VISTAS Counselor Education and Supervision

VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences. Papers on a program or practice that has been validated through research or experience may also be submitted. This digital collection of peer-reviewed articles is authored by counselors, for counselors. VISTAS Online contains the full text of over 900 proprietary counseling articles published from 2004 to 2017.

End-of-Life Issues and the Supervisory Relationship

Megan M. Mahon, Tara M. Hill, Amber M. Lange, and Victoria I. Sepulveda


A client wishing to exploring end-of-life issues and the option of suicide may present as a complex stressful, ethical, legal case for a counselor (Crawford, 1999). A study by Rogers, Gueulette, Abbey-Hines, Carney, and Werth (2001) found that mental health professionals experience a very high rate of interaction with clients who are expressing suicidal ideation and/or completion (p. 369). Their research suggests that endof-life issues will be encountered by most mental health professionals during their career. The Doctoral Student Case for the 2007 American Counseling Association’s (ACA) Graduate Student Ethics Case Study Competition was titled End-of-Life Issues and The Supervisory Relationship. This case presents a counselor, Martha, who has completed her master’s degree and is in the process of completing her two years post-graduate counseling work under the supervision of Bonnie. Martha has a 58 year-old female client who has been diagnosed with terminal cancer and has been given six months to live. Her doctor referred her to counseling because she has been experiencing depressive symptoms. This client wants Martha to provide counseling and support as she considers ending her life. She is Hopi and believes that death is not something to be feared, and believes that Western medicine interferes with the natural process of death. Martha feels ethically and morally responsible to provide counseling and support for her client’s exploration of a decision about choosing whether or not to end her life own life. Martha does not feel that her client’s symptoms of depression are severe enough for a diagnosis of Major Depressive Disorder. The client’s husband has called Martha and threatened to sue her if she assists his wife with ending her life. Martha’s supervisor, Bonnie, feels very uncomfortable with Martha, her supervisee, accepting this case. Bonnie has not had much personal experience in end-of-life care, but feels that this client is considering ending her life due to a Major Depressive Disorder. Bonnie feels that Martha must take action by warning the client’s doctor and family of the client’s decision to end her own life. Bonnie feels that she personally is uncomfortable taking this case because of her own personal moral and ethical beliefs regarding suicide. Bonnie feels that Martha must stop seeing this client and refer her to another counselor.

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