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A Right to Die?

:
Ethical Dilemmas of Euthanasia

DIANNE E. ALBRIGHT
RICHARD J. HAZlER

Euthanasia is considered an important social issue of the 1990s. Mental health professionals should
understand thedifferences between voluntary,involuntary,passive, andactiveeuthanasia; mercykilling,
and assisted suicide. This article encourages counselors to ethically formulate client-supportive positions
to helpclientsface life-and-death decisions.

Each era presents new issues for counselors, and euthanasia may be that issue
for the 1990s. Margaret Battin, a philosophy professor at the University of
Utah, believes this topic will become the "most important social issue of the
next decade" (Steinbrook, 1991, p. A24). Not a week goes by without some
related newsworthy event occurring and the resurgence of debate on caring
versus killing (Arkes et al., 1991). Television talk show hosts, comedians, and
made-for-TV movies currently deal with this topic, and news about Dr. Jack
Kevorkian ("Dr. Death" or the "suicide doctor") is a regular event. Clients
need our professional support and direction on these issues as increasing
numbers of people are struggling with issues of dying, allowing loved ones
and self to die with dignity, and the possible legal ramifications involved.
Allowing a person to choose death involves a myriad of ethical issues and
dilemmas. Euthanasia, suicide, mercy killing, use of the living will, and "do
not resuscitate" (DNR) orders, all involve professionals who must make
decisions based on personal values and ethical principles rather than on the
law. This article is designed to help counselors whose clients are faced with
these decisions by citing limitations of the euthanasia concepts, examining
critical aspects of the related literature in the context of current events, and
summarizing the evolving issues most important to the counselor. The pur-
pose of this article is to remind counselors of key issues involved in the hope
that personal biases and values will be recognized and clarified before dealing
with clients in need of help.

Dianne E. Albright is an assistant professor at Central Missouri State University, Department


of Psychology and Counselor Education, 117 Lovinger, Warrensburg, MO 64093. Richard J.
Hazier is a professor in the School of Applied Behavioral Sciences and Educational Leadership,
Ohio University, 201 McCracken Hall, Athens, OH 45701.

Counseling and Values / Aprl/1995 / Vol. 39 177


CONCEPTS OF EUTHANASIA

The widespread ethical belief that human life must be sustained at all cost
(Baer, 1978) has created many practical and ethical problems for modern
society in which longevity is vastly increased. The extraordinary way medicine
can now fight disease has greatly increased our attention to the conflict between
whether quality of life or simple existence best defines the concept of human
dignity (Capron, 1979). An examination of key euthanasia terms that have an
impact on the issues of quality of life versus life at all costs and on taking
responsibility for actions on life-and-death matters is a necessary first step in
understanding these problems.
Euthanasia was derived originally from two Greek roots meaning simply
"good death" (Beauchamp & Walters, 1989). The concept is defined further
as (a) an easy death or means of inducing one, and (b) the act or practice of
painlessly putting to death persons suffering from incurable conditions or
diseases (Guralnik, 1961).These definitions convey the important implication
that euthanasia is a manner of acting, rather than the omission of an act. It
is often, therefore, recognized as a form of killing rather than allowing to
die. Euthanasia is subdivided additionally into the terms of passive, active,
voluntary, and involuntary (Meier & Cassel, 1983), which deserve further
clarification.
Passive euthanasia occurs when individuals fail to take measures that might
prolong someone's life. This allows death to occur through the omission of
life-saving measures (DNR orders would corne under this heading). Active
euthanasia, sometimes referred to as "mercy killing," is an act intended specifi-
cally to shorten a person's life rather than to simply allow it to end. Voluntary
euthanasia is referred to as "assisted suicide" and means that a competent
person explicitly asks for assistance in bringing on death. It is important to
note that people in highly emotionally or logically unstable conditions
(e.g., in extreme crisis, hallucination, psychosis) should not be identified as
competent to make such critical decisions (Corey, Corey, & Callanan, 1988).
Involuntary euthanasia is much more controversial than the previously
described types of euthanasia because the dying person plays no active part
in the decision. This occurs when family, guardians, or physicians of in-
dividuals identified as incompetent (infants, those with mental illnesses,
minors, and others who may not be able to request death under certain
conditions) hasten the process of death (Corey et al., 1988). The case for such
a position has been stated as the following:
It is harder morally to justify letting somebody die a slow and ugly death, dehumanized,
than it is to justify helping him to escape from such misery. This is the case, at least, in
any code of ethics which is humanistic or personalistic i.e., in any code of ethics which
has a value system that puts humanness and personal integrity above biological life and
function. (Fletcher, 1979, p. 149)

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Such a position, however, is in conflictwith a 1973American Medical Association
(AMA) House of Delegates Position Statement that advocated preserving
human life at all cost. The AMA has since softened this position by stating that
the physician has "a duty to do all that he can for the benefit of his individual
patient" (AMA, 1989, p. 193). These conflicts become increasingly more dif-
ficult with every advance in medical capabilities. Each advance serves to
widen the range of our decision-making obligations and increasing moral
responsibilities (Fletcher, 1979).

