TPC Journal V8, Issue 3- FULL ISSUE

The Professional Counselor | Volume 8, Issue 3 251 (Werth & Holdwick, 2000), and previous “standards of mental health practice [have treated] all suicides as products of mental illness” (Cohen, 2001, p. 279). However, health care advocates of PAD, such as Dr. Jack Kevorkian, have fought for individual rights to choose dignified death when faced with terminal illness (Kevorkian, 1991). As the legalization of PAD emerged in the aforementioned states, the topic of debate shifted from the right to choose hastened death toward the policies that guide health care professionals to assist terminally ill individuals in hastening their deaths (Werth & Holdwick, 2000). Language within each state statute slightly varies, but requirements to legally hasten death are similar across states. There are no formal requirements for PAD in Montana, because a law permitting PAD does not exist in that state; however, there is a legal precedent that protects physicians from prosecution as long as there is written consent from the patient ( Baxter v. Montana , 2009). For all other states, patients must be over the age of 18, permanent residents of the state, have been determined by an attending and consulting physician to be suffering from a terminal illness, and carry a life expectancy of under 6 months to be eligible to legally hasten their deaths. Patients must voluntarily express their wishes to die orally, make a written request for medication to end their lives in a humane and dignified manner, and be deemed mentally competent to make end-of-life decisions by a licensed psychiatrist or psychologist. In addition, there is typically a 15-day waiting period between the initial request and when the physician provides a written prescription for medication to end life (Death with Dignity, 2018). In the legal requirements of each state and district statute, there is no mandate for counseling services beyond an assessment of competency. However, PAD clients and their families often work with mental health professionals throughout the process of considering hastened death and implementing PAD (Fulmer, 2014). As more states move toward legislation to legalize PAD, counselors are becoming more involved in the interdisciplinary teams of health professionals working to meet the needs of this population. Interdisciplinary teams may be comprised of medical physicians, psychiatrists, psychologists, social workers, palliative care nurses and specialists, occupational therapists, and mental health counselors (O’Connor & Fisher, 2011). Clients pursuing PAD have physical, social, emotional, spiritual, and practical needs as they deal with the process and experience of dying (Daneker, 2006). Helping professionals’ roles can be blurred as the interdisciplinary team works together to meet PAD clients’ needs (O’Connor & Fisher, 2011). Physical needs include keeping clients comfortable in their final months of life when all other treatment options are exhausted. Practical needs include making arrangements for after death and navigating the legal processes to hasten death, including the competency assessment a psychiatrist or psychologist must conduct to ensure that PAD clients are stable and well-informed enough to decide to hasten their death (O’Connor & Fisher, 2011). Clients’ social, emotional, and spiritual needs will vary depending on the nature of the terminal illness, individual contexts, and familial and cultural contexts; counselors are trained to address such biopsychosocial needs within clients’ individual and cultural contexts (Peruzzi, Canapary, & Bongar, 1996; Werth & Crow, 2009). A counselor’s primary role is to address how clients’ medical diagnoses are impacting their biopsychosocial well-being, including their decision-making processes to hasten death (O’Connor & Fisher, 2011; Peruzzi et al., 1996; Werth & Crow, 2009). Counselors build a unique therapeutic relationship that provides professional emotional support, and they help clients reflect on the factors that have led them to make this life-ending decision. They may explore what hastened death means to clients’ families or communities. Counselors also seek to understand how clients’ spiritual beliefs and emotional needs influence their well-being and decision making. Counselors recognize that spirituality and religious practices can be significant to clients when discussing dying, death, and