Ethical Issues on Physician-Aided Suicide

Introduction

Physician-assisted-suicide and end-of-life concerns signify unification for counselling and medical ethics. In physician-aided suicide, doctors serve as facilitators of death while the patients execute the act itself as the clients are the direct agents of their death (Appelbaum, 2016). Although the role of counsellors in end-of-life issues is indirect, it is fundamental because their objective is to help the client enhance the quality of their life by relieving mental disorders that may be motivating the patient’s request to end their life (Thacker & Blueford, 2018). However, when handling matters end-of-life, the prevalence of ethical repercussions and emergence of dilemmas is high because the code of ethics for counsellors fails to address physician-assisted suicide explicitly.

Personal values

I chose to be a professional counsellor because I have a strong desire to help people through the difficulties and challenges of life. While in high school, I interacted with troubled people and discovered that the benefits and challenges of assisting people through difficult phases gave me pleasure. On reflection of these occasions, I realised my strengths and skills were listening and understanding people’s emotional state and perspectives. Consideration of these strengths made me pursue a profession that gives me a sense of satisfaction. These experiences also assisted me in cultivating and strengthening my values of caring, compassion, fairness, flexibility, honesty and acceptance.

I realised I was compassionate because I was sensitive to the agony and anguish of those I assisted. Through compassion, I made my friends more comfortable when they were suffering by offering support and confidence essential in the recovery process. Compassion and caring allowed me to assist people in crisis apparently through actions and deeds that involve emotional elements of the relationship that is built on honesty, acceptance of prevailing circumstances and being flexible. Combination of my values assisted me in helping people with the emotional support that lessened depression and strengthened a person’s resolve to overcome a challenge.

However, upholding personal values that underpin my religious beliefs and ethics is likely to impair my capability to deliver care and assistance to clients dealing with end-life-issues, especially physician-assisted suicide (Danyliv & O’Neill, 2015). The current case is personally challenging because it devalues some lives. For instance, in this case, encouraging the patient to accept physician-assisted-suicide will imply that the life of people with disabilities is worth less than others, and death is preferable to suffer. Although the client is physically disabled, he is not intellectually incapacitated, and as such, he needs support and encouragement necessary to battle the disease while encouraging the patient to accept the procedure violates my religious standpoint on the subject.

On the other, advising the client against PAS might appear as a disregard of the client’s autonomy. Since the patient is 35 years and of sound mind, it is apparent that he is capable of making decisions and is aware of his condition. In this case, conditioning the patient to delay or avoid physician-assisted-suicide will not be fair to the patient as it will prolong the suffering. Feeding the patient any form of hope is directly dishonest because the available information indicates that the patient has twelve months to live, also false hope will show that I have failed to accept and be flexible as dictated by my values. Being flexible and accepting the circumstances is essential in counselling and other aspects of life as it assists the counsellor to collaborate with other care providers in helping the patient.

Risks and Difficulties

Counselling ethics are a type of pragmatic ethics that are most practical and underpinned by five principles characterised by virtue and authority. The five principles include non-maleficence, autonomy, beneficence, justice and fidelity (Leikas, Koivisto, & Gotcheva, 2019). The autonomy aspect holds that a person has a right to make personal health care decisions, non-maleficence makes it ethically overbearing for care providers not to hurt or advance harm on a client. Beneficence dictates that care providers must promote well-being at all costs while fidelity advocates for loyalty and fulfilling promises and justice foster equity and obedience of the law (Leikas, Koivisto, & Gotcheva, 2019). Equality suggests that clients have access to PAS and care providers; counsellors included must obey the law and ensure the patient receives sufficient support and fair allocation of resources.

Each of the five pillars is binding ethically and the foundation of the legal protocol. For instance, autonomy is the underpinning doctrine of informed consent, and maleficence motivates obligatory reporting of any abuse. In the case of justice, it covers the law, and all ethical codes, including counselling, stipulate that practitioners must operate within the law (Leikas, Koivisto, & Gotcheva, 2019). While the law is explicit in its directives and creates constraints of tolerable conduct that counsellors can work within, in the realm of end-life-issues ethical dilemmas are likely to occur. Ethical dilemmas increase risks and difficulties in dealing with the client in this case because it creates a collision path for moral principles and personal values (Watson, 2019). A conflict of principles results in an ethical dilemma which creates the need for one principle to take primacy over the other. Physician-assisted-suicide arouses ethical dilemmas like any other ethical issues that implore each principle to different levels. Conflicts regarding moral viability and legality of physician-aided-suicide are centred on two constraints, that of autonomy and that of life.

Developing an inclination towards assisted suicide supports the superiority of autonomy while increasing the risk of opposing maleficence and beneficence. Maleficence and beneficence are aligned to dispute physician-assisted-suicide as they stand for not harming and killing the client. However, the situation becomes more difficult because non-maleficence in the case study collides with making the client suffer. Recommending prolonged suffering contradicts non-maleficence while doing well as dictated by beneficence conflicts with facilitating intense pain that can be eliminated. In this case, the difficulty in resolving the conflict is between autonomy, non-maleficence and beneficence.

