Teaching Death and Dying Issues in Counselor Education
Journal Articles
Popular Media:
More to dying than meets the eye: Martha Atkins at TEDx SanAntonio 2013
https://www.youtube.com/watch?v=vg8WAv0YT9c
Chayim Aruchin – The Center for Culturaly Sensitive End of Life Advocacy & Counseleing
https://www.youtube.com/watch?v=hWKikg69HWs
Living with grief: A conversation between two men.
https://www.youtube.com/watch?v=ff7z6ujUB-A
ACA Code of Ethics:
(Copied word for word from 2014 ACA Code of Ethics)
Section A
The Counseling Relationship
A.1. Client Welfare
A.1.d. Support Network Involvement
Counselors recognize that support networks hold various meanings in the lives of clients and consider enlisting the support, understanding, and involvement of others (e.g., religious/ spiritual/community leaders, family members, friends) as positive resources, when appropriate, with client consent (American Counseling Association, 2014, p. 4).
A.2. Informed Consent in the Counseling Relationship
A.2.c. Developmental and Cultural Sensitivity
Counselors communicate information in ways that are both developmentally and culturally appropriate. Counselors use clear and understandable language when discussing issues related to informed consent. When clients have difficulty understanding the language that counselors use, counselors provide necessary services (e.g., arranging for a qualified interpreter or translator) to ensure comprehension by clients. In collaboration with clients, counselors consider cultural implications of informed consent procedures and, where possible, counselors adjust their practices accordingly (American Counseling Association, 2014, p. 4).
A.2.d. Inability to Give Consent
When counseling minors, incapacitated adults, or other persons unable to give voluntary consent, counselors seek the assent of clients to services and include them in decision making as appropriate. Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf (American Counseling Association, 2014, p. 4).
A.7. Roles and Relationships at Individual, Group, Institutional, and Societal Levels
A.7.a. Advocacy
When appropriate, counselors advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients (American College Counseling Association, 2014, p. 5).
A.7.b. Confidentiality and Advocacy
Counselors obtain client consent prior to engaging in advocacy efforts on behalf of an identifiable client to improve the provision of services and to work toward removal of systemic barriers or obstacles that inhibit client access, growth, and development (American Counseling Association, 2014, p. 5).
Section B
Confidentiality and Privacy
B.1. Respecting Client Rights
B.1.a. Multicultural/Diversity Considerations
Counselors maintain awareness and sensitivity regarding cultural meanings of confidentiality and privacy. Counselors respect differing views toward disclosure of information. Counselors hold ongoing discussions with clients as to how, when, and with whom information is to be shared (American Counseling Association, 2014, p. 6)
B.2.b. Confidentiality Regarding End-of-Life Decisions
Counselors who provide services to terminally ill individuals who are considering hastening their own deaths have the option to maintain confidentiality, depending on applicable laws and the specific circumstances of the situation and after seeking consultation or supervision from appropriate professional and legal parties (American Counseling Association, 2014, p. 7).
State of Tennessee Laws
How to Complete a Physician Order for Scope of Treatment (POST) Form
http://www.endoflifecaretn.org/wp-content/documents/POSTGuidanceforHealthCareProfessionals.pdf
CHAPTER 0450-01
GENERAL RULES GOVERNING PROFESSIONAL COUNSELORS
0450-01-.13 PROFESSIONAL ETHICS. All licensees and certificate holders shall comply with the current code of ethics adopted by the American Counseling Association, except to the extent that it conflicts with the laws of the state of Tennessee or the rules of the Board. If the code of ethics conflicts with state law or rules, the state law or rules govern the matter. Violation of the code of ethics or state law or rules may subject a licensee or certificate holder to disciplinary action.
(1) The certified professional counselor and licensed professional counselor and anyone under his supervision shall conduct their professional practice in conformity with the legal, ethical and professional standards promulgated by the Board under its current statutes and rules and regulations.
(2) Each applicant and certificate holder or licensee is responsible for being familiar with and following this code of ethics.
(3) A copy of the code of ethics may be obtained by writing the American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304.
(4) In the event an applicant, certificate holder, licensee, or other individual has a question regarding legal, ethical, and professional standards neither the Board nor its administrative personnel shall consider such questions unless presented with a proper petition for a declaratory order, subject to the requirements set forth in T.C.A. § 4-5-223.
(5) In addition to the other requirements of this rule, all licensees and certificate holders who practice counseling electronically shall comply with the Ethical Standards for Internet Online Counseling adopted by the American Counseling Association, www.counseling.org, except to the extent that they conflict with the laws of the state of Tennessee or the rules of the Board. If the standards for the ethical practice of internet counseling conflict with state law or rules, the state law or rules govern the matter. Violation of the standards for the ethical practice of web counseling or state law or rules may subject a licensee or certificate holder to disciplinary action.