CULTURALLY DIFFERENT CONCEPTS OF LIFE AND DEATH

Client, counselor, and third-party attitudes toward life and death are culturally
derived, thereby making the recognition of cultural differences critical to
understanding the vastly different decisions that can be made. These cultural
value judgments help determine one's thoughts, beliefs, and, eventually,
actions regarding euthanasia. A better understanding of some major differences
in cultural views toward life and death will therefore help counselors working
with clients by increasing understanding and improving the potential for
choosing appropriate techniques.
Western culture endorses the belief that life is preferable to death. The belief
in the preservation of life is also influenced by religious and metaphysical
beliefs. The [udeo-Christian tradition affirms life as a gift from God even with
all its difficulties (Volicer, 1986). Smith and Perlin (1979) emphasized this by
observing that "human beings have limited sovereignty over their own lives"
in the Western view, and "it is God, no human persons, who is the Lord of
Life and Death" (p. 1622). The theme of necessary suffering is also common
in Eastern religions. Buddhism, for example, claims that suffering improves
karma and assures a person of better reincarnation (Smith & Perlin, 1979).
Islam claims that "the moment of death is foreordained and suffering should
not be avoided because it serves for expiation of sins" (Smith & Perlin, 1979,
p.655).
Eastern cultures differ from Western culture in that they often view release
from life as a goal to be sought as opposed to something to be avoided (Hopfe,
1987). These beliefs result in actions that may seem unreasonable to those
from typical Western cultures. "The basic world view of Hinduism is that life
is an endless cycle of birth, life, death and rebirth and the goal of religion is to
cease living..." (Hopfe, 1987, p. 104). Hill and Shirley (1992) stated that the
belief that life is sacred and suicide violates that sacredness is central to
Hinduism. If the continuation of life means only suffering, however, then both
religious and medical practice would be to let the natural process of dying take
its course. Self-destruction is even commended in theistic Hinduism when it
demonstrates devotion to a deity (Smith & Perlin, 1979). The willingness of
World War II Japanese warriors to inflict their own deaths may seem out of
place to some Westerners who have been trained in the sacredness of life.

Counseling and Values / Apr//1995 / Vol. 39 179


Westerners often do not recognize that Shintoists' love of, and worship for,
their nation together with the Confucianists' high sense of honor come together
to make seppuku (a form of suicide) a religious experience (Hopfe, 1987).
Individual countries have added their own interpretations to the Western
outlook regarding preservation of life. The Netherlands, for instance, has
several thousand occurrences of euthanasia each year as doctor-assisted
suicides. Although still technically a criminal offense, Dutch law forbidding
these assisted suicides is almost never enforced by authorities (Steinbrook,
1991). Euthanasia is generally accepted there when strict conditions are met
(e.g., repeated conscious and entirely uncoerced requests by the patient, a
hopeless medical situation, and a second opinion from another physician).
Culturally bound attitudes toward life, death, and euthanasia begin to shift
as the philosophic beliefs and coping strategies of the individuals within that
culture change. Recent public opinion polls in the United States have shown
that 50% to 60% of Americans now favor the legalization of euthanasia and
physician-assisted suicide under certain conditions (Steinbrook, 1991). These
figures may partly explain the reason that convictions are so hard to obtain
for such offenses that are still illegal.
The concept of life at all costs is clearly not a universal belief that counselors
should expect all clients, loved ones, or other professionals to hold. These
different religious, moral, governmental, and personal ways of viewing the
issue are compounded further by advances in modem society that are stretch-
ing humankind's ability to have an impact on life preservation. The result is
that additional responsibilities forced on professionals dealing with such
complex decisions demand that close attention be paid to ethical guidelines
for selecting appropriate behaviors.

