Ethical Guidelines for Counselors When Working With Clients With Terminal Illness Requesting Physician Aid in Dying

In 2005, the American Counseling Association (ACA) introduced a new ethical standard for counselors working with clients with terminal illness who are considering hastened death options. The authors' purpose is to inform counselors of the Death With Dignity Act and explore relevant ethical guidelines in the ACA Code of Ethics (ACA, 2005). Keywords: death with dignity, ACA Code of Ethics, end of life, physician aid in dying ********** The state of Oregon voted to approve the Oregon Death With Dignity Act (Or. Rev. Star. 127.800 et seq., 1994) in 1994, the first law in the United States establishing individuals' right to hasten their own deaths in the face of a terminal illness. The state of Washington followed suit in November 2008, when voters approved the Washington Death With Dignity Act (Wash. Rev. Code 70.245, 2008). Since these changes in legislation, the National Association of Social Workers (Mackelprang & Mackelprang, 2005), the American Psychological Association (Farberman, 1997), and the American Counseling Association (ACA) have made revisions in their professional codes of ethics to address the role of the counselor in working with these individuals. As right-to-die battles for individuals with terminal illness reach widespread coverage in the media, there has been a growing appreciation for the counselor's role in working with clients facing end-of-life issues. To address some of these deeply personal ethical issues, the ACA Code of Ethics (ACA, 2005) has included a new standard (A.9.) to guide counselors working with individuals with terminal illness who are considering hastened death options. There are several end-of-life concerns currently making headlines in the media. In this article, we focus specifically on adult individuals with terminal illness who request physician aid in dying, ethical guidelines for professional counselors in the ACA Code of Ethics, and the role of the counselor working with this population. TERMINOLOGY According to the organization Compassion & Choices (n.d.), hastened death is a term used when an individual with terminal illness makes a rational decision to take self-directed action and choose when, within the final 6 months of life, death from terminal illness will occur. The term physician aid in dying is also considered apt terminology for discussing the choices of terminal illness in a manner that allows compassion and dignity for individuals facing end-of-life decisions (Tucker, 2008). Suicide or physician-assisted suicide are not considered to be appropriate terms because of distinguishable differences between hastened death factors and suicidal intent as defined under Oregon's Death With Dignity Act. To understand these differences, counselors need to understand the rationale of individuals with terminal illness who request physician aid in dying and to have knowledge of safeguards that have been put in place to protect those who may be experiencing depression. Individuals with terminal illness cite combinations of the following reasons for requesting physician assistance with hastened death: intolerable pain, mind-altering side effects from medications, loss of bodily functions, loss of identity, desire for autonomous control, fears about future quality of life while dying, and negative past experiences with the dying process (Pearlman et al., 2005). According to the American Association of Suicidology (2012), individuals who are suicidal exhibit the following characteristics: a sense of hopelessness, rage or uncontrolled anger, reckless behaviors, increased drug or alcohol use, withdrawal from support systems, unusual anxiety, dramatic mood swings, and thinking there is no reason for living. Individuals who are terminally ill report a desire to live, but also ask to have options to choose a peaceful and dignified death that allows for control and autonomy in the final stages of life (Compassion & Choices, n. …