Propose different challenges that your colleague did not discuss related to counseling terminally ill patients. Then, provide an alternate course of action for this case. Please support your response with sources. Respond to the following:

1. C. Bix-End of Life Decisions

My personal feelings on end of life decisions can vary depending on the circumstances. In cases with terminally ill individuals I tend to feel that they have the right to decide how to die. A few years ago my dad was diagnosed with colon cancer and went through the surgeries, radiation, and chemotherapy.

It was very difficult for him and when he was considered cancer free I asked him if he would go through it again if the cancer came back and he gave me a solid "No". He said that he could not imagine going through all of that pain again and I could respect that decision even though it was painful for me to hear. My dad's situation is different but the mind frame is similar. I believe that if there is no chance that the individual will recover from the illness and their quality of life will be greatly diminished then that decision lies with them and I should have no say in the matter.

I believe that I would have a hard time counseling individuals who were terminally ill simply because it would be emotionally draining when they pass. It is essential for counselors who work with terminally ill clients to engage in personal counseling to discuss their personal thoughts and feelings about death and decisions about hastening death (Duba & Magenta, 2008).

Potential Ethical Challenge

The ethical issue with end of life decisions is that of avoiding causing harm to clients and breaking confidentiality. According to the ACA Code (2014) a counselor has the option to maintain confidentiality depending on laws and circumstances of the situation when counseling terminally ill clients who wish to end their life.

So the dilemma lies within the personal values of the counselor if the state does not restrict such situations. One would then need to consider the harm that would come to the client if they were forced to die a painful death due to other's imposing their own values on him/her. Counselors are ethically bound to avoid harming their client's and to minimize or to remedy unavoidable or unanticipated harm (ACA, 2014).

Course of Action

In order to make an informed decision regarding breaking confidentiality with a terminally ill client who is considering hastening their death I would need to consider the state laws, consider my own beliefs about death and right to die, and be aware of any cultural influences (Remley & Herlihy, 2016). In the case study with Jason, I would have to say that I would maintain confidentiality. It appears that he has already made his decision;

I would maybe counsel him on making arrangements or possibly try to gain closure from his family before his death if he were interested in that. The way that I view him not continuing to take his medication is no different than an obese person continually eating unhealthy (it will eventually contribute to their death), he has every right to choose how he much he is medicated. I would seek consultation from a colleague or supervisor and would document any assessments, consultations, and treatment options that were considered and chosen (Remley & Herlihy, 2016).

Reference:

American Counseling Association (ACA). (2014). 2014 ACA code of ethics [White Paper].

Duba, J. D., & Magenta, M. (2008). End-of-life decision making: A preliminary outline for preparing counselors to work with terminally ill individuals. The Family Journal, 16(4), 384-390.

Remley, T. P., Jr., & Herlihy, B. (2016). Ethical, legal, and professional issues in counseling (5th ed.). Upper Saddle River, NJ: Pearson.

2. M. Beau-My personal values on end of life decision makes me feel uncomfortable because I value the sanctity of life but also have mixed feelings. A case that comes to mind is the Terri Shiavo. It is unfortunate, that Terri did not have the ability to decide whether to prolong her life or end it.

I would not want to prolong my life in a vegetative state. What kind of life would one live in that condition? There are instances though such as someone diagnosed with terminal cancer that could have the possibility of prolonging their life through medication and proper medical attention. As an example, my friend was diagnosed with stage 4 ovarian cancer and is in remission. Her case is different from Terri because she is not in a vegetative state.

Ethical Challenge

End of life decisions are very difficult especially when the client is helpless and unable to decide for themselves and have the family intervene on their behalf. As excruciating the case may be for a counselor to deal with, they must respect the client's decision. Herlihy and Corey further described, according to the ACA Code, in Standard.a.4.b. (ACA, 2014) counselors are aware of and avoid imposing their own values, attitudes, beliefs, and behaviors (p.193). We all have our bias but must put into perspective the five key principles that apply to counseling a client and families regarding end of life issues. The most important is autonomy as it allows the client to make their own decision.

Duba and Magenta (2008) indicated, "despite a myriad of ethical and moral principles to rely on, a counselor's personal values regarding life and death can complicate the situation" (p.384). Counselors are not equipped in this area as they have not received the proper training and will experience the most challenges. In my mind, it is difficult to envision how does one provide counseling to a terminally ill patient.

The therapist must be self-aware not to allow countertransference to take place as it will interfere in helping the patient cope with end of life decisions. Allowing your personal fears and your perspective about death to influence a client's decision is selfish and unethical. The therapist must examine his or her own attitudes towards death before initiating treatment. According to the ACA Code, in Standard.a.1.a. (ACA, 2014) states, the primary responsibility of counselors is to respect the dignity and promote the welfare of clients.

Course of action

There is conflict when ethics and the law collide. As an example, state law require therapist to disclose information when there is reason to believe a client possess an imminent danger. A therapist will encounter conflict because the legal standards supersede ethical standards in the profession. On the other hand, the therapist must adhere to statues of confidentiality that protect HIV patients as it affords the rights or health care and prevention programs.

Moreover, if the patient decides to terminate his medication as such was the case with James, the therapist must keep this information confidential from other individuals as he has the duty to protect his client.

According to the ACA Code, in Standard.B.2.a. (ACA, 2014) states, the general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues.

References:

Herlihy, B., & Corey, G. (2015). ACA ethical standards casebook (7th ed.). Alexandria, VA: American Counseling Association.

American Counseling Association Code of Ethics (2014) retrieved from http://www.counseling.org/docs/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=4

Duba, J. D., & Magenta, M. (2008). End-of-life decision making: A preliminary outline for preparing counselors to work with terminally ill individuals. The Family Journal, (16)

3. K. John-My personal value in assisted suicide is very open. I currently work with adults with disabilities. Most of my people will never get better with treatment. I often see and hear about their depressing lives and how they wish they could just wake up with no pain. I can understand how their disability affects their lives each time I visit another task or independence is lost. In my state, it is not legal but if people want to die they will find a way.

One potential challenge would be ACA code A.9.b. Protecting Clients. It is my job to protect my clients. Suicide is self-harm. No matter what my stance is it is my job to protect my clients. I think I would be upfront with my client and let them know if they want to discuss assisted suicide the risk they are taking by discussing this with me.

If my client continued to discuss with me I would contact the appropriate authority. I also think it is important to utilize code C.2.a. Boundaries of Competence. I would consult and possibly refer to another counselor. I would do this because of my own personal opinion on the topic and I would want the person to have someone who had a nonbias opinion on the topic.

American Counseling Association (ACA). (2005). 2005 ACA code of ethics [White Paper].

4. I would like to offer you two different scenarios to see if you might have a different gut reaction and would want to make different therapeutic decisions. Let's say you are working with an 86 year old man who is suffering from a terminal illness and is in pain. This client wants to hasten his death. Consider what you reaction is and if you could or could not work with this client.

Let's take the exact same situation and make the client now 9 years old and the parents are making the decision with the child. Consider if you have a different reaction and if you could or could not work with this client.