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Course 2D - The Ethics of Advance Directives: Assisting Clients and Families with Preferences for End of Life Care Including Those with HIV-AIDS
This course is sponsored by CEU by Net and is approved and/or pre-approved or automatically approved for 2 credit hours by multiple State Boards including Texas, Alabama, and Florida, TCBAP (Texas Certification Board) and TAAP, IC&RC, NAADAC, Florida Certification Board, and California CCADE, CCAPP, and CADTP. EACC awards 2 Total PDHs in Domain I, III effective June 6, 2020. Course also awards 1.25 CA BBS Hours effective 10.01.15 and 2.0 before that date, and 1.25 NBCC Hours as of 05.01.15 and 2.0 before.
This study is published by the federal Agency for Healthcare Research and Quality (AHRQ), and is written by Barbara L. Kass-Bartelmes, M.P.H., C.H.E.S., and Ronda Hughes, Ph.D..
The course is both an ETHICS course and a COUNSELING INTERVENTION course, and is appropriate for professionals who are working with [or may encounter] cancer patients, HIV-AIDS patients, stroke patients, terminally ill children, those who are in intractable pain, and others for whom End of Life care is an Issue. Say the authors, "Predicting what treatments patients will want at the end of
life is complicated by the patient’s age, the nature of the illness, the ability of medicine to sustain life, and the emotions which patients and families endure."
Counseling dying or gravely ill or at-risk people and their families regarding their decisions for End of Life Care (Advance Directives) is fraught with both ETHICAL and INTERVENTION issues. Such counseling assistance is a delicate matter, and can be difficult for counselors to carry out without inadvertently inserting their own biases into the intervention. This course teaches a 5-step research-based method to avoid such conflicts.
This 5-step counseling approach is also appropriate for working with clients who have chronic diseases such as cancer, kidney failure, CHF, and HIV/AIDS -- where there is considerable uncertainty about when death is likely to occur, but which is nevertheless a complex issue which may exacerbate co-occurring disorders including SUDs.
The main issue in working with people who are seriously ill is, how far do you want medical personnel to go, to delay death? HIV-AIDS patients differed significantly from other ill patients, in several areas. There are also circumstances in which the reaction of the patient to discussing such issues varies significantly, depending upon the specific stage or type of illness and age of the individual - including the reaction of terminally ill children.
The research therefore calls upon Behavioral Health and other medical professionals to tailor the approach according to the illness and the situation, i.e., HIV-AIDS vs Cancer vs Stroke vs. Alzheimer's .... and impending death vs. uncertainty of when death will occur.
The approach is, accordingly, a 'KNOWLEDGE FRAMEWORK’ and a 'GUIDELINE' for working with individuals with differing medical issues and life circumstances including HIV-AIDS -- and to do this work ethically. The research included discussion with patients with various medical conditions which they could face when he or she nears the end of life, including severe intractable pain, disabling stroke, permanent coma, mental deterioration, etc.. The patients were then asked to indicate which of these circumstances they would consider worse than death, i.e., under which conditions they would NOT want measures to be taken to prolong life. HIV-AIDS patients differed significantly from other ill patients in not wanting to prolong life under these circumstances.
This course is also helpful for those providers who work with HEALTHY individuals who work in life-threatening situations including MILITARY deployment to war zones, police officers, firemen, SWAT teams, undercover agents and other such at-risk occupations.
GOALS OF THIS COURSE:
1. Learn the terms pertaining to individuals' and surrogates' LEGAL RIGHT to make 'End of Life' care decisions.
2. Based upon the extensive research which produced this document, become aware of the need for clearer documentation and communication of patients' and surrogates' preferences for End of Life Care within the clinical record and in the direct communication provided to the treating physician and other caretakers.
3. Understand the THERAPEUTIC BENEFITS and the ETHICS of engaging in discussions about ‘end of life preferences‘ with applicable clients and their partners, spouses, families or surrogates (representatives).
4. Know that discussion and decisions about Advance Directives are important at multiple stages of proximity to death -- whether death is potentially imminent (as with late-stage AIDS patients and other critically ill people), or when the individual is adjusting to a diagnosis of serious illness which may ultimately result in death including HIV and cancer, or when preparing for high-risk medical procedures, or when coming to terms with the risk of critical injury in high-risk employment (military, law enforcement, etc.).
5. Based upon the extensive research presented in this document, learn that the choices for End of Life Care vary significantly, depending upon the specific type of life-threatening illness or circumstance -- such as the prevalent desire of those with HIV/AIDS to limit or rule out medical interventions to prolong life, vs. the preference of those with a different illness or life threatening situation to extend life through direct medical intervention.
6. Learn a five-part, research-supported PROCESS for structuring discussions about End of Life preferences, which inherently supports our ETHICAL RESPONSIBILITY for assuring the welfare and legal rights of the client.
This publication is dated 2003. However, the AHRQ considers this document to be nevertheless highly relevant to the subject at hand, when compared to other documents available within their research library and available elsewhere on the internet. This article is listed 3rd on the list of 261 AHRQ publications on this topic when most recently reviewed.
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