Dignified Assisted Suicide Case Study
There are many ethical issues that psychologists face on a daily basis. This range from assessment and treatment practices to privacy, education, and even to interpersonal relationships with clients and their families. To help navigate the ethical waters, there are set standards. To this end, we present a hypothetical case in which this therapist has been challenged with an ethical problem.
CLIENT: Victor Wright, a 37yearold white male patient and resident of Oregon suffering from a latestage AIDS diagnosis. He has been battling the disease for 7 and a half years now and is expected to succumb to its overwhelming advance in the next 6 months. He has been my patient for 5 years and I have come to know he and his family incredibly well. I was recommended to him, whereas he …show more content…
sought me out, after suggestion by his Primary Care Manager (PCM) or doctor at an extended care facility for AIDS patients in Portland, Oregon.
SITUATION: Mr. Wright, given his terminally ill state and looking to find a place of peace in his conscience, requested counseling. Among other items he has asked to discuss is his families’ financial stability after his passing, a disclosure of his life’s deepest secrets, and a wish to die in a dignified manner more immediately than his terminal diagnosis would suggest. His request for assisted suicide conflicts with two codes and an ethical debate amongst many scholars. Should his wishes be considered under Oregon’s Death Through Dignity Act
(https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDigni
tyAct/Pages/ors.aspx) or should his desire be redirected toward quality endoflife care and the patient be counseled to the very end? In one scenario, a physician may properly evaluate and prescribe medication to assist in his suicide. In another, the American Psychological Association neither “endorses nor opposes” assisted suicide and encourages those in my profession to reduce mental suffering that may lead to a patient wishing to end their lives
(http://www.apa.org/about/policy/assistedsuicide.aspx). Each side of this ethical dilemma peels back a teaching that has brought me to this profession. It is my deepest desire to help others and this is why I chose this profession. The flame inside insists I should be there for humanity…but how? Is it a tacit denial of my raison d'être to ignore this man’s plea and a degradation of his humanity forcing him to live in absolute pain? Or am I upholding an honorable position through the duration of his care for the support of mental faculties and family continuity until nature takes him from our earth?
HISTORY OF PRESENT ILLNESS: The client was referred to me by his Primary Care
Manager (PCM) in order to help with, as his doctor described, the patient’s deep insistence that
“life can get no better and ending it would be preferred to living longer.” This was many years ago and he has since been met for counseling on an average of once per month for the last 5 years. The nature of his disease is a slow onset and violent end.
TREATMENT/THERAPY: Ironically, physicians are the ones to enact assisted suicide in
Oregon and psychologists do not provide patients the necessary drugs to commit. However, the physician in this case referred his patient to me as a lastditch effort to ensure the proper decisions were being made by Mr. Wright’s advanced medical team. After several years in deep discussion with the patient it was my recommendation to Mr. Wright’s PCM that there was no curable depression in this case. Instead, it had simply been a long progression of a terrible
Codes of Ethics 3 disease where counseling provided comfort and support during the hardest years. Furthermore, assisted suicide in this case may be very much preferable to the alternatives; a long painful death or an unclean/undignified suicide for family to discover without prior necessary openended counseling. ETHICAL ISSUE: Psychologists reach deep inside their collective resources to cure an insatiable desire by patients to end life early when no alternatives exist to cure their ailments. The APA suggests there are alternatives to death and there’s a long way to go on the research front. However in the issue of last moments, leading to final months of life in this case in particular, would I be prolonging an inevitable undignified death? Is the issue so black and white in this case I should only consider one option? Would I disrespect the teaching and direction of the APA by suggesting this is the only option for this case?
BOTH SIDES ETHICAL DILEMMA: On one side of the debate we dissect the perceived patients right to end their own life based on a totality of circumstances. These circumstances include a terminal disease and a chance to leave this world on terms directed by the patient not the disease. On the other side of the debate we observe the mandate of professionals to preserve life at all costs until the end in hopes there may be another answer to cure. CLIENT PERCEPTION: I believe my client and even his family will perceive medical professionals in a negative manner if we do not explore his desires, understand his condition, and provide a furthered discussion on future choices. In denying his request or ignoring it’s significance we may turn off the channel of discussion that would ultimately lead to a dark, disorderly, and possibly disruptive suicide. The client is to a point in his illness, with no known cure and only months to live, where he has made an irrevocable decision.
PLAN: The plan is to validate the patients beliefs, verify that there is no other options, provide comfort, plan further counseling sessions with direct family members on future plans, and recommend a dignified assisted suicide to his PCM.
I take the side of dignified and assisted suicide in this case. When there is no alternative and the power of a psychologist will provide great comfort to a victim of disease, I would nearly dishonor my profession to withhold my services to a client.
CURRENT SITUATION: The clients situation currently demands that family members be involved in the discussion of this decision. Planning should be arranged for his estate, finances, and burial requests. While this may be unimaginably difficult for some, it may only be worsened without the directed discussion of a psychologist.
My Argument:
Final Quote on Human Integrity: In the end, my argument can best be summarized by Stephen
Hawking who once said, "I think those who have a terminal illness and are in great pain should have the right to choose to end their lives, and those who help them should be free from prosecution…” (http://www.huffingtonpost.com/2013/09/17/stephenhawkingassistedsuicideoption_n_3940942.html)
It is a simple matter of integrity that we respect the wishes of those
who
Codes of Ethics 4 have no alternative and require societal kindness to support the furtherance of their life’s direction whatever that may be.