ETHICAL CONSIDERAnONS

Three key ethical principles of autonomy, nonmaleficence, and beneficence seem


to have the greatest impact on decisions related to euthanasia. They speak
directly to the difficult issues of independence of personal choice, defining
harm, causing harm, and clarifying the differences between "not harming"
and "benefiting" another person. These issues are at the core of continuing
debates about euthanasia and about the role, responsibilities, and actions of
professional counselors.
Counselors first have an obligation to respect the integrity and to promote
the welfare of clients, recognizing their need for freedom of choice (American
Association for Counseling and Development [AACD], 1988, Section B:1).
This principle of autonomy can mean that refusing a competent person's request
for cessation of therapy or cessation of life (suicide) could show disrespect for
that person's deliberate choices (autonomy). It would at least deny the freedom
to act on those choices (Meier & Cassel, 1983), which is also a part of the
autonomy concept.

180 Counseling and Values / April 1995/ Vol. 39


The autonomy concept can seem to be in direct conflict with another critical
guideline, which is the counselor's duty to "do no harm" (nonmaleficence)
(Kitchener, 1984). The acts of suicide and mercy killing clearly do physical
harm because they involve the intentional, active ending of a life. The decision
for the counselor relates not to whether one concept is correct and one is
incorrect, but instead, which one should take precedence in a given situation.
Hill and Shirley (1992) stated that decisions to withhold or withdraw medical
treatment when the outcome may be death are moral decisions. Clients'
values and goals, which make their lives humanly purposeful, should be of
paramount concern in making these decisions.
Exploration of some sample situations should help clarify the implications
of autonomy versus nonmaleficence issues for the counselor. Foregoing
resuscitation (passive euthanasia), for example, is sometimes justified accord-
ing to the principles of both autonomy and nonmaleficence. Persons treated
as autonomous have the right to govern their own lives, and this can be
extended to the nature and situation of their own deaths, "the ultimate final
freedom" (Martin & Redland, 1988,p. 4). The concept of nonmaleficence or "do
no harm" can also be interpreted to support such passive euthanasia when
treatment would cause sufficient trauma, pain, and burdens that outweigh
the benefits. Obviously, allowing or assisting someone to end a life can be
identified as harm in many contexts. Nevertheless, harm could also be con-
strued as being done when a patient makes wishes known (i.e., requesting no
extraordinary lifesaving measures) and this request is not honored. Acting
against the values of a patient is acting against the patient's wholeness, and
this causes its own suffering (O'Mara, 1987). Also, when life is continually
shattered by pain, the free choice for a shorter life can be thought of as one for
the greater physical good (Smith & Perlin, 1979).
Health care professionals can view death as a part of the process of life as
opposed to something entirely unrelated to life and living. This life-as-a-
process view emphasizes an understanding of client rights as well as of ethical
principles related to aiding clients in having a quality death experience
(O'Mara, 1987). One of the ways people attempt to improve their right to
autonomy and the freedom to choose in life-and-death issues is by advance
preparation of a written refusal for certain treatments in specified circumstan-
ces. Some states have enacted Natural Death Acts (e.g., in 1976 California
began this legislation) that honor such living wills. Senator Jacob [avits (0-
NY) in his speech to the House Aging Committee in 1975 emphasized the
need for such laws by stating that:
Birth and death are the most singular events we experience, and therefore the contempla-
tion of death, as of birth, should be a thing of beauty. That is what makes the right to die
with dignity an issue of morality and humanity as well as of policy and law. (as cited in
O'Mara, 1987, p. 18)

The third principle of beneficence must also be given consideration because


it often comes into conflict with autonomy issues. This principal imposes a

Counseling and Values / Apri/1995 / Vol. 39 181


duty on the counselor to "benefit clients" in addition to not harming them. It
is a logical principle but one that can promote paternalistic behaviors on the
part of the professional.
The principle of beneficence is most often interpreted to take precedence
over the principle of autonomy in responding to suicidal attempts when
underlying terminal illness is absent. Nevertheless, the suicidal person who
has a terminal and painful medical condition or who is in an advanced state
of decrepitude and is also mentally competent and fully rational provides a
very different context. Some believe that this latter situation should always
have the principle of autonomy assume priority over beneficence (Young,
1989).
The age of the individual involved in these decisions is a specific variable
that has stirred much controversy, particularly in the case of infants (perinatal
ethics). One side of the issue supports absolute preservation of all human life,
whereas the other side would be influenced by specific conditions.
Some life is so full of pain and suffering or devoid of meaning that it should not be
maintained...Some children will have such a poor quality of life or place such a burden
on parents or society that they should not be saved. (Reedy, Minoque, & Sterk, 1987,
p.58)

