Ethical Issues in Counseling Terminally Ill Patients - Essay Example

Ethical issues in counseling terminally ill patients Aims and Objectives Counseling came into existence when the first man ever sought advice from the other. Though the paradigms of modern day counseling may well be never ending, yet the actual essence remains the very same. Whether it is a psychological issue at hand, or even a personal problem, whenever a person seeks advice, and there is another one to offer it, it falls in the realm of counseling. Given the aforementioned realm, understanding the crux of counseling shall be made simple. It is an illusion if it is only considered in terms of a therapists’ room, much on the footsteps of Freud wherein the client would rest on a sofa and the counselor would offer advice. In the world of medical practice and health care, there are many complex issues than ordinarily meet the eye. The provision of care facilities involves issues to patient and subsequently to the relatives is very important. A very important tool for making sure that this has happened is the correct use of counseling. These are integral to both the well-being of both the patient and the health care provider. This paper shall endeavor to dwell upon certain areas of influence in the same realm, and help institute certain working parameters for professionals. Centuries ago, while the science of medical care was in its technical evolution stage, the prime area of reference was only the administration of health care. However, in today’s world, where the scientific world has come of age in its standing vis-à-vis disease care and prevention, subsidiary issues have emerged that are considered to be of prime importance in the domain of health care. The changes in society and life all around the world have brought about considerable changes in the lifestyles of humanity. Similarly, the profession of health care has seen its development through the ages, and many additional factors like counseling concerns need to be understood better. Ethical science has always found it difficult to decide, about the extent of the information being provided to the patient. Essentially, if one would put oneself in he shoes of the patient, then one would like to receive every bit of information that is related to the medical condition. However, when one looks at the issue from the perspective of the clinician, then the need can be appreciated of withholding some information from the client, for the latter’s benefit. Where does the line of morality and ethics come here, and from where the jurisdiction of science starts, is the focus of this research. There are and always have been two sides to this issue. While one believes that the terminally ill patient should be given all available data, while the other group is in favor of professional secrecy resulting from adequate counseling, which is necessary to the cause of the treatment. What follows is an inquiry into issues which are integral to the cause of counseling to patients; both sides shall be represented therein, and the most plausible option shall be elucidated. Subsequently, a few areas are discussed hereunder, which are considered for an evaluation of the issue. Literature Review Given that counseling is a kind of treatment restricted mostly to verbal exchanges, practitioners do not have to be medically qualified. In most countries, however, psychotherapists must be trained, certified and licensed with a range of different licensing schemes and qualification requirements in place around the world. Counselors may be psychologists, social workers, trained nurses, psychiatrists, psychoanalysts, or professionals of other mental health disciplines. Psychiatrists’ training focuses on the prescription of medicines, with some training in counseling. Psychologists have special training in mental health assessment and research in addition to counseling. Social workers have special training in mental health assessment and treatment as well as linking patients to community and institutional resources. Given the circumstances, it is believed that it may well be necessary to counsel the patient when he is terminally ill. After all, the true beneficence lies in the cure of the patient, and if this cannot be actualized at the end of the day, then the health-care process would have drastically failed. “Physicians frequently ignore their patients’ wishes when they consider the appropriateness of truth telling. A complete shift from nondisclosure to mandatory disclosure without considering patients’ preferences may lead to serious harm to patients who do not want to be told the truth” (Asai, 1995). The health care provider possibly knows best when and what is necessary for the patient. It is also purported that by counseling, one would be able to present a scenario that is non-malicious. Lies and withholding of truth have integrally been taken as sinful over the years spanning human civilization. So it would go without saying, that if somebody is counseling to the patients, then an act of good is being conducted. “The purpose of truth telling is not simply to enable patients to make informed choices about health care and other aspects of their lives but also to inform them about their situation. Truth telling fosters trust in the medical profession and rests on the respect owed to patients as persons” (Glass, et al, 1997). It is thus believed, that the actual regard would be actualized when the patient finds his cure. Subsequently, if the nurse feels that there is something that the patient would be well off without knowing, then they should not disclose that information during the counseling session. “The best time to discuss life-altering and life-threatening disease is when patients can remember the conversation, understand its significance, and participate in health care decisions” (Chodosh, 2000). The ethical grounds may seem to be coming under contention here, but even still, the stance for the cure of the patient is paramount in the health care profession. For that, ends may well justify means. If somebody is not being counseled at the time of crisis, then it can well be imagined, they do not value the mental and emotional state of the patient. This in effect is an insult to the person, who is not being allowed to be a party to the issues pertaining to his