Attached, an Article on Human Happiness: http://www.theatlantic.com/health/archive/2013/01/theresmoretolifethanbeinghappy/266805/ References
1.
https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignit yAct/Pages/ors.aspx 2. http://www.apa.org/about/policy/assistedsuicide.aspx
3. http://www.huffingtonpost.com/2013/09/17/stephenhawkingassistedsuicideoption_n_3940942.html
CLIENT: Victor Wright, a 37yearold white male patient and resident of Oregon suffering from a latestage AIDS diagnosis. He has been battling the disease for 7 and a half years now and is expected to succumb to its overwhelming advance in the next 6 months. He has been my patient for 5 years and I have come to know he and his family incredibly well. I was recommended to him, whereas he …show more content…
sought me out, after suggestion by his Primary Care Manager (PCM) or doctor at an extended care facility for AIDS patients in Portland, Oregon.
SITUATION: Mr. Wright, given his terminally ill state and looking to find a place of peace in his conscience, requested counseling. Among other items he has asked to discuss is his families’ financial stability after his passing, a disclosure of his life’s deepest secrets, and a wish to die in a dignified manner more immediately than his terminal diagnosis would suggest. His request for assisted suicide conflicts with two codes and an ethical debate amongst many scholars. Should his wishes be considered under Oregon’s Death Through Dignity Act
(https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDigni
tyAct/Pages/ors.aspx) or should his desire be redirected toward quality endoflife care and the patient be counseled to the very end? In one scenario, a physician may properly evaluate and prescribe medication to assist in his suicide. In another, the American Psychological Association neither “endorses nor opposes” assisted suicide and encourages those in my profession to reduce mental suffering that may lead to a patient wishing to end their lives
(http://www.apa.org/about/policy/assistedsuicide.aspx). Each side of this ethical dilemma peels back a teaching that has brought me to this profession. It is my deepest desire to help others and this is why I chose this profession. The flame inside insists I should be there for humanity…but how? Is it a tacit denial of my raison d'être to ignore this man’s plea and a degradation of his humanity forcing him to live in absolute pain? Or am I upholding an honorable position through the duration of his care for the support of mental faculties and family continuity until nature takes him from our earth?
HISTORY OF PRESENT ILLNESS: The client was referred to me by his Primary Care
Manager (PCM) in order to help with, as his doctor described, the patient’s deep insistence that
“life can get no better and ending it would be preferred to living longer.” This was many years ago and he has since been met for counseling on an average of once per month for the last 5 years. The nature of his disease is a slow onset and violent end.
TREATMENT/THERAPY: Ironically, physicians are the ones to enact assisted suicide in
Oregon and psychologists do not provide patients the necessary drugs to commit. However, the physician in this case referred his patient to me as a lastditch effort to ensure the proper decisions were being made by Mr. Wright’s advanced medical team. After several years in deep discussion with the patient it was my recommendation to Mr. Wright’s PCM that there was no curable depression in this case. Instead, it had simply been a long progression of a terrible
Codes of Ethics 3 disease where counseling provided comfort and support during the hardest years. Furthermore, assisted suicide in this case may be very much preferable to the alternatives; a long painful death or an unclean/undignified suicide for family to discover without prior necessary openended counseling. ETHICAL ISSUE: Psychologists reach deep inside their collective resources to cure an insatiable desire by patients to end life early when no alternatives exist to cure their ailments. The APA suggests there are alternatives to death and there’s a long way to go on the research front. However in the issue of last moments, leading to final months of life in this case in particular, would I be prolonging an inevitable undignified death? Is the issue so black and white in this case I should only consider one option? Would I disrespect the teaching and direction of the APA by suggesting this is the only option for this case?
BOTH SIDES ETHICAL DILEMMA: On one side of the debate we dissect the perceived patients right to end their own life based on a totality of circumstances. These circumstances include a terminal disease and a chance to leave this world on terms directed by the patient not the disease. On the other side of the debate we observe the mandate of professionals to preserve life at all costs until the end in hopes there may be another answer to cure. CLIENT PERCEPTION: I believe my client and even his family will perceive medical professionals in a negative manner if we do not explore his desires, understand his condition, and provide a furthered discussion on future choices. In denying his request or ignoring it’s significance we may turn off the channel of discussion that would ultimately lead to a dark, disorderly, and possibly disruptive suicide. The client is to a point in his illness, with no known cure and only months to live, where he has made an irrevocable decision.
PLAN: The plan is to validate the patients beliefs, verify that there is no other options, provide comfort, plan further counseling sessions with direct family members on future plans, and recommend a dignified assisted suicide to his PCM.
I take the side of dignified and assisted suicide in this case. When there is no alternative and the power of a psychologist will provide great comfort to a victim of disease, I would nearly dishonor my profession to withhold my services to a client.
CURRENT SITUATION: The clients situation currently demands that family members be involved in the discussion of this decision. Planning should be arranged for his estate, finances, and burial requests. While this may be unimaginably difficult for some, it may only be worsened without the directed discussion of a psychologist.
My Argument:
Final Quote on Human Integrity: In the end, my argument can best be summarized by Stephen
Hawking who once said, "I think those who have a terminal illness and are in great pain should have the right to choose to end their lives, and those who help them should be free from prosecution…” (http://www.huffingtonpost.com/2013/09/17/stephenhawkingassistedsuicideoption_n_3940942.html)
It is a simple matter of integrity that we respect the wishes of those
who
Codes of Ethics 4 have no alternative and require societal kindness to support the furtherance of their life’s direction whatever that may be.
Attached, an Article on Human Happiness: http://www.theatlantic.com/health/archive/2013/01/theresmoretolifethanbeinghappy/266805/ References
1.
https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignit yAct/Pages/ors.aspx 2. http://www.apa.org/about/policy/assistedsuicide.aspx
3. http://www.huffingtonpost.com/2013/09/17/stephenhawkingassistedsuicideoption_n_3940942.html