The risk, in this case, is compromising the patient’s autonomy by influencing the decision to avoid physician-assisted-suicide or supporting the patient’s choices, thus failing to recognise and protect the sacredness of life. The situation also presents the risk of conveying a message that the value of particular lives, especially those of people with disabilities is less than that of others when the counsellor assumes the pro-physician-assisted-suicide perspective. On the other hand, besides compromising the client’s autonomy, a counsellor opposing the physician-assisted-suicide idea will only prolong the client’s suffering that can be eliminated. The situation is exacerbated by the legal implications that are likely to arise primarily in cases where the client’s wishes are violated, or the patient is not provided with sufficient information or support to facilitate the making of informed decisions.

Practical Strategies

• Respect the client’s autonomy

The client, in this case, is physically disabled, but his cognitive capabilities are not impaired, and he is aware of his current medical situation and life expectancy. In this connection, it is assumed that the patient is logical and can verbally state his preference, thus relegating the counsellor in the position of providing advice and educating the patient on available options. Due to the dominating ethical challenges, the counsellor should take the standard subjective approach that demands the counsellor to respect the autonomy of the patient, thereby letting the patient maintain control of the situation.

• Apply the ACA code of ethics

The ACA code of ethics is designed to serve various purposes. Notable purposes of the code of ethics are to establish obligations of the members of the organisations and offer the guidance necessary in informing the ethical practice of professional counsellors (American Counseling Association, 2014). In this sense, a counsellor that encounters challenging situations can refer to the outline procedures and guidelines to ensure the making of informed decisions. Although the code of ethics is not explicit on some factors, it identifies ethical considerations relevant to professional counsellors and as such, can assist them in making appropriate decisions that protect the interest of the clients.

• Avoid clinical pessimism

The counsellor should avoid the assumption that since the client has requested physician-assisted-suicide, there is nothing that can be done. The counsellor can be helpful to the patient by just listening to the client’s concerns and providing reassurance that there is time to exploit other approaches to the situation. Empirical evidence indicates that with proper support and encouragement, some patient’s that requests physician-assisted-suicide are likely to change their minds primarily after counsellors provided substantive interventions.

• Consider moral principles, do research and consult

Empirical evidence indicates that it is essential for counsellors to consider moral doctrines, study pertinent literature and ask associates and expert organisations when grappling with ethical dilemmas. Moral principles are the source of the counselling standards, and as such considering moral principles will assist the counsellor in making informed decisions (Brown, Byrnes, & Fleenor, 2012). Doing the research and broad consultation is also integral in guiding the decision-making process as the counsellor will have an in-depth appreciation of the client’s culture, perception of issues and perhaps a practical approach that meets the client’s needs.

Conclusion

Counsellors are likely to meet more clients struggling with end-of-life decisions as most jurisdictions are legalising and embracing the physician-assisted suicide across the globe. While the American Counselling Association’s code of ethics is not clear on physician-assisted suicide, counsellors must strive to assist in improving the quality of their client’s life. Although counsellors must formulate personal principles regarding end-life-issues, they must acknowledge and respect the client’s beliefs on the subject as the principle of autonomy is the core of all counselling principles. The principle of independence gives clients the liberty to make personal decisions. Therefore, the role of a counsellor regardless of the situation is to empower, respect the client and acknowledge the value system of the client and not impose personal values onto clients.

References

American Counseling Association. (2014). Ethical & Professional Standards. Retrieved 10 November 2019, from https://www.counseling.org/knowledge-center/ethics

Appelbaum, P. (2016). Physician-Assisted Death for Patients With Mental Disorders—Reasons for Concern. JAMA Psychiatry, 73(4), 325. doi: 10.1001/jamapsychiatry.2015.2890

Brown, K. M., Byrnes, E. K., & Fleenor, K. G. (2012). Maintaining the Counselor–Client Relationship: Ethical Decision-Making in Online Counseling and Social Networking.

Danyliv, A., & O’Neill, C. (2015). Attitudes towards legalising physician provided euthanasia in Britain: The role of religion over time. Social Science & Medicine, 128, 52-56. doi: 10.1016/j.socscimed.2014.12.030

Leikas, J., Koivisto, R., & Gotcheva, N. (2019). Ethical Framework for Designing Autonomous Intelligent Systems. Journal Of Open Innovation: Technology, Market, And Complexity, 5(1), 18. doi: 10.3390/joitmc5010018

Thacker, N. E., & Blueford, J. M. (2018). Resolving Value Conflicts with Physician-Assisted Death: A Systemic Application of the Counselor Values-Based Conflict Model. Professional Counselor, 8(3), 249-261.

Watson, A. (2019). Collision: An opportunity for growth? Māori social workers’ collision of their personal, professional, and cultural worlds and the values and ethical challenges within this experience. Journal of Social Work Values and Ethics, 16(2).