Kennedy Inst Ethics J. 2020;30(1):31-69. doi: 10.1353/ken.2020.0000.
This paper has both theoretical and practical ambitions. The theoretical ambitions are to explore what would constitute both effective and ethical treatment of Autism Spectrum Disorder (ASD). However, the practical ambition is perhaps more important: we argue that a dominant form of Applied Behavior Analysis (ABA), which is widely taken to be far-and-away the best "treatment" for ASD, manifests systematic violations of the fundamental tenets of bioethics. Moreover, the supposed benefits of the treatment not only fail to mitigate these violations, but often exacerbate them. Warnings of the perils of ABA are not original to us-autism advocates have been ringing this bell for some years. However, their pleas have been largely unheeded, and ABA continues to be offered to and quite frequently pushed upon parents as the appropriate treatment for autistic children. Our contribution is to argue that, from a bioethical perspective, autism advocates are fully justified in their concerns-the rights of autistic children and their parents are being regularly infringed upon. Specifically, we will argue that employing ABA violates the principles of justice and nonmaleficence and, most critically, infringes on the autonomy of children and (when pushed aggressively) of parents as well.
本文兼具理论和实践抱负。理论上的抱负是探索什么构成有效的和合乎道德的自闭症谱系障碍(ASD)治疗方法。然而,实践上的抱负或许更为重要:我们认为,一种广泛被认为是治疗 ASD 的最佳方法——应用行为分析(ABA),表现出对生物伦理学基本原则的系统性违反。此外,这种治疗方法的所谓好处不仅没有减轻这些违反行为,反而常常使其恶化。我们并不是第一个警告 ABA 的危险的人——自闭症倡导者多年来一直在敲响警钟。然而,他们的呼吁在很大程度上被忽视了,ABA 继续被提供给自闭症儿童的父母,并经常被他们强烈推荐为合适的治疗方法。我们的贡献是从生物伦理的角度来论证,自闭症倡导者完全有理由对此表示担忧——自闭症儿童及其父母的权利经常受到侵犯。具体来说,我们将论证,使用 ABA 违反了公正和不伤害原则,并且最关键的是侵犯了儿童(在被积极推动时)以及(当被积极推动时)父母的自主权。