own life. “The wish to protect dependent relatives conflicted with the wish to be open, makes decisions very difficult. Considerable suffering is caused by poor communication, and much of this is avoidable” (Stedeford, 1981). Subsequently, they may not really be able to handle the intensity of the facts, and may even be misdirected by certain details. Their lack of appreciation of reality may in turn lead them to deal with the situation in an undesirable manner which maybe detrimental to the health-care process. Handling counseling is not something that comes naturally to every patient. The patient may take the facts as an adverse reality, and may act in retaliation as well. In the cause of health-care provision, a nurse or a physician may well withhold some information which they consider would be important for the client not to know. “Patients studied want their physicians to be highly professional and expert clinicians and show humaneness and support, but their first priority is for the physician to respect their autonomy” (Rudin, et al, 2004). Counseling is rational and accessible. It is not some esoteric, undefinable, mystical process that only some people can grasp, a faith that only converts believe in and others do not. It is a logical process which anyone can understand and follow. There is no reason for anything in a session to be unreasonable or mysterious. On the contrary, in good counseling every step should make complete sense to one, the patient; one may end up in strange territory, but it should be entirely clear to one how one got there. “Not to speak of the diagnosis may simply alarm the patient, who in many cases will already have some idea of what their symptoms indicate. It leaves patients open to discovering their diagnosis in inappropriate ways or to seeking further information from dubious sources” (Clafferty, 2000). This would be the right thing to do in the eyes of many, as withholding any information would then give the right to the practitioners to withhold anything they please. This would then result into a general feeling of mistrust and lack of belief within the patients at large, because then they would not be able to trust the health-care providers with their lives. “While physicians cannot control all the stated reasons for patients seeking legal redress, they are able to influence the quality of their relationships with patients. And, as already noted, the foundation for a good patient-physician relationship is communication” (Huntington, 2003). The patient can often be stricken with panic and enter a frantic state. Worse still they can enter the zone of depression, which would be another psycho-somatic condition associated with their primary condition; a gamble that is not worth the take. Thus, counseling becomes all the more relevant. There are certain familial considerations that are very important for certain communities, Bower believes that “if we see errors being made that might threaten relatives’ and friends’ wellbeing, how can we be expected to stay silent? When I am in my more frequent and more comfortable role as the doctor I always invite my patients to involve their family, medically or otherwise, as fully as they wish” (2000). It can thus be considered important to empower the family of the people, as well as the patients themselves, so that they can get a better understanding of the issues. In this way, they are also made part of the counseling cycle and help in easing out things for the patient. Issues may oscillate between how intense they are, but nonetheless, they remain all the more important for all terminally ill patients. Given the fact that all human beings are susceptible to challenging situations, it becomes imperative for them to qualify for the need for counseling. Methodology The methodology for the study entails a simple yet sequential process. Primarily, it is a comparative, cross-sectional study between two different patient groups, to find out the usage and efficacy of counseling in terminally ill patients. It is questionnaire-based study, which shall give us demographic as well as technical data into the subject. It is a cross sectional study, which means that it shall have a sample that is representative of varying segments of the society. It is not merely a study of one group, one community or one class within the community. The subjects for this study shall be in two groups. Firstly, there would be the patients who are terminally ill, and are receiving some sort of counseling in this stage. The second one would be with the same factors, except that there would be no intervention in as far as counseling is concerned. A questionnaire shall be devised that shall be same for the two tiers, and would attempt to find out varying information on the subject. As the questionnaire would primarily have objective and closed-ended items, thus the statistical analyses at the end would involve item and questionnaire analysis. The patients would have to be from the terminally ill genre, so that an impact can directly be seen of the efficacy (if any) which the counseling can produce. They would be belonging to two different cities, and hence would represent different living, climatic and socio-economic conditions. Similarly, their diseases would possess the same difference in primary characteristics that would be taken as variables in case individual factor analysis needs to be considered at any point in time. A sample of 200 patients each (a total of 400), is considered as suitable to make a reasonable comparison for the sake of the study. These would be a fair enough sample of a population, to establish a trend of the incidence of counseling in terminally ill patients. Further, it would help in establishing the trend analysis for the condition, including its incidence and management. Prior permission would be taken firstly from the hospital/hospice administration, and then from the patients. A consent form for participation of the patient shall be made available before the actual questionnaires shall be administered. For ethical and secrecy reasons, the patients shall be confirmed on the consent form that no information about their identity shall be disclosed at any point in the study. It is important to consider this, as patients may not like to share any information about their health if they