Regulations in 1985 made it illegal to deny treatment to a newborn on the


basis of perceived or expected handicaps. These were struck down in 1986.
The current status of this changing situation is that if treatment of the infant
is to prolong dying, it will be withheld (Reedy et al., 1987). Counselors will
not be in a position to counsel infants, but parents, relatives, and other health
professionals will all have great struggles with such legal and personal issues
before, during, and after these difficult decisions are finally made. These
individuals and the struggles they bear call directly for the professional skills
of counselors.
Mercy killing of elderly people has also been publicized widely and
demonstrates the conflicts created by the beneficence concept. Roswell
Gilbert, a 76-year-old engineer, was convicted because of his active role in his
terminally ill wife's death. He spent 5 years in prison for assisting in
euthanasia of the "theoretically kindest sort" by ending her suffering from
Alzheimer's and a painful bone disease ("Mercy Killer," 1985, p. 3). The
confusing dimensions of controversy can be seen when it is recognized that
state voters rejected proposals supporting such acts in Washington State
(Gross, 1991), whereas national polls taken at the same time show that a
majority of Americans approve of such acts (Knox, 1991). "Dr. Death," Jack
Kevorkian, has been in the news and courts many times for assisting in the
suicides of those with terminal illnesses. He is also in the process of taking a
new poll to determine what Americans think about this issue. Michigan's
assisted-suicide ban, which resulted in brief imprisonments for Kevorkian,
has continued to be overturned, although the "suicide doctor" has been
present at 20 suicides to date since 1990 ("Charges Against," 1994, p. 2).

182 Counseling and Values / April 1995 / Vol. 39


Clearly, there are complex legal, ethical, and highly personal differences on
these issues among large groups of people, within families, and even within
the individuals themselves.

IMPLICATIONS FOR COUNSELORS

Counselors must keep current on the growing legal, social, and ethical infor-
mation related to euthanasia that is available. They must use this information,
their thoroughly considered personal beliefs, and an empathic understanding
of their clients to prepare themselves for taking stands on whether, when, and
under what conditions people will be allowed to choose death with dignity.
There are no more easy choices for these situations than there are for the
myriad of other difficult human issues professionals must face together with
their clients. A key factor to be remembered, however, is that counselors do
face these situations together with clients rather than alone. Counselors must
clarify their own beliefs and values related to these issues while at the same
time sharing the burden of these issues with the beliefs and value systems of
their clients.

Counselor Self-Preparation

"Clarifying values, testing options and assessing personal outcomes takes


time and an understanding of other processes that condition the decision-
making process" (Reedy et al., 1987, p. 62). There are several steps related to
their own beliefs, knowledge, and actions that counselors must take before
assisting others in the life-and-death decisions surrounding euthanasia.
1. Determine whatculturally influenced moral theory, personal biases, andpersonal
perspectives you have as a counselor and a person. Examine the degree to which
they have an impact on your work. It is most critical to start with the
recognition that you have such influences on you just as any other effective
human being has. Without a clear understanding of these influences and how
they relate to your client, you may be forced into a situation in which you
continually find yourself deciding for the client rather than with the client.
2. You should assess your general ethical decision-making process, understand it,
anduse it to deal consistently with allethical dilemmas including these. You should
have a set of steps that you follow whenever you are confronted by any ethical
dilemma. First, you need to ask yourself the following questions: (a) Am I
being sensitive to doing what is best for my clients in light of their values,
goals and the preservation of human dignity? (b) Are their fundamental
human rights being upheld? (c) Are my personal values being held in check
and not affecting my decision-making process? (d) Are my clients' needs
being held paramount to my own? (e) Have alternatives been fully explored
and are all facts known? (f) Have I sought additional help and consultation?
(g) Am I acting ethically and responsibly? If you have answered no to any of

