The use of aversive stimuli in treatment: the issue of consent

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.