believe that he/she may be labeled in the future for any types of special and/or biased treatment. Data Analysis Firstly, data would be collected from the sample. For that purpose, personal presence would be mandatory at the hospital. The patients may like to take the questionnaires home and return them the next day duly completed if physical presence is not possible. After the data is collected, then subsequent information would be tabulated and analyzed for the consequent discussion upon the study. There are two different types of questionnaires that shall be made available. Firstly, there is the consent form for the patients that will seek demographic information about them, along with permission for participating in the study. Secondly, there is the basic tool (questionnaire) that would be available to be filled by the patients, inquiring about the need and efficacy of counseling at this stage of their illness through direct and indirect questions. Once the objective data is made available through the questionnaires, then the data shall be fed to the computer software SPSS, and subsequent evaluation shall be done. Special areas of interest as far as the results are concerned shall include the incidence of asthma, the awareness about it, and the knowledge of the patients about the same. Finally, a comparison would be done on these three parameters among the two cities mentioned. Ethics and Practical Issues Essentially, counseling is considered as a moral obligation in almost all cultures and theologies around the world. It is taken as a compulsory act of beneficence, without which the integrity of the health-care provider is lost, and essentially the entire process of health care suffers an emotional blow. The act of kindness is hence lost, and there surfaces an immense feeling of betrayal and anguish on part of the patient. Conversely, the other side presents an equally convincing argument. For one, many patients around the world do not have the technical expertise to understand and analyze the information provided to them. To add, a patient goes through several ups and downs during the treatment process. Evolutionary research is required in the realm of counseling treatment in today’s time. It is more so due to the fact that the actual physical incidence of terminally ill diseases have been understood and isolated, however the psycho-medical treatment methodologies are far from being ascertained. Therefore, it is extremely important to understand the use of counseling, as this is one of those issues in the contemporary world, whose proper utility has not yet been actualized to perfection. Support Group therapy has long been used in cases which have an overlapping concern for the medical and the psychological practice. Therefore, it was envisioned; the patients of counseling should also be able to undergo this treatment, with the optimism that positive results would be drawn out of this research. For half of the participants of the study who are in the primary study group, a 100 % possibility is there to find a new road towards cure. This is because actual treatment shall be administered upon them, in the form of the support group method. This shall be in addition to the treatment they are already getting. As far as the other group is concerned, though a direct benefit may not be there, but it is believed that by their repeated answers to items in the questionnaire, a feeling of positive self-actualization shall be triggered over time. The consent shall be taken in the form of a written form, which would be filled after being thoroughly explained by their own psychiatrist and the primary researcher. The concern for this study is the secrecy of the treatment. Their privacy would be ensured, and involvement would be totally voluntary. There are no side-effects of this program, hence no major ethical concern is anticipated. Counseling is a dialog. It is not a teaching session. One presents data, the therapist offers ideas about that data, as well as his own data -- his feelings, his past experience, his own theories -- then one pick up the ball, and so on. Has the therapist helped one discover truth about oneself, one’s life, one’s feelings -- and is this material helping one make the changes one want -- or is he up a tree? If the latter, one must speak up. No therapist will be right all the time, of course, and it may be that one expects for change are unrealistic or misguided. One has to sort this out together. But the final word is the individual’s own. A therapist can tell one what’s probably going on with a person, what seems to be happening, but it is only one who can say if he is right. Without one active testing of the material, counseling degenerates into a thought experiment, a series of entertaining speculations and psychobabble that have no impact on one’s life, one’s behavior, one’s feelings. Counseling is aimed at solving problems, and solves them via a number of different approaches and techniques; commonly counseling involves a therapist and client(s), who discuss their issues in an effort to discover what they are and how they can manage them. As sensitive topics are often discussed during counseling, therapists are expected, and usually legally bound, to respect patient privacy and client confidentiality. References Asai, A. (1995). Should physicians tell patients the truth? Western Journal of Medicine. July; 163(1): 36–39. Bower, P. (2000). Do you admit to working within the system? British Medical Journal. September 23; 321(7263): 768. Chodosh, J. (2000). The treacherous path of truth-telling with demented patients. Western Journal of Medicine. November; 173(5): 323–324. Clafferty, R. (2000). Telling patients with schizophrenia their diagnosis. British Medical Journal. August 5; 321(7257): 384. Glass, K. et al. (1997). Bioethics for clinicians: 7. Truth telling. Canadian Medical Association Journal. January 15; 156(2): 225–228. Huntington, B. (2003). Communication gaffes: a root cause of malpractice claims. Journal of Baylor University Medical Center. April; 16(2): 157–161. Rudin, D. et al. (2004). Good physicians from the perspective of their patients. September 12. doi: 10.1186/1472-6963-4-26. Stedeford, A. (1981). Couples facing death. II--Unsatisfactory communication. British Medical Journal. October 24; 283(6299): 1098–1101. Read More