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End of Life Decisions Essay

End of Life Decisions

            The case of Jason is one that can be commonly found in the HIV positive community. Not because they are suicidal but because they view their daily life as a punishment for their life actions and therefore death is the release from pain and suffering they are looking for. In Jason’s case, he seems to have a clear idea of how he wants to deal with his illness and he is at peace with his decision. However, as his counselor, I would strongly discuss the intricacies of the informed consent contract with him. I would be negligent in my duty as his counselor if I fail to inform him that by going off his medication and traveling, I would be forced to inform health authorities about his actual health status in order to protect those around him who may unwittingly get unintentionally infected by him. He needs to understand that our doctor-patient confidentiality agreement has its limitations and this is one of those limitations.

            It is a sad reality that in this day and age of alternative lifestyle acceptance, there are still those who shun the so called “third-sex”. It is this shunning by the very

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people who should have been his support group, his immediate family composed of his mother, father, and siblings, that greatly contributed to his depression. The fact that his church failed in its duty to be his religious beacon of light and understanding when he came out to them as well. Due to these aforementioned factors, Jason has always had suicidal tendencies. These tendencies were even stronger and more pronounced during his teen-age years as he struggled with his sexuality development related questions.

            As his counselor, I would be tasked with the painful decision of keeping or breaking the patient confidentiality agreement with Jason. Therefore, I must from the very beginning make sure that he familiar with all the informed consent sections of our patient-doctor relationship. In Chapter 8 of the textbook ACA Ethical Standards Casebook by book Corey, G. (2005) he specifically explains and instructs us to follow the guidelines listed in the 2005 ACA Code of Ethics which clearly explains that the confidentiality agreement  “does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm.“  However, decisions to break the confidentiality agreement must be based upon proper consultative analysis with other counselors and a long hard look at Jason’s character and possible reactions. I am positive that after undergoing those check and balance procedures, I will realize that since the reality of Jason going off his medications is a reality and he cannot be convinced not to do it, my duty has now shifted to protecting the innocent people around him whom he may infect either intentionally or unintentionally. He will have left me with no choice except to break the confidentiality agreement.

            A counselor must remember however, that such end of life decisions are not easily arrived at by the patients and therefore, one must understand the process by which the patient arrived at the final decision based upon his religious beliefs. In their article Cultural Diversity At The End of Life: Issues and Guidelines for Family Physicians that was published by the for the American Family Physician Journal (2005), H. Russel Seabright and Jennifer Gafford indicated that the ethnic minority of the United States decide upon a totally different set of End of Life decision criteria than their American counterparts. The authors continue to mention that there are 3 basic cultural dimensions considered when it comes to End of Life decisions which they listed in the same article as “communication of “bad news”; locus of decision making; and attitudes toward advance directives and end-of-life care.”

            An End of Life Decision is not something that a patient must decide upon by himself. Therefore, it is the job of the counselor to insure that the patient is well informed about the repercussions of his decision while considering the patient’s moral and family values, spirituality, and relationship dynamics.

Work Cited

Corey, G. (2005). ACA Ethical Standards Casebook. Location: Publisher.

Searight,  H. Russell, Ph.D., M.P.H. & Gafford, Jennifer, Ph.D. (2005). Cultural diversity at the end of life: Issues and guidelines for family physicians. American Family Physician. Retrieved January 19, 2008 from http://www.aafp.org/afp/20050201/515.html

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