Legal and Ethical Considerations for Mental Health Professionals Related to End-of-life Care and Decision Making

Abstract

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

Ethical decision making in mental health contexts: Representative models and an organizational framework.

“…These publications are found not only in psychology journals, but also in social work, marriage and family therapy, behavioral science, and counseling journals. A number of publications address specifi c challenges when serving clients who have faced such issues as (a) domestic violence or battered women (e.g., Edwards, Merrill, Desai, & McNamara, 2008 ;Koenig, Rinfrette, & Lutz, 2006 ), (b) end-of-life care (e.g., Werth, 2002 ), (c) geriatric neuropsychology (e.g., Martin & Bush, 2008 ), and (d) HIV and AIDS. There also have been models or guidelines developed for serving clients within specifi c contexts, such as (a) religious communities (e.g., Hill & Mamalakis, 2001 ), (b) managed care (e.g., Belar, 2000 ;Tjelveit, 2000 ;Younggren, 2000 ), (c) child clinical psychology (e.g., Mannheim et al, 2002 ), (d) outpatient care ( Truscott, Evans, & Mansell, 1995 ), and (e) play therapy ( Seymour & Rubin, 2006 ).…”

Untitled

“…The law, which now protects the lives of all people in society, will then sanction an easy and permanent solution to rid society of the burdensome and vulnerable people. Physician-assisted suicide and active euthanasia, rather than non-palliative care for the terminally ill, will become the preferred treatment and the expected duty of the physician to perform (Ersek, 2006, Gesundheit et al, 2006Werth, 2002). The President's Commission Report (President's Commission, 1982), Deciding To Forego Life-Sustaining Treatment, insists that the "slippery slope arguments must be carefully employed lest they serve merely as an unthinking defense of the status quo.…”

When Does the “Duty to Protect” Apply with a Client Who has Anorexia Nervosa?

“…Another concern related to the application of the duty to protect with clients who have anorexia is, essentially, where to draw the line with other behaviors that may eventually lead to death, such as substance abuse (see Frederick, 1980) or cigarette smoking (see Lichtenstein & Bernstein, 1980). The overarching issue of when the duty to protect applies with individuals whose behavior is putting them at risk of harm is beyond the scope of this article but has been discussed recently by Werth and Rogers (2003; see also Werth, 2002). For the present purposes, comparisons with other behaviors are appealing, but these "indirect self-destructive behaviors" (Farberow, 1980; see also McIntosh & Hubbard, 1988) are different from the situation with anorexia as it has been presented in this article in at least two significant ways (of course, if such individuals are not different in these significant ways, then intervention would be appropriate).…”