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these questions, the next step would be to analyze your ability to turn each
one into a yes and take the necessary steps to do so. Answers that continue to
be in the negative call for referral of the affected clients to suitable counselors
who can better handle the specific situation. Inattention to these steps could
put the counselor into compromising positions leading to significant negative
ethical and legal implications. On the other hand, following these steps consis-
tently will ensure a fair, consistent, and professional approach where biases are
minimized, whichisa position that is highly defensible both ethically and legally.
3. Examine institutional protocols, legal precedents, and liabilities. One of the
benefits of working for an agency or with a group of professionals is that they
normally develop protocols for dealing with potentially volatile situations.
Do not isolate yourself from this benefit. Seek out organization protocols and
regulations that have an impact on your actions and on related legal issues
and liabilities. Those that you find will not be likely to absolve you completely
from difficult decisions, but they will help you to set logical parameters for
your choices. Potential legal ramifications including malpractice suits,
revocation of the license to practice, or possible imprisonment could be the
result of noncompliance with the law and the ethical codes of your profession.
4. Obtain differing professional perspectives from supervisors and colleagues. One
core ingredient in that process is that peers can and should be consulted on
difficult decisions. Use other respected professionals for their experience,
their interpretations, and their ability to help you carry out and access the
quality of your decision-making process.

Client Considerations

Once counselors understand their own orientation to the issues, they must
then focus on their client's needs. Many areas will need to be explored
regarding the client's worldview: (a) Within what personal, legal, religious,
and moral framework does the client exist? (b) What are the client's philosophic
and religious beliefs and method of making meaning out of life? (c)What type
of support system is available to the client and how do relatives view the
client's decision? (d) How hopeless is the situation surrounding the illness?
(e) Have alternate possibilities and decisions been thoroughly explored? (f) Has
the client been told of the legal ramifications of the decisions in question and,
if not, is the counselor qualified to do so? (g) Does the client possess strong
decision-making skills and, if not, can the counselor help improve those
skills? and (h) Is there a system of referral in place for the client should the
counselor be unable or unwilling to handle the situation?
The primary duty of the counselor is to provide counseling and support and
to maintain as much substantial autonomy for the client as possible. This task
mayor may not necessarily lead to a reaffirmation of the goodness of life in
all situations (Young, 1989). Autonomy allows clients to have the final word
about which treatment to choose and to refuse treatments they do not want.

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Nonjudgmental, understanding counselors, enmeshed in a society that
generally affirms only the choice for extending life, may find themselves torn
between wanting to support the client they know and care for and, on the
other hand, wanting to support the continued life of the client at all costs. The
choices are not always simple or clear but then counseling rarely deals with
the simple, clear choices.

Potential Counselor Actions

There have been noted commonalities of experiences for the "helpers" in-
volved in the cases that have been cited previously (Humphry, 1991b; Quill,
1991; Rollins, 1991).These commonalities seem to relate clearly to the needs and
actions of professional counselors in many ways. Two of these relationships
deserve particular emphasis because they relate so directly both to the needs of
the client and to the foundations of counseling: empathic understanding and
recognizing the major importance of the counselor's supportive role.
Regardless of the personal values, beliefs, or wishes for the person in need,
successful helpers were always able to reach points of total empathy with those
they were helping. They were then able to see things from the other person's
point of view and to understand the difficult decisions from that unique perspec-
tive. The successful helpers eventually became personally convinced that the
individual's decision was the right decision for that particular person at that
time regardless of the helper's initial view of the situation.
Counselors must recognize from these examples that they can play the
critical and difficult role in helping clients personally articulate the "impor-
tance of informed decision making, the right to refuse treatment, and the
extraordinarily personal effects of illness and interaction with the medical
system" (Quill, 1991,p. 693).The counselors' spiritual, legal, professional, and
personal boundaries can be pushed to the limit during these times. They need
to be explored extensively to acquire a strong sense of commitment to their
positions and to the techniques they decide to use in these situations. Success-
ful counselors must be ready to actively set their clients free to get the most
out of their remaining time while maintaining dignity and control on their
own terms until death. This task is made even more difficult by the fact that
many others close to the client (sometimes including the counselor) may not
agree with the client's decisions because of their own personal needs, fears,
and potential for hurt during these difficult times.
Counselors who have full understanding of their own ethical stands on
these sensitive issues, as well as of their client's needs, wishes, and perspec-
tives, will still be faced with difficult decisions on what actions to take.
Humphry (l991a) provided guidelines to those who are contemplating self-
deliverance from terminal illness. These steps may be adapted for counselors
to help provide additional insight as well as to give direction to clients in
coping with and resolving the decisions that must be made:

