This paper addresses issues in the use of facilitated communication with persons having severe communication impairments, including autism. The research on facilitation is summarized, indicating that the vast majority of studies have found no evidence of communication but have found evidence of facilitator influence on the communicator's response. Difficulties in proving true communication with this approach are noted. Questions about the reliability and generalizability of positive results are raised. Ethical, legal, and social concerns in the use of this methodology are also raised. These include differences between groups over whether facilitated communication should be used with a particular individual, risks of legal liability (as in accusations of sexual abuse under facilitated communication), and the social impact of such allegations on family or staff. Guidelines are suggested, which include evaluating the individual for ability to communicate without facilitator influence. The importance of establishing baseline communication competency is stressed. Above all, further research is urged to find out the conditions under which autistic individuals can communicate as well as finding methods for preventing facilitator cuing. (DB)