open access
메뉴
open access
메뉴
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.
구인회 (2004). 현대인에게 있어 죽음의 의미와 그 도덕적 문제. 철학탐구, 16, 59-81.
국립암센터 (2008). 품위 있는 죽음에 대한 대국민 인식 조사. 국립암센터 보도자료.
김교빈 (2006). 죽음에 대한 유교의 이해: 죽음을 두려워 않는 낙천적 세계관. 철학연구, 75, 1-19.
김학태 (2009). 무의미한 생명연장치료 중단에 관한 법 윤리적 고찰. 외법논집, 33(1), 311-338.
노동일 (2009). 치료 거부권, 죽을 권리 및 존엄사에 대한 재검토: 헌법적 관점에서. 公法學硏究, 10(2), 3-29.
서영석, 최영희, 이소연 (2009). 상담에서의 윤리적 의사결정모델 개관. 한국심리학회지: 상담 및 심리치료, 21(4), 815-842.
손명세 (2009). 삶의 마감방식의 결정에 대한 한국의 과제. 대한의사협회지, 52(8), 734- 737.
신동일 (2009). 사전진료지시서: 법 이론과 현실. 안암법학, 28, 229-254.
이종원 (2007). 안락사의 윤리적 문제. 철학탐구, 21, 155-187.
정재영 (2008). 자살에 대한 개신교인의 인식과 교회의 책임. 신학과 실천, 16, 35-61.
조동일 (1993). 죽음과 질병에 대한 전통사상의 견해. 이화여대 간호과학연구소 발행 단행본(3): 1993년 간호대학 학술심포지움, 7-12.
최준식 (2006). 종교학적 관점에서 보는 생명과 인간의 의미, 죽음연구, 2, 47-57.
한국상담심리학회 상담전문가 윤리강령 (2004). 1.나.(1).
Abeles, N., & Barlev, A. (1999). End of life decisions and assisted suicide. Professional Psychology: Research and Practice, 30(3), 229- 234.
Albright, D. E., & Hazler, R. J. (1995). A right to die? Counseling & Values, 39(3), 177-190.
American Counseling Association. (2005). Code of ethics. Alexandria, VA: Author.
American Psychological Association Working Group on Assisted Suicide and End-of-life Decisions (2000), Report to the board of directors of the American Psychological Association. Retrieved September 16, 2009, from http://www.apa.org/ pi/aseolf.html
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics (5th ed). Oxford, England: Oxford University Press.
Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed). Oxford, England: Oxford University Press.
Berger, J. T. (1998). Culture and ethnicity in clinical care. Archives of Internal Medicine, 158(19), 2085-2090.
Blevins, D., & Papadatou, D. (2006). The effects of culture in end-of-life situations. In Werth, J. L. Jr. & Blevins, D. (Eds.). Psychosocial issues near the end of life: A resource for professional care providers (pp.27-55). Washington, DC: American Psychological Association.
Block, S. D. (2000). Assessing and managing depression in the terminally ill patient. Annals of Internal Medicine, 132(3), 209-218.
Candib, L. M. (1995). Medicine and the family: A feminist perspective. New York: Basic Books.
Candib, L. M. (2002). Truth telling and advance planning at the end of life: Problems with autonomy in a multicultural world. Families, Systems, & Health, 20(3), 213-228.
Cooke, M., Gourlay, L., Collette, L., Boccellari, A., Chesney, M. A., & Folkman, S. (1998). Informal caregivers and the intention to hasten AIDS-related death. Archives of Internal Medicine, 158(1), 69-75.
Corey, G., Corey, M. S., & Callanan, P. (2007). Issues and ethics in the helping professions. (7th Ed.). Belmont: Thompson Brooks/Cole. 서경현, 정성진 역(2008). 상담 및 심리치료 윤리. 서울: 시그마프레스.
Cottone, R. R., & Claus, R. E. (2000). Ethical decision-making models: A review of the literature. Journal of Counseling & Development, 78(3), 275-283.
Crawford, R. (1999). Counseling a client whose family member is planning a suicide. The Family Journal, 7, 165-169.
Dowbiggin, I. (2005), A concise history of euthanasia: Life, death, god and medicine. Lanham, MD: Rowman & Littlefeld Publishers, Inc. 신윤경 역 (2007). 안락사의 역사. 경기: 섬돌.
Duba, J. D., & Magenta, M. (2008). End-of-life decision making: A preliminary outline for preparing counselors to work with terminally ill individuals. The Family Journal, 16(4), 384- 390.
Faiver, C. M., & O'Brien, E. M. (2004). Spirituality and counseling. American Journal of Pastoral Counseling, 7(4), 25-49.
Farberman, R. K. (1997). Terminal illness and hastened death requests: the important role of the mental health professional. Professional Psychology: Research and Practice, 28(6), 544- 547.
Farrugia, D. (1993). Exploring the counselor's role in “right to die” decisions. Counseling and Values, 37(2), 61-71.
Fitting, M. D. (1986). Ethical dilemmas in counseling elderly adults. Journal of Counseling and Development, 64, 325-327.
Fulbrook, P. (1994). Assessing mental competence of patients and relatives. Journal of Advanced Nursing, 20, 457-461.
Gallagher-Thompson, D., & Osgood, N. J. (1997). Suicide in the later. Behavior Therapy, 28, 23-41.
Garcia, J. G., Cartwright, B., Winston, S. M., & Borzuchowska, B. (2003). A transcultural integrative model for ethical decision making in counseling. Journal of Counseling and Development, 81, 268-277.
Garrow, S., & Walker, J. A. (2001). Existential group therapy and death anxiety. Adultspan, 3(2), 77-87.
