Historically, exposing future mental health professionals to diversity has primarily meant preparation for different racial and ethnic groups. Recently, however, thanks in large measure to the efforts of counseling psychologists, there has been an increasing interest in acknowledging the special needs of other underrepresented groups, such as the elderly, gay men and lesbians, and persons with disabilities. This article presents a rationale for including training about persons infected with the human immunodeficiency virus (HIV) in psychology graduate programs. Some of the reasons why students need training about HIV include the prevalence of the disease, ethical obligations, and competency considerations. A specific way to introduce students to the many issues related to HIV disease is to include persons with HIV disease in courses on providing services for diverse populations. Specific information that should be covered includes the epidemiology of HIV disease, confidentiality concerns, the issue of rational suicide, the students 'personal prejudices, HIV disease basic, HIV-related semantics, neurological conditions, and psychosocial factors and stressors.
This article reviews legal and ethical considerations that mental health professionals will want to consider when being involved with people who are considering end-of-life care options and making end-of-life decisions. The author discusses legal issues (case law and state statutes), ethical issues (professional codes of ethics, ethical metaprinciples, cultural considerations, and ethical decision-making models), and standards of care (attitudes of mental health professionals, positions of large national mental health professional associa-
tions, and acceptable actions in end-of-life situations) related to end-of-life care and decision making.This article reviews legal and ethical considerations associated with end-oflife decision making for mental health workers (in some places, I will focus on psychologists and psychiatrists, but for the most part, the discussion will be relevant for professional counselors, social workers, and marriage and family therapists as well). Because providing services to people facing end-of-life issues occurs within and may be constrained by the professional's perception of a legal and ethical environment, these matters must be accurately and comprehensively understood to promote optimal clinical decision making.Many mental health professionals have fears about potential ethical or legal repercussions associated with providing clinical services (e.g., individual or family counseling and consultation) to individuals and their loved ones who are dealing with end-of-life decisions. These concerns can interfere with the devotion of attention to the client's issues. Most of the time, such fears are based on misinterpretations of theoretically relevant case law, state statutes, and ethics codes (Werth, 1999). The focus of this article is on how the letter and spirit of the law and some of the current professional codes of ethics apply in end-of-life situations. In addition, the concept of the standard of care is reviewed, and the implications for practice are discussed. I conclude the article by offering a course of action in situations where end-of-life decisions are being considered 373
This article reviews ten of the most common mental health-related arguments against assisted death and applies them to the withholding/withdrawal of treatment to determine if the concerns expressed are truly unique to assisted death. After this analysis it is suggested that the mandatory involvement of a mental health professional can alleviate many of the concerns specifically associated with assisted death and that a mental health professional may also be helpful in situations involving the withholding/withdrawal of treatment.
Disability rights advocates have expressed significant concern about the potential dangers assisted suicide poses for persons with disabilities. This article extends this examination of concerns to withholding and withdrawing treatment in general and, in the specific case of physicians, using the futility rationale to discontinue or not start treatment. The arguments set forth against assisted suicide are applied to withholding and withdrawing treatment and futility and are shown to be at least as applicable to these other forms of hastening death. The article concludes with some policy suggestions.
The American Psychological Association's Working Group on Assisted Suicide and End-of-Life Decisions (2000) recently called for the development of resources to assist training programs in incorporating end-of-life issues into undergraduate and graduate courses. After explaining why teaching about the dying process is relevant to psychology, I provide suggestions for how instructors can include end-of-life issues and decisions in courses on ethical, legal, and professional issues; adult and life span development; counseling diverse populations; and assessment and diagnosis. Each section contains a brief review of key issues, provides sample discussion questions, and highlights appropriate references.
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