Rehabilitation Counselor Ethical Considerations for End of Life Care

Among the changes in the 2010 revised Code of Professional Ethics for Rehabilitation Counselors (Commission on Rehabilitation Certification [CRCC] 2010) are standards and guidelines addressing end of life care for clients who are terminally ill. The CRCC standards provide guidance in three key areas: 1) counselor competency for working with end of life clients (A.9.a) 2) counselor scope of practice regarding end of life clients (A.9.b) and 3) counselor choices pertaining to confidentiality in cases where terminally ill clients are considering hastening their own deaths (A.9.c) A.1.a, A.2.a, A.4.a. B.1.b.  B.2.a" I.1.b) With these new guidelines, rehabilitation counselors must now anticipate and consider potential dilemmas that may arise when applying CRCC (2010) Standard A.9 in conjunction with other ethical standards and seek resources to resolve such dilemmas. This article seeks to (1) explore some considerations and implications that Standard A.9 may present for the rehabilitation counseling practitioner, (2) to familiarize rehabilitation counselors with other portions of the Code that will assist their ethical implementation of A.9, and (3) to provide initial best practice considerations. End of Life Issues Consider the following case scenario: You prepared yourself for the inevitable phone call from a client, but it still jolted you when it did finally come: "I knew it was really only a matter of time, and now my doctors think it's probably going to be only a few months until I pass on. I have enjoyed my job so much, and the last few months they have even let me do most of my work out of my parents home. But now I feel like I am becoming a drag on everyone, and maybe it's time I just gave up trying. My options are limited. Maybe it's time I did something to move my death along. Have you had any experience with this type of thing? I need your advice. I have always admired your wisdom, so I wanted to get together with you about this." The term "end of life" is understood to mean the developmental period in a person's life when approaching death colors the content of many of their decisions and actions (Papalia Martorell, 2014) This period of time may differ widely from person to person, and could consist of days, weeks, or months. A person who enjoys good health will be unable to live forever, and by their 70's or 80's, end of life becomes a part of almost everyone's thought process. People in good health often complete living wills or personal care directives, and for those with severe medical issues or with a terminal diagnosis, being able to assure themselves that existential, spiritual, familial, and emotional aspects of their care are also going to be addressed are often cited among the most important concerns of patients (Greisinger, Lorimor, Aday, Winn, Baile, 1997) Those whose health is less steady or who have progressive disabilities and received terminal diagnoses are even more apt to be preoccupied with end of life concerns (Smart, 2012) End of life is not limited to the medical aspect of death; it may include areas such as financial and legacy decisions, creating memorials, attaining a comfortable spiritual acquiescence, and saying goodbye to family and friends. End of life concerns impact each theater of a person's life including work roles, educational roles, family roles, and community roles. Not everyone who is seen by a rehabilitation counselor will need nor seek counseling at end of life. Many may find their needs met by pastoral, rabbinical, or monastic counseling; others will confide in, and receive guidance from, their healthcare professionals, including physicians, nurses, or hospice staff. People with disabilities however, especially those with severe disabilities, may also benefit from specialized expertise from a rehabilitation and/or mental health counselor who has knowledge and skills to serve people who are approaching death.