Gunderson, M. (2004). A Kantian view of suicide and end-of-life treatment. Journal of social philosophy, 35(2), 277-287.
Herlihy, B., & Watson, Z. E. (2004). Ethical issues in assisted suicide. In D. Capuzzi(Ed.), Suicide across the life span (pp.163-184). Alexandria, VA: American Counseling Association.
Hewitt, J. L., & Edwards, S. D. (2006), Moral perspectives on the prevention of suicide in mental health settings. Journal of Psychiatric & Mental Health Nursing, 13(6), 665-672.
Hill, M. R., & Mamalakis, P. M. (2001). Family therapists and religious communities: Negotiating dual relationships. Family Relations, 50(3), 199-208.
Hill, T. P., & Shirley, D. (1992). A good death: Taking more control at the end of your life. New York: Addison-Wesley.
Joiner, T., Kalafat, J., Draper, J., Stokes, H., Knudson, M., Berman, A. L., & McKeon, R. (2007). Establishing standards for the assessment of suicide risk among callers to the National Suicide Prevention Lifeline. Suicide & Life-Threatening Behavior, 37(3), 353-365.
Kitchener, K. S. (1984). Intuition, critical evaluation and ethical principles: The foundation for ethical decisions in counseling psychology. The Counseling Psychologist, 12(3), 43-55.
Kleespies, P. M. (2004). Life and death decisions: Psychological and ethical considerations in end of life care. Washington, DC: American Psychological Association.
Manis, A. A., & Bodenhorn, N. (2006). Preparation for counseling adults with terminal illness: personal and professional parallels. Counseling and Values, 50(3), 197-208.
Mishara, B. L. & Weisstub, D. N. (2005). Ethical and legal issues in suicide research. International Journal of Law and Psychiatry, 28, 23-41.
Neimeyer, R., A. (2000). Suicide and hastened death: Toward a training agenda for counseling psychology. The Counseling Psychologist, 28(4), 551-560.
Rawls, J. (1999) A theory of justice. Cambridge, MA: Harvard University Press. 황경식 역 (2003). 정의론. 서울: 이학사.
Rich, K. L., & Butt, J. B. (2004). Rational suicide: uncertain moral ground. Journal of Advanced Nursing, 46(3), 270-283.
Rogers, J. R., Gueulette, C. M., Abbey, H. J., Carney J. V., & Werth, J. L. (2001). Rational suicide: An empirical investigation of counselor attitudes. Journal of Counseling and Development, 79, 365-372.
Rosenfeld, B. (2006). Assisted suicide and the right to die: The interface of social science, public policy, and medical ethics. Washington, DC: American Psychological Association.
Schwiebert, V. S., Myers, J. E., & Dice, C. (2000). Ethical guidelines for counselors working with older people. Journal of Counseling and Development, 78, 123-129.
Siegel, K. (1986). Psychosocial aspects of rational suicide. American Journal of Psychotherapy, 40(3), 405-418.
Szasz, T. (1986). The case against suicide prevention. American Psychologist, 41(7), 806- 812.
Tarvydas, V. M. (1998). Ethical decision making processes. In R. P. Cottone & V. M. Tarvydas (Eds.), Ethical and professional issues in counseling (pp.144-155). Upper Saddle River, NJ: Prentice-Hall.
Tarvydas, V. M. (2004). Ethics. In T. F. Riggar & D. R. Maki (Eds.), Handbook of rehabilitation counseling (pp.108-141). New York: Springer.
Tarvydas, V. M., & Cottone, R. R. (1991). Ethical responses to legislative, organizational and economic dynamics: A four-level model of ethical practice. Journal of Applied Rehabilitation Counseling, 22(4), 11-18.
Tjeltveit, A. C. (2006). Psychotherapy goals and outcomes, the good life, and the principle of beneficence. Psychotherapy: Theory, Research, Practice, Training, 43(2), 186-200.
Walker, D. F., Gorsuch, R. L., Tan, S. Y., & Otis, K. E. (2008). Use of religious and spiritual interventions by trainees in APA- accredited Christian clinical psychology programs. Mental Health, Religion & Culture, 11(6), 623-633.
Welfel, E. R. (2006). Ethics in counseling & psychotherapy: Standards, research & emerging issues (3rd ed.). Belmont, CA, USA: Thomson, Brooks/Cole.
Werth, J. L. Jr. (1996). Rational suicide? Implications for mental health professionals. Washington, DC: Taylor & Francis.
Werth, J. L. Jr. (1999). Mental health professionals and assisted death: Perceived ethical obligations and proposed guidelines for practice. Ethics and Behavior, 9(2), 159-183.
Werth, J. L. Jr., Blevins, D., Toussaint, K. L., & Durham, M. R. (2009). The influence of cultural diversity on end-of-life care and decisions. American Behavioral Scientist, 46(2), 204-219.
Werth, J. L. Jr., & Crow, L. (2009). End-of-life care: An overview for professional counselors. Journal of Counseling and Development, 87, 194- 203.
Werth, J. L., Jr., Gordon, J. R., & Johnson, R. R. Jr. (2002). Psychological issues near the end of life. Aging and Mental Health, 6(4), 402- 412.
Werth, J., L. Jr., & Holdwick, D., J., Jr. (2000). A primer on rational suicide and other forms of hastened death. The Counseling Psychologist, 28(4), 511-539.
Werth, J. L. Jr., & Rogers, J. R. (2005). Assessing for impaired judgment as a means of meeting the “duty to protect” when a client is a potential harm-to-self: Implications for clients making end-of-life decisions. Mortality, 10(1), 7-21.
Yalom, I. D. (1998). Existential psychotherapy. In B. Yalom (Ed.), The Yalom reader: Selections from the work of a master therapist and storyteller (pp.167-265). New York: Basic Books.
