End-of-Life Decisions:

Ethical Concerns for the

Counseling Profession
PRESENTED BY ALEXANDRA BASSETT

Why I Chose This Topic

Trauma Work
Diagnosis of terminal illness
Prolonged mental illness
Self-Determination vs. Client Well-Being
Conflict?
Where do I stand?

How it Relates to my Professional Development

Personal Values vs. Ethical Decisions

Know the difference
Apply ethical codes without imposing values

Why its Important to the Counseling Field

Most Often Involved Physicians
Depression under diagnosed
Counseling referrals ignored
Mental Health Professionals
Their role in end-of-life decisions

Counseling through the decisions

Advocacy
Working together with the medical field
More referrals
Educating the medical field

Article Review
Callahan, J. (1994). The ethics of assisted

suicide. Health & Social Work, 19(4), 237-44.

Self-determination versus client well-being

In the case of suicide, well-being trumps self-determination

Rational suicide
Destigmatization

Media Review
Barbara Mancini
Father was terminally ill
Did not stop her father from committing suicide
Was arrested for assisting a suicide
Charges dropped after 1 year
Advocacy

Case Study: The Facts

Kameron

Lack of support system

34

Past A&D issues

Mixed race

Depression

Transgender male

Suicide Ideation

Body Dysmorphic

Move to Oregon Death

Disorder
HIV positive, AIDS

with Dignity Act

Case Study: Ethical Concerns

Confidentiality
B.2.a. Serious and Foreseeable Harm and Legal
Requirements

Is this foreseeable? Specific plan?

B.2.b. Confidentiality Regarding End-of-Life Decisions

Terminally ill
Right to maintain confidentiality

Case Study: Solutions

Maintain Confidentiality
No immediate harm
Safety Contract
Increase Frequency of Sessions

Monitor Suicidal Thoughts

Continue Work on Depression/Trauma of Diagnosis

ACA Code Analysis

Confidentiality
B.2.a. Serious and Foreseeable Harm and Legal
Requirements
B.2.b. Confidentiality Regarding End-of-Life Decisions
Autonomy vs. Client Welfare
Do these come into conflict with each other?
Autonomy Fostering the right to control the direction of
ones life
A.4.a. Avoiding Harm
A.4.b. Personal Values

References
American Counseling Association (2014). ACA Code

of Ethics. Alexandria, VA: Author.

Callahan, J. (1994). The ethics of assisted
suicide. Health & Social Work, 19(4), 237-44.
Cohen, E. D. (2000). Permitting suicide of
competent clients in counseling: Legal and moral
considerations. The International Journal of
Applied Philosophy, 14(2), 259-273.

References Continued
Ganzini, L., Fenn, D. S., Lee, M. A., Heintz, R. T., &

Bloom, J. D. (1996). Attitudes of oregon psychiatrists

toward physician-assisted suicide. The American
Journal of Psychiatry, 153(11), 1469-75.
Hadjistavropoulos, T. (1996). The systematic
application of ethical codes in the counseling of
persons who are considering euthanasia. The
Journal of Social Issues, 52(2), 169-188.
Manetta, A. A., & Wells, J. G. (2001). Ethical issues
in the social worker's role in physician-assisted
suicide. Health & Social Work,26(3), 160-6.

References Continued
Maynard, B. (2014). Brittanys first video. [Video blog

post]. Retrieved from

http://www.thebrittanyfund.org/category/videos/
Maynard, B. (2014). A video for my friends. [Video blog
post]. Retrieved from
http://www.thebrittanyfund.org/category/videos/
Peruzzi, N., Canapary, A., & Bongar, B. (1996). Physicianassisted suicide: The role of mental health
professionals. Ethics & Behavior, 6(4), 353-366.
Werth, J.J., Burke, C., & Bardash, R. (2002).
Confidentiality in end-of-life and after-death situations.
Ethics & Behavior, 12(3), 205-222.