TPC Journal V8, Issue 3- FULL ISSUE

250 The Professional Counselor | Volume 8, Issue 3 Multiple scholars have discussed the need to explore values related to personal conflicts to maintain ethical practice in counseling (Cottone & Tarvydas, 2016). However, few sources have yet to provide direction for counselors on how to resolve personal values-based conflicts regarding PAD. There is an added layer of difficulty with PAD clients because of the multifaceted nature of personal and professional values at play. Counselors are grounded on the ethical principles of promoting client autonomy and respecting cultural differences in decisions (ACA, 2014), but hastening death conflicts with the counseling profession’s inherent stance to “first do no harm” and to maintain client safety and preserve life when clients desire to end their lives (Cohen, 2001). Even though hastening death is legal in certain states, values surrounding the decision to end life do not simply cease because there is justified reasoning for a decision. Thus, counselors face a challenging dichotomy between law and values in their practice with PAD clients. Recent changes in the counseling profession’s ethical code also contribute to the potential challenge of maintaining ethical practice with PAD clients. The ACA Code of Ethics (2005) included codes that addressed counseling practice with clients considering end-of-life options. Section A.9 in the ACA Code of Ethics (2005) provided guidelines about the quality of care counselors should uphold for clients facing the end of their life, including the counselor’s role in assisting clients with end-of-life decisions. Counselors were tasked with the responsibility to reflect upon personal values and morals regarding end-of-life to ensure competent and ethical care. Although the revised ACA Code of Ethics (2014) includes considerations for confidentiality, legal concerns, and client safety during end-of-life care, there is no longer a designated section for the end-of-life care of terminally ill clients, and explicit codes regarding PAD are absent. The ACA Code of Ethics (2014) included guidelines for counselors regarding methods to maintain client autonomy and seek continuing education to address the holistic needs of clients, along with giving clients the tools necessary to make the most appropriate decisions for their care. However, lack of explicit codes about PAD and few guidelines related to end-of-life care might cause ambiguity when values-based ethical dilemmas about PAD arise. In summary, consideration for counselors’ personal and professional values, along with the ethical and legal implications at hand, creates unique potential for a values-based conflict surrounding PAD unlike other sources of values-based conflicts. Values are influenced by numerous factors in multiple settings and contexts (Heller Levitt & Hartwig Moorhead, 2013). Therefore, resolving value conflicts related to PAD warrants a unique systemic perspective that considers the multiple influential sources that shape values about death and grief in personal and professional realms (Neimeyer et al., 2014). The authors of this article review PAD, counselors’ roles in the hastened death process, and an applied method of managing values-based conflicts with PAD through a values-based ethical decision-making model and ethical bracketing. The impacts of personal and professional values will be described through an ecological systems lens. It is important for counselors to understand PAD in the context of various systems, as individuals’ decisions concerning PAD are influenced by multiple sources that contribute to their beliefs and values related to death and dying. Physician-Assisted Death PAD is currently legal in six U.S. states: California, Colorado, Montana (by court ruling), Oregon, Vermont, and Washington, as well as Washington, DC (Death with Dignity, 2018). Hawaii will become the seventh state to legalize PAD when their legal statute takes effect in January 2019 (Death with Dignity, 2018). PAD has been a topic of debate throughout American society and health care for decades (Werth & Holdwick, 2000). Many have voiced opposition to PAD as a legalized option