The use of adverse stimuli in treatment: the issue of consent.
Guardian consent is not enough—prove the aversive is the only way and that the client gains from it.
01Research in Context
What this study did
Murphy (1993) wrote a think-piece, not an experiment. He asked one question: who can say 'yes' to an aversive like shock or strong reprimands?
The paper looks at clients with intellectual disability. It argues that proxy consent—mom, dad, or guardian signing for them—is weak when the treatment can hurt.
What they found
The author found no ethical shortcut. If the client cannot understand the risks, proxy consent is 'shaky.'
The only moral route is to prove the aversive is truly best for the client, not just easy for staff.
How this fits with other research
Saunders et al. (1988) came first. Their six client rights say 'give the most effective care.' Murphy (1993) adds the guardrail: 'only after real consent.'
Brown et al. (2025) later turns the idea into a checklist. They tell BCBAs how to add safety and consent steps when a functional analysis might use aversives.
Roberts et al. (1987) asked parents what they accept. Parents liked DRI and overcorrection; they disliked time-out and drugs. Glynis would warn: parent dislike does not equal informed consent—you still need to show the client benefits.
Why it matters
If you run an FA with spray, white noise, or any aversive, do not rely on a quick guardian signature. Write a one-page plain-language sheet. List the risk, the hoped-for gain, and the non-aversive options you tried first. Read it aloud to the client and the proxy. Only proceed when both say 'yes' and you have data showing the procedure is truly needed.
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02At a glance
03Original abstract
It has been argued that, in the consideration of the use of aversive stimuli in treatment, the issues are ideological and philosophical as well as technical. Adopting Horner's (1990) definition of what is meant by 'aversive' in the ideological debate, it is suggested that the crucial issue is the inability of making clients to give their informed consent. It is proposed that proxy consent might be an alternative, but that this would be unacceptable if aversive procedures could be shown to be never in the best interests of the client, or shown to violate clients' rights or to be against the interests of society because of anticipated harm or injustice to others. It is concluded that it is difficult to be certain that it is ever in the best interests of the client for aversive procedures to be employed, that aversive interventions appear not to violate clients' rights necessarily (except possibly the right to dignity and respect while the intervention is operating, and perhaps the right to choice at the beginning of the intervention), but that the inescapable difficulty in the use of aversive interventions is the likelihood that they will be misused with other clients than the ones for whom they may be initially designed.
Journal of intellectual disability research : JIDR, 1993 · doi:n/a