Continuity of Care: Emotional and Ethical Issues in End of Life Treatment – Test

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Please describe briefly how you would respond to these situations if you are a private practice therapist. If you work with clients in a hospital setting, describe how the client's situation (as below) might impact the treatment once they are in your care.

1. You have seen a client previously in therapy and she calls to make an appointment. When you meet, she tells you that she has been diagnosed with breast cancer. You continue to work together throughout her treatment. She is well enough even during chemo to come to your office. She then experiences a period of remission and continues to work with you. The diagnosis and cancer experience has inspired her to make some changes in her life. She tells you, "life is short, I have to make it what I want it to be." Over the next few years, you meet regularly. She is able to pay because she has a good job with benefits and the policy covers a portion of your fees. The work is very productive and the client makes tremendous progress in many areas of her life. Then she comes in and tells you the cancer has returned. You meet more often for a few weeks as she deals with her fear and the crisis of the new diagnosis. After a few months, she becomes so ill she can't come to your office. She then has to go on permanent disability and so has a severely reduced income. How do you handle this?

2. A colleague retires and sends you a client, asking that you charge the fee she was previously charged, lower than your usual fee, and you agree. The client suffers daily migraines as a result of a brain cancer she experienced in her early twenties. She also suffers from severe depression, partially but not completely a result of her very poor health. Because of the migraines, you relax your 24 hour notice policy, agreeing to reschedule in the same week if she is unable to come to your office on a given day. Going forward, it becomes difficult to differentiate her absences due to her physical condition from her absences due to depression. You believe that the best strategy for the illness is for her to stay home when she feels too ill and the best strategy for the depression is for her to commit to come to the office. How do you handle this?

3. You have a client who is near the end of her life. Her husband, with whom you have had no contact up to this point, calls and asks if you can come to their house, where she is bedridden, and help them talk through how to care for her in her final months. He also requests that you help them talk with their children, ages 3 and 6, about the impending loss. What do you do?

4. You have been working with a client in her home due to illness. She's been able to meet in her living room, and has chosen to meet with everyone out of the house. She is now too sick to get out of bed and asks you to sit on her bed with her when you meet. She is also unable to be alone so there is always a member of her support community in the house. Is this problematic for you?