Cognitive Therapy and the Dutch/Anglo Patient Clinical, Ethical and Legal Issues

Suicide and the patient's request for assistance in the state of Oregon are the main issues herein raised. The health issue is that the patient is alone and suffering from Parkinson's which will only further debilitate him in the coming years. He has no interest in suffering through it. He appears to suffer from hopelessness, which can be clinically assessed as being the main cause for suicide ideation (Beck, Kovacs, Weissman, 1975, p. 1146).

Deal with Patients Presenting with Issues of Suicide

Cognitive therapy (CT) or cognitive behavior therapy (CBT) as it is also called would be useful in dealing with the patient's presenting issues of suicide because "a substantial body of research supports" this model's application "to be effective in reducing symptoms and relapse rates" in cases of depression (Beck, 2005, p. 953). The patient in this case suffers from hopelessness, which is related to depression, and thus CT could be a beneficial treatment mode. CT allows the patient to focus on actions in one's life that can be changed in order to affect a different, more positive outlook and reinforce a more stable disposition.

During the cognitive therapy sessions, the therapist would be able to use my "congruent" traits to help the patient deal positively and effectively with his "incongruence" (McNeil, 2013, p. 8). The whole thus helps the fractured and fragmented to put the pieces more in order. Becks's "empirically validated treatments" using cognitive therapy in this case would thus be instrumental because of the depressive/hopelessness core that the patient is experiencing (Jones, Lyddon, 2000, p. 342). Likewise there is the study by Asamsama, Dickstein, and Chard (2015) that shows how cognitive therapy is a good approach to dealing with serious issues of depression and why it can be a beneficial treatment modality because of its focus on altering client behavioral patterns and the use of the Beck Depression Inventory-II model.

Deal with this Client's Problem

The therapist would deal with this client by instructing him that in Oregon it is illegal to assist in one's suicide and that it is only legal to assist in terminally ill cases. This is what is known as a dying law. In this patient's case, because it is not strictly a terminally ill case, though it might become that in the next few years, it is unlawful to assist him in the proposed suicide. What is needed to deal with this client is cognitive therapy which can re-orient the patient to better ways of thinking about his situation and how he can overcome the loneliness and isolation he feels. This CT approach would focus on "automatic thoughts and core beliefs" within the patient and this would be isolated and shown as to why they need to be dealt with more effectively (Berk, Henriques, Warman, Brown, Beck, 2004, p. 265).

The therapist would also adhere to the Ethical Code of Conduct of the American Psychological Association and offer fidelity and responsibility to the client as well as integrity (APA, 2010). So if after some discussion of the impact of the law on the patient's case and the patient still requested suicide, the therapist would alert the responsible authority in this case so that this information is known. After all, as Sasso, Strunk and Braun (2015) have shown, "therapist adherence is differentially related to outcome among depressed patients" (p. 976). Likewise, using the cognitive therapy approach would be helpful because it has been shown that it "lowers patients' risk for engaging in a future suicidal act by helping them to recognize the warning signs when they are in crisis and to use cognitive and behavioral coping strategies" to overcome the suicidal ideation (Wenzel, Beck, 2008, p. 198).

Consideration of Client has the Right to Kill Himself

The patient does not have the right to kill himself under these circumstances according to Oregon state law, which has a dying law that does not strictly apply to the patient as he is not terminally ill. While there is a likelihood of his reaching such a terminally ill state in the future, at the moment it is not the case. Therefore, the therapist would caution the patient that what he is suggesting is unlawful. This would be the first phase of the CT treatment. The second would be to focus on types of thinking that could be used to avert these suicidal thoughts. This approach would also be ethical because the therapist has the "moral principle of beneficence" which "compels psychologists to act to protect patients who threaten themselves" (Knapp, VandeCreek, 2006, p. 129).

Laws in Jurisdiction or Physician-Assisted Suicide

In...

If the patient wished to travel to the Netherlands then he would be able to find a physician who could lawfully assist him in his suicide as assisted suicide is legal there.
Netherlands Law

The laws are that way in the Netherlands because of the cultural significance of that nation and its reflection in the laws that govern that society. In America, there are no assisted suicide laws (it is illegal), only assisted dying laws (in which case the patient must be terminally ill) (Buiting, Deiden et al., 2009).

Decision of Contacting Client's Relatives

Researcher/therapist would not personally contact his relatives or friends regarding his decision, at least not before discussing the matter with him. As he is calm and rational in his demeanor and outlook, it is most respectful to give him the courtesy of not informing on him to others, because they may not even have a beneficial or positive impact on him and his situation. The best course is to proceed with CT and address the thinking and actions affecting his current outlook and set about repairing those and instilling in him a course that gives a more positive and hopeful outlook. However, to avoid being sued for malpractice, the therapist would discuss the case with authorities and supervisors in order to know the best way forward in order to protect all involved (Packman, Andalibian, Eudy, Howard, Bongar, 2009, p. 405).

Feelings Reflect Values

The researcher's beliefs regarding suicide are that it is morally wrong, because life is given to individuals by God and God determines when that should end; for the person to determine that is to assume too much authority. Researcher/therapist sympathizes and empathizes with the patient, especially as he is lonely and does not want to suffer through this burden. However, the researcher believes there is a meritorious effect of accepting that which is given us and so this could be used for a positive impact in the patient's case. It would be something that we could discuss over the course of cognitive therapy.

Theoretical Approach to the Treatment

Research/therapist would be open and honest with the patient throughout the course of cognitive therapy but researcher/therapist would not force views upon him. Instead, it would be a case of let's see what works better for the patient. What if we give these thoughts, ideas or notions some consideration and see how that impacts your feelings and life?

Patient's Feelings and Ideas

That is the CT approach, where there is guidance. Research/therapist could, of course, use my own personal beliefs to support him in this approach if he so desired and the therapist could draw upon those resources to assist in the transformation.

Essentially, in order to avert the willingness to commit suicide, it might be necessary to discuss with the patient some of the reasons in which suffering (as he surely will be suffering in the coming years) can be viewed as meritorious. This would, of course, involve a religious dynamic to the discussion and this could possibly be a sensitive issue depending upon the patient's past history or religious/cultural beliefs (Rajaei, 2010). Aside from this dimension, there is every reason to be sympathetic towards the patient's decision. It is a rational choice, but depending upon whether or not there is an alternate way of viewing the situation, in terms of the religious-cultural dynamic, it may happen that the coming years present an opportunity for spiritual growth rather than an obstacle in physical capability and development. The cognitive therapy approach would give a basis for this understanding to be legitimately formed in patient's life and would also for the possibility of this option being explored substantially so as to give a better reason for avoiding suicide as a rational response to the onset of Parkinson's -- especially if it opens up a caring community to the patient as a result. In this way, a cognitive therapy treatment that focuses on developing a community rapport by enhancing the patient's spritiual/religious life could be a significant foothold in combating the loneliness and hopelessness that he feels.