TPC Journal V8, Issue 3- FULL ISSUE

249 Nancy E. Thacker, Jillian M. Blueford Resolving Value Conflicts With Physician- Assisted Death: A Systemic Application of the Counselor Values-Based Conflict Model Counselors are becoming more involved with clients pursuing physician-assisted death (PAD) as legislation for legalization increases. PAD may present complex values-based conflicts that can challenge counselors to maintain ethical practice in counseling. When conflicts arise, counselors must engage in ethical decision making that considers systemic influences on personally held beliefs and values. The authors merge ecological systems theory with the counselor values-based conflict model to offer a holistic approach to resolving values-based conflicts surrounding PAD. In this article, the authors review PAD and counselors’ roles in the hastened death process, discuss sources and impacts of personal and professional values through an ecological systems lens, and provide an applied method of managing values-based conflicts with PAD through a case illustration. Keywords : physician-assisted death, hastened death, values-based conflict, ethical decision making, ecological systems Individuals with terminal illnesses encounter difficult end-of-life decisions amidst experiencing physical and emotional distress (Daneker, 2006). Currently in six U.S. states and Washington, DC, terminally ill individuals have a legal right to end their lives via physician-assisted death (PAD). As legislation for legalization of PAD increases, more terminally ill patients can consider PAD as an option (Miller, Hedlund, & Soule, 2006). As a result, the need for mental health professionals to assist individuals dealing with these end-of-life decisions is on the rise. The topic of death presents complex questions about the meaning of life and death and evokes reflections on one’s personal beliefs and values surrounding death and dying (Yalom, 2009). Terminally ill individuals may confront their personal beliefs about a morally just or good death, explore feelings about the process of dying, and consider their levels of personal control or power in their processes of dying (Laakkonen, Pitkala, & Strandberg, 2004; Yalom, 2008). Religion and spirituality often contribute to terminally ill individuals’ beliefs and values surrounding death and dying and can influence end-of- life decisions (Reiner, 2007). Each personal belief and value is influenced by systemic factors, cultural experiences, and cultural customs or expectations that play a role in end-of-life decision making (Laakkonen et al., 2004; Neimeyer, Klass, & Dennis, 2014). Counselors will confront their beliefs and values about death and dying as terminally ill individuals who are contemplating PAD (PAD clients) seek counseling to explore end-of-life decisions (Werth & Crow, 2009). If counselors’ beliefs and values conflict with PAD clients’ beliefs and values, or PAD itself, then it may present an ethical dilemma that challenges the quality of care counselors provide (Heller Levitt & Hartwig Moorhead, 2013). Although not all counselors may experience a value conflict related to PAD, those who do experience a conflict may look to the American Counseling Association’s (ACA) Code of Ethics (2014) and an ethical decision-making model that accurately addresses the values- based nature of the ethical dilemma at hand. The Professional Counselor Volume 8, Issue 3, Pages 249-261 http://tpcjournal.nbcc.org © 2018 NBCC, Inc. and Affiliates doi:10.15241/net.8.3.249 Nancy E. Thacker, NCC, is a doctoral candidate at the University of Tennessee, Knoxville. Jillian M. Blueford, NCC, is a doctoral candidate at the University of Tennessee, Knoxville. Correspondence can be addressed to Nancy Thacker, 501 BEC, 1122 Volunteer Blvd, Knoxville, TN 37996-3452, nthacke2@vols.utk.edu.