End‐of‐Life Care: An Overview for Professional Counselors

The American Counseling Association (ACA) revised its code of ethics in 2005. This extensive process was designed to update the code, given the changes in the world and in the field during the 10 years since the previous code was released. Among the many revisions, one that stands out and makes ACA unique among all the large national mental health organizations is Standard A.9, End-of-Life Care for Terminally Ill Clients. Although other groups have addressed end-of-life (EOL) issues, none have explicitly incorporated them into the ethics code for the organization. Considering that the numbers and percentages of older adults are expected to increase significantly in the next few decades (Maples & Abney, 2006; Myers & Harper, 2004), along with the fact that death is unavoidable, the ACA Ethics Code Revision Task Force is to be commended for its foresight in including this section and its efforts to provide counselors and their clients with some direction. The fact that the ACA Code of Ethics (ACA, 2005) includes a section on EOL issues is all the more remarkable given the relative lack of attention to these issues by ACA as a whole and by authors publishing in counseling journals. In fact, as we discuss later in this article, ACA and the counseling profession in general could reasonably be considered to be lagging behind others in terms of addressing dying and death. Given this combination of developments, the purpose of this article is to provide professional counselors with an overview of EOL issues, including ethical and legal concerns, practice considerations, and recommendations for the field. * Review of the Literature To provide a foundation for this article, using PsycINFO we conducted a review of the literature published from 1995 to 2007 in journals with "counseling" or "counselor" in their titles. We searched abstracts, titles, and subjects using the terms "end-of-life," "end of life," "death," "dying," "grief," "death attitudes" "terminally ill patients," "hospice," and "palliative care" but excluded suicide in nonterminal illness situations. This generated 155 articles. We then excluded articles published in journals that were clearly medical or rehabilitative in nature (e.g., Patient Education and Counseling), which eliminated 67 articles; appeared in psychology journals (e.g., The Counseling Psychologist), which eliminated 10 more; or were merely book reviews, personal stories, or an introduction to other articles, which led to 11 more being dropped. (Note. We decided not to include The Counseling Psychologist or the Journal of Counseling Psychology as counseling journals because, even though counseling psychologists are ACA members and counselors may read these journals, these are official publications associated with a division of the American Psychological Association and, therefore, technically not "counseling" journals. Counselors may read other psychology or social work journals, and, rather than try to determine which journals were most read by professional counselors, we made a clear distinction between counseling journals and psychology or social work publications. Even if we had included these journals, the number of articles would have increased by only 6:4 on assisted suicide, 1 on grief therapy, and 1 on HIV.) Twenty-seven additional articles were eliminated because they dealt with non-EOL situations (e.g., paternal involvement with children postdivorce and grief; Spillman, Deschamps, & Crews, 2004), had EOL issues as only a minor part of the article (e.g., a review of bibliotherapy resources; Nicholson & Pearson, 2003), or focused on nonhuman situations (e.g., pet loss; Toray, 2004). Thus, a search of the PsycINFO database indicated that between 1995 and 2007, only 40 articles published in all counseling journals appeared to be directly related to EOL issues. Furthermore, the vast majority of these were narrow in focus and scope, leading to an absence, to date, of a published comprehensive review of the topic in a counseling journal. …