Could you (and should you) coach someone who wants to die?

This question arose out of a 2015 ruling in the Pretoria High Court granting  Robin Stransham-Ford the right to commit medically assisted suicide.

Facing a Grim End
Let me paint a scenario. You have a new client who has been diagnosed with a terminal illness. What’s more, if the illness were to run its course, the end would not be pretty. She would die slowly and in pain, there is the possibility of dementia, and it would be awful for her family to witness. She wishes to think through how to end her life, as well as figuring how to “finish her business“ with her friends and family.

Values Meets Law and Professional Ethics
This is both a values based dilemma and a criminal condundrum, so your guidance is going to come from the law of the land, your personal value system and the values of the professional body to which you have aligned yourself – in my case, COMENSA. The pertinent clauses in the COMENSA Code of Ethics are to be found in Section 3 of the Code, which relates to the COMENSA values;

• Accountability
• Inclusivity
• Integrity
• Professional competence

Ethics Toolkit
The Ethics Toolkit (available to members on the COMENSA website) gives us a method of considering any ethical dilemma:

Step 1    Apply objective analysis

Once you have recognised that an ethical issue exists, gather all of the relevant information together and evaluate all of the possible options that are open to you.  You may need to bypass your personal biases during this step in order to get to a comprehensive list of options. Get all the options down and don’t censor them.

How do you feel about a terminally ill person’s right to die a dignified death rather than a horrible death by natural causes? If you are against it, could you nevertheless assist someone who desires to choose the manner and timing of her own passing? To whom are you primarily accountable? Who else?

Step 2    Consider the consequences

Consider the positive and negative consequences associated with each of your options.  Separate facts from assumptions.

• Are your sources of information credible? How would you know that you have been told the truth? Do you need a medical opinion from your client’s medical practitioner?
• Who are the stakeholders and who would carry the possible burdens and risks? How do they feel about the choice your client wishes to make? Does your client have the support of her family? All of them? If not, do her most trusted loved ones support her, at least?
• Who or what could be hurt? What might your role be with them?
• Who or what could benefit, and in what way?
• How significant would the benefits and/or damages be? What about any reputational damage to you should your participation become common knowledge.
• What are the implications over time?
• How do you feel now, and how might you feel after the deed has been done?
• It remains illegal to help someone to die. Are you prepared to put yourself at risk of criminal prosecution, or not? If not, might you refer to another coach?
• Do any of the options mean discarding ethical principles?

Step 3    Decide on the most appropriate course of action

Consider the following as you analyse and decide.

• How would the action measure up to your moral principles and values?
• What would the impact of your actions be on the greater good of your social, professional and ecological environment?
• If you rank your values, how can they be used as a measure to promote or subordinate your options?
• Will your actions involve treating others as you would expect to be treated?
• Would you be comfortable if your actions were a matter of public knowledge?

It is possible that you have considered the questions above on your own. However, at this stage you should discuss the dilemma and your thinking with your Coach Supervisor. This is not to be taken lightly, after all.

Step 4    Implement your decision and act with commitment

Once you have decided on the course of action that would maximise the benefits and minimise the damage, develop and follow a plan with your client, taking full responsibility for your decision.  Ensure that you are able to justify your choice and that you are comfortable with your reasoning. This will require a particularly high level of care in contracting with this client.

Step 5    Monitor, evaluate and modify

Monitor the effect of your decision, remain open for new information and evidence that may come forward and, if necessary, be prepared to revise your choice or take alternative action in the light of new knowledge.

Step 6    Learn from the experience

This is another step in the process that might be best done in supervision. What would you do differently if such a dilemma presented itself again in the future? Ensure that all the facts of the matter and the resultant decisions are recorded as a case study for future reference.

As coaches, we never know what our clients may need help with. My view is that it is our job to enable clients to live their best life – and, if needs be, their best death. But that’s me. What about you?

References:

The COMENSA Code of Ethics  

The COMENSA Ethics Toolkit for Coaches and Mentors

Contact me
If you are a coach and this topic is something you need to think about, email me at belinda@leadershipsolutions.co.za and let's set up some professional Supervision time.