HSV 203 Introduction of Counseling Professions, Unit 2 DB: End-Of-Life Challenges, POST University, May 2025

 HSV 203 Unit 2 DB: End-Of-Life Challenges

 

Sarah is a 68-year-old woman diagnosed with terminal cancer. After extensive treatments, her prognosis remains poor, and she is experiencing significant pain and discomfort. Sarah expresses a desire to discuss end-of-life options, including the possibility of physician-assisted suicide (PAS), which is legal in her state. You, as her counselor, hold strong personal and religious beliefs that oppose PAS, viewing it as morally wrong. Despite this, you are committed to providing Sarah with the best possible support during this difficult time. 

 Sarah's family is divided on the issue. Her adult children are supportive of her wishes, while her siblings strongly oppose PAS, advocating for continued aggressive treatment regardless of her discomfort. This family conflict adds to Sarah's emotional burden, making it difficult for her to find peace and clarity in her decision-making process. 

• How do your personal values and beliefs align or conflict with Sarah's desire to explore PAS? Reflect on your initial emotional and ethical response to this scenario. If you have a strong conflict between your personal values and Sarah's wishes, under what circumstances, if any, would you consider referring Sarah to another counselor? What are the ethical implications of such a referral? 

 

Whatever my personal beliefs as a counselor are towards something are completely irrelevant to the choices that a patient wants to make. Their choices would always be number one in anything I do. The patient is the one who has the strong pain and is going through all the medical procedures, and the choices she makes in her life are her choice. I would support that. If she came to me to ask about the different options open to her, I would present to her what I know to be available.  

 

• What are your ethical responsibilities as a counselor in this situation? For this discussion, you will use the American Counseling Association (ACA) ethical codes. 

 

“A.1. Client Welfare: A.1.a. Primary Responsibility  

“The primary responsibility of counselors is to respect the dignity and promote the welfare of clients.” 

This line is from the Professional Code of Ethics for Professional Counselors, and it explains that the welfare of the client and patient is the top responsibility of the patient. If the client asks for my help to navigate the choices open to her, I will do that with an open mind, with only her will being in mind.  

 

 

• How can you navigate the tension between your personal beliefs and your professional obligation to support Sarah's autonomy and well-being? What strategies might you use to manage this conflict? 

 

My personal beliefs are irrelevant to the needs of the patient. Now, if the patient was undecided what to do and asked me for my personal beliefs, I would certainly explain those. However, I would not expect her to follow those because I said those beliefs. Ultimately, the choice comes down to her, and I would suggest that she also ask these same questions of her medical doctor.  

 

• How would you approach the family conflict regarding Sarah's end-of-life decisions? What role should you play in facilitating communication and understanding among family members? 

 

What might work is a group meeting where the family members get together in my office or another private room and talk out loud about the different options and choices. Make sure that each family member feels they are heard, and then the patient can get a chance to discuss these items one by one.  

 

• Besides PAS, what other end-of-life options and support can you offer Sarah to ensure she feels heard and supported? How can these options be presented in a way that respects her autonomy and your professional ethics? 

 

I would also suggest that she ask these questions of her medical doctor to see what other medical procedures might exist. This might take seeing other doctors who specialize in other treatments that her current doctor might not be trained in. If the patient is comfortable on computers, maybe there are online support groups who can offer her other options and to talk to other patients who have been through similar treatments. Sometime there are options available in other countries that are not available in the US, and those options should also be discussed.