received a question from a colleague regarding an ethical dilemma of sorts. Following is the exchange between the two—one that, hopefully, will be helpful to others confronted with a similar issue.

Question:

Tom, 

I am facing a potential ethical issue with an employee I supervise who believes that my agency has the best staff in her area to work with her son who has ASD. She is considering resigning—which I very much want to avoid— so we can serve her son. We spoke about ethics at the last ABA meeting and I would GREATLY appreciate your perspective on this. 

Answer from Tom Freeman (with some minor edits for clarity):

So . . . here is what I think.

Receiving services from your organization is fine if she feels you are the best provider of services available, and she should be able to continue to work for your company. Your agency must draw a bright line between the provider of supervision of her clinical work and the supervision of whomever eventually provides services to her son. In other words, her clinical supervisor must not also act as the supervisor for her son’s service provider. So long as there are levels of supervision that allow her to be insulated from the case within the agency, and she acts independently and exclusively as the guardian on her son’s case, then this should be workable.

This is clearly a difficult ethical issue, but she should not have to lose her job in order to get the best possible services for her son. For example, a nurse or doctor at a hospital (or even in a clinical practice) should not have to quit for a family member to receive services from that hospital or practice. However, that nurse or doctor should not be directly involved in the delivery of services, or the decision making on the case in any way—other than as a concerned family member.

If in the course of treatment, conflicts of interest do arise, then a meeting of all concerned should be held to see if it can be worked out, or if the case needs to be transferred. But as long as everyone goes into this with their eyes open, and with awareness of the potential for multiple roles to get in the way of proper services (and steps are taken to prevent that), I would try it. 

Perhaps some other behavior analysts who regularly deal with this type of question would have a different take on this, but in my opinion, she should not be presented with this difficult lose-lose choice. Of course, within the agency, the supervisors of these different clinicians must be very aware of the situation, and THEIR supervisor has to monitor the case carefully.