최근 존엄사 관련 사건들이 사회적으로 이슈화되면서, 이성적 자살을 비롯한 삶의 마지막에 관한 결정이 의료계뿐만 아니라 정신건강전문가들이 다루어야 할 당면 과제가 되고 있다. 이성적 자살을 포함한 삶의 마지막과 관련된 결정을 상담할 때, 상담자는 윤리적 원칙들이 충돌하는 윤리적 딜레마를 경험하게 된다. 본 연구에서는 이성적 자살 등 삶의 마지막에 대한 결정과 관련이 있는 종교 및 철학적 입장, 윤리적 원칙, 법과 윤리규정, 사회문화적 맥락, 내담자 개인 특성 등을 탐색하였다. 이 때 상담자가 각 측면을 고려하면서 수행할 수 있는 역할을 성찰자, 분석가, 실행자, 탐색가, 평가자로 구분하여 제시하였다. 또한 본 연구에서는 지금까지 상담 분야에서 제기되어온 윤리적 의사결정모델들을 참고하여, 이성적 자살 등 삶의 마지막을 결정하는 과정에서 상담자가 활용할 수 있는 통합적인 윤리적 의사결정모델을 제안하였다. 본 연구에서 제안한 윤리적 의사결정모델은 상담자가 고려해야할 측면과 역할을 포함하고 있고, 의사결정과정을 비판적-평가적 차원과 직관적 차원을 통합적으로 고려하면서 반성적 평형 상태를 이루어가는 과정으로 개념화하고 있다.
Counselors are likely to face an ethical dilemma when their clients present issues with regard to end-of-life decisions. The present study discussed philosophical and religious standpoints, ethical principles, legal and ethical issues, sociocultural contexts, and client's individual characteristics that counselors need to consider in dealing with client's end-of-life decisions. Then, it was proposed that counselors take on roles of an existential thinker, analyzer, implementer, explorer, and evaluator to consider corresponding aspects. Also, on the basis of the extant ethical decision-making models, the present study proposed an ethical decision-making model that counselor may use in counseling those presenting issues in end-of-life decisions. The model includes the five aspects to consider and counselor roles to take. The model also conceptualizes the decision-making process as the one in which counselors strive to achieve reflective equilibrium by considering both critical and intuitive domains.
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