The Tangle of Autonomy, Beneficence, Liberty, and Consent in the CESS Debate

Peterson (2023) wrote a think-piece, not an experiment.

She looked at the fight over contingent electric skin shock (CESS) for people with intellectual or developmental disabilities who speak few or no words.

The paper maps four ideas that knot together: autonomy, beneficence, liberty, and consent.

There is no clean answer.

When clients cannot say "yes" or "no" in full sentences, the four values tug in opposite directions.

Peterson says behavior analysts must name the tension out loud and keep looking for what they still do not know.

Cooper et al. (1990) already warned that clients have the right to eat too many doughnuts and take a nap.

That early paper put autonomy on the table; Peterson keeps it there and adds the consent puzzle.

Lerman (2023) and Zarcone et al. (2023) go further.

They say, "Stop CESS now."

Their call to action sounds stricter than Peterson’s map, but it lands on the same side: when consent is murky, do not shock.

Wishart (1993) saw this coming.

That paper said informed consent is the main wall against any aversive, and proxy consent rarely climbs over it.

Peterson widens the lens: even non-aversive plans need the same hard look when the client cannot talk.

If you write plans for non-speaking clients, pause at every goal.

Ask: "Who chose this?"

If the answer is only the team, dig deeper.

Add assent checks, trial opt-outs, and stakeholder voices.

Peterson gives you language to explain the ethical knot to supervisors and families, and a push to keep revising until the client’s own voice—however they show it—steers the plan.