1. Contextual Factors that Influence Ethical Decision-Making
Brodhead, Cox, and Quigley (2018)

2. Chapter Overview
Ethical decision making is behavior – thus a function of the same laws and principles that govern all behavior
Ethical decision-making involves a choice context
An overview of basic research on choice behavior
Factors that affect clinical decision-making

3. Ethical Decision-Making
Laws and Principles of Behavior

4. Ethical Decision-Making
The science and practice of behavior analysis emphasizes the importance of consequences and their effect upon future behavior
A class of responses might be labeled as “ethical” if it matches group values
Ethical responses are selected by environmental variables like any response

5. Ethical Decision-Making
A choice context exists when two or more responses are available
The behavioral processes that may affect the likelihood that people engage in one response over another have been studied
e.g., matching law, discounting, demand
Despite the abundance of research on choice, little attention has been given to ethical choice contexts

6. Basic Research on Choice Behavior

7. Basic Research on Choice Behavior
Choice can be conceptualized as two or more concurrently available response options (Catania, 2013)
The relationship between the frequency of response choice (e.g., pecking keys) and obtained reinforcement can be examined (e.g., FR-1 versus FR-5)
The schedule of reinforcement may differ for each response option
Dimensions of the reinforcer may differ for each response option
Organisms tend to allocate more behavior to the response option that results in greater amounts of reinforcement (i.e., matching law)
Organisms tend to want things sooner and for certain – rather than later and uncertain

8. Basic Research on Choice Behavior
Response Choice #1
FR-5
Response Choice #2
FR-1
The pigeon will likely peck the black key more than the white key to maximize reinforcement

9. Basic Research on Choice Behavior
Client #1
Each hour billed at $125
Client #2
Each hour billed at $85
All else being equal, the BCBA will likely allocate more time to client #1 to maximize monetary reinforcement

10. Basic Research on Choice Behavior
Client #1
Each hour billed at $125
Limit of 5 hours per week
Client #2
Each hour billed at $85
Limit of 20 hours per week
All else being equal, the BCBA will likely allocate more time to client #2 to maximize monetary reinforcement

11. Basic Research on Choice Behavior
Client #1
Each hour billed at $125
High frequency of aggression
Client #2
Each hour billed at $85
High frequency of skill acquisition
All else being equal, the BCBA will likely allocate more time to client #2 to maximize other reinforcers

12. Basic Research on Choice Behavior
Insurance Company
Pays $125 per hour
Medicaid
Pays $75 per hour
All else being equal, the BCBA will likely admit the individual referred from the insurance company

13. Basic Research on Choice Behavior
Insurance Company
Pays $125 per hour
50% of claims are paid
Medicaid
Pays $75 per hour
85% of claims are paid
All else being equal, the BCBA will likely allocate more time to the individual with Medicaid

14. Basic Research on Choice Behavior
Functional analysis
Increased risk of harm and increased understanding of maintaining variables
Descriptive assessment
Decreased risk of harm and decreased understanding of maintaining variables
All else being equal, the BCBA may allocate time to completing a descriptive assessment if immediate minimization of harm is most important. A descriptive assessment may not reduce the long-term risk of harm as much as a functional analysis though.

15. Basic Research on Choice Behavior
The previous slides are examples of how concurrently available schedules of reinforcement, quality of reinforcement, and delayed and probabilistic outcomes may alter BCBA time allocation
The sooner, certain, and more reinforcement gained from working with one client leads to more time spent working with that client
These examples also provide context for daily analyses of BCBA behavior that might be labeled as “right” or “wrong”

16. Basic Research on Choice Behavior
The previous examples are highly simplified
Multiple variables alter the schedules and quality of reinforcement
Reimbursement rates need to be sufficient to maintain the health of the organization
Nonetheless, an understanding of choice behavior is helpful for understanding and modifying ethical decisions

17. Factors that Influence Clinical Decision-Making
The Material for Building

18. Some Factors that Influence Clinical Decision-Making
Clinical decisions impact the lives of those served
250,000 individuals die prematurely from medical errors each year in the US
Clinical decisions should be evaluated for optimization
Optimization – decisions that maximize benefits and minimize harms

19. Some Factors that Influence Clinical Decision-Making
Length of time to make a decision
Amount of information available
Expertise and background
Availability of resources

20. Some Factors that Influence Clinical Decision-Making
Length of time to make a decision
Increased length of time to make decisions increases the likelihood the decision will be optimal. The inverse is also true.
Amount of information available
Expertise and background
Availability of resources

21. Some Factors that Influence Clinical Decision-Making
Length of time to make a decision
Amount of information available
Generally speaking, the more relevant information available, the greater the likelihood an optimal decision is made
The amount of information also supports ethical decision-making
Expertise and background
Availability of resources

22. Some Factors that Influence Clinical Decision-Making
Length of time to make a decision
Amount of information available
Expertise and background
Generally speaking, increased expertise and background (experience) increases the probability of optimal decisions
Increased expertise and background also apply to ethical decision-making
Availability of resources

23. Some Factors that Influence Clinical Decision-Making
Length of time to make a decision
Amount of information available
Expertise and background
Availability of resources
Increased resources, and ease of access to resources, increase the probability of an optimal decision
Resource types
Treatment (e.g., picture cards)
Continuing education (e.g., CEU events, peer-review publications)