Case Study:
Frank’s mother is currently in the hospital for Cancer. The doctors have stated that her Cancer is terminal and that she has approximately six months to live. They have given Frank several options for treatment that would extend her life but not save her life. Frank has the power of attorney and is ultimately the person that will make the decisions for his mother. Frank's mother is no longer able to understand treatment options due to dementia that inhibits understanding. Frank’s mother many years ago told Frank that she didn’t want any life-saving procedures but no legal documents were ever signed. He also remembers his mother talking about how sad it was when her brother's children did not opt for any life-saving treatment for him many years ago. Throughout the years he has gotten many mixed messages from his mother about what she would want at the end of her life. Frank has cared for his mother since he was 16 when his father died in an accident where his father worked. He has asked his siblings (two younger sisters) what he should do but they are waiting her him to make the decision. Frank has always managed to take responsibility for his families decisions but now he feels powerless. Frank is coming to counseling to help him make a decision as to what to do about his mother.
Multicultural Issues:
Frank and his mother are Orthodox Jews
http://hods.org/pdf/press/jewishpress.pdf
Frank and his mother are African American
http://ethnomed.org/clinical/end-of-life/cultural-relevance-in-end-of-life-care
Frank and his mother are of Hispanic Origin
http://depts.washington.edu/pfes/PDFs/End%20of%20Life%20Care-Latino.pdf
Ethical Model of Decision Making
When looking at ethical decision making in a multicultural context Knapp and VanderCreek (2007) state that “the practices of some individuals from culturally diverse backgrounds may offend very basic Western values.” When this happens they suggest using the decision-making process of Beauchamp and Childress (2001), which is:
- Uphold the most significant moral principle
- Have
a realistic chance of success
- Be
used only if no morally preferable option is available
- Overstep
the offended norm to the least possible degree
- Minimize
the negative effects on the offended moral belief
When looking at more traditional Ethical Decision-Making Models Tymchuk (1986) may be the most appropriate because the first step has to do with determining stakeholders (Cottone & Claus, 2000). This, in a multicultural context, will allow the professional to consider what the norm may be for each individual family involved. Steps two and three allow the professional to consider possible alternatives and to consider the consequences of each; which, in some ways, mimics steps 1-5 as listed above (Cottone & Claus, 2000) (Knapp & VanderCreek, 2007). The only step that is not included is to consult with other professionals which is a step that needs to be withheld no matter what model is used as per the ACA Code of Ethics and the State Guidelines in the State of Tennessee (American Counseling Association, 2014) (CHAPTER 0450-01 General Rules for Professional Counselors, 2014).
References
American Association for Marriage and Family Therapy. (2014, May 28). Retrieved from American Association for Marriage and Family Therapy Web site: http://www.aamft.org/imis15/Content/Advocacy/Medicare.aspx
American College Counseling Association. (2014, May 17). Retrieved from American College Counseling Association: http://www.collegecounseling.com
American Counseling Association. (2014, March 12). American Counseling Association. Retrieved from American Counseling Association Web site: http://www.counseling.org/resources/aca-code-of-ethics.pdf
Atkins, M. (2013). More to dying than meets the eye: Martha Atkins at TEDx SanAntonio 2013. Retrieved from https://www.youtube.com/watch?v=g8WAv0YT9c
Beauchamp, T., & Childress, J. (2001). Principles of biomedical ethics. New York: Oxford University Press.
CHAPTER 0450-01 General Rules for Professional Counselors. (2014, June 7). State of Tennessee . Retrieved from State of Tennessee Web site: http://www.tn.gov/sos/rules/0450/0450-01.20130123.pdf
Chayim Aruchin – The Center for Culturaly Sensitive End of Life Advocacy & Counseleing. (2012, May 24). Retrieved from http://www.youtube.com/watch?v=hWKikg69HWs
Cooper, A. (2014, February 23). Living with grief: A conversation between two men. Retrieved from https://www.youtube.com/watch?y=ff7z6ujUB-A
Cottone, R. R., & Claus, R. E. (2000, Summer). Ethical decision-making models: A review of the literature. Journal of Counseling and Development, 78, 275-283.
Currier, J. M., Holland, J. M., & Neimeyer, R. A. (2008). Making sense of loss: A content analysis of end-of-life practitioners' therapeutic approaches. Journal of Death & Dying, 57(2), 121-141. doi:10.2190/OM.57.2.a
Johnson, W. B., & Barnett, J. E. (2011). Preventing problems of professional conpetence in the face of life-threatening illness. Professional Psychology, Research and Practice, 42(4), 285-293. doi:10-1037/a0024433
Knapp, S., & VanderCreek, L. (2007). When values of different cultures conflict: Ethical decision making ina multicultural context. Professional Psychology, Research and Practice, 38(6), 660-666. doi:10.1037/0735.7028.38.6.660
Werth, Jr., J. L. (2002). Incorporating end-of-life issues inot psychology courses. Teaching of Psychology, 29(2), 106-111.
Werth, Jr., J. L., & Crow, L. (2009, Spring). End-of-life care: An overview for professional counselors. Journal of Counseling & Development, 87(2), 194-202.