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1. Become as knowledgeable as possible regarding the course of clients' illnesses,
prognoses, and treatments tried and those yet available. Acquire written consent
from clients to speak to doctors involved. You may even seek access to
medical records.
• Discuss your findings with clients and explore alternatives for the time
remaining.
• Be certain that clients who are unhappy, unable to cope, confused, or
depressed are not merely reacting to the news of the terminal illness.
Remember that client depression is curable even though death is incurable.
• Examine client reasons for wanting to die. They will often have watched
loved ones suffer, deteriorate, and cause pain to others. Help them to
understand that their own deaths do not need to progress in all the ways
that they have seen in others before them.
2. Knowtheclients'familysupport systemsand what theirviewsare regarding life-
and-death decisions. Clients will need caring and understanding from sig-
nificant others. You may need to offer family counseling, or intervene with
others on the client's behalf, or both.
• Identify the family members who should be involved in helping make these
decisions.
• Explore how clients are now being viewed by others. Are they being treated
as the same competent and responsible people they were prior to the
diagnoses? Are their wishes and views being respected? Counselors may
need to intervene where relatives require help viewing client decisions as
rational acts performed by intelligent individuals who make plans and wish
them to be followed.
3. Clients who are near death may need help in some of the following areas.
Try to help clients cope with their psychic pain as well as their physical
pain.
• What do they fear most about dying? What is it they most seek to avoid?
• Explore their religious beliefs. Can their God accept suicide or a form of
euthanasia or are they supposed to suffer in preparation for life in the
hereafter?
• Consider ways to make their lives feel useful and fulfilling rather than
simply filling up time.
• Identify people in their lives with whom they must make peace. Are there
compliments to others that must be given?
4. Act as a resource person and sounding board for clients.
• Have a list of books to help clients explore their issues, realize they are not
alone, and lead them through their grieving processes.
• Know the available resource agencies and support groups and help clients
make the contacts they desire.
• Clients who do not have a support system in place may need counselors to
help them develop such a system that can relate to their personal prepara-
tions for death.

186 Counseling and Values / Aprll1995 / Vol. 39


• Be certain to question the existence of any pending special events (e.g., births,
weddings, and others) that clients may wish to attend. These are important
because clients who are questioning whether or not it is advisable to die
right away are probably not ready to do so.
5. Help clients understand the importance of various personal and formal docu-
ments associated with the end of one's life (i.e., Humphry, 1991a; Hill & Shirley,
1992). These include letters to loved ones of intent, method, and reasons for
death; living wills; wills citing distribution of property; insurance documents;
and durable power of attorney for health care (someone similar to an executor
who will see that wishes are carried out). This preparedness may help save
others as well as the dying person from additional grief and difficulties.
6. Regardless of clients' decisions, offer tolerance, compassion, and understanding
related to the difficulties in governing their own lives and choices about death.
Supporting clients as they make informed choices based on their own value
systems may be difficult when the counselor, client, and loved ones all have
different opinions about what should be done and how.
7. Counselors may beof great comfort to loved ones and friends after theclient has
died. Be prepared to answer questions, help absolve guilt, lend support, and
provide compassion to family members. Know of resources available, sup-
port groups, reading materials, and referral sources for all the significant
others left behind.

SUMMARY

Dying is an experience that many people fear, partially because the how or
when of its occurrence is not known. It is also a cause of fear because it can
represent the ultimate state of being out of control. All health care profes-
sionals, including counselors, must raise their sensitivity to this dying process
and respect the fears and values of their clients (O'Mara, 1987). Clients must
be allowed the opportunity to make informed decisions, to consider refusal of
treatment, and perhaps even to allow death to come naturally or at the person's
own hand. One noted case involved a patient who was allowed to choose her
time of death by the physician who set her free "to get the most out of the time
she had left, and to maintain dignity and control on her own terms until her
death" (Quill, 1991, p. 693).
The right to determine or to control the circumstances of one's own death
will be a major civil rights issue that cannot be ignored (Battin, as cited in
Steinfels, 1991). People do not want to be forced to end their lives or to have
them ended. They hope for death to be peaceful. Euthanasia is seen as an
option by many when one's life is no longer acceptable. Just as divorce was
once so shocking, 10 years from now people may be wondering "what's all
the fuss about?" (Humphry, cited in Sinnett, Goodyear, & Hannemann, 1989,
p. 571). The next century may see death without pain, with dignity, and
perhaps even at a prearranged time as the norm (Steinbrook, 1991). Modern

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society will surely continue its strong debate of the issues because "as fast as
we have been trying to figure out how to allow people to die more peacefully,
we keep improving the technology that makes it all the harder to do so"
(Callahan, cited in Steinbrook, 1991/p. A24). Counselors will be the necessary
advocates for clients on both pro and con sides of the euthanasia debate.
Change will continually take place and clients will need help coping with
these life-and-death issues.

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