In the Public Interest

"Heavy lifting" is a term often used to characterize the hard work in a job, career or profession. In psychology, the term could define work in a number of areas such as jails, prisons, homelessness, addictions, etc. Psychologists who work among the most marginalized people are indeed engaging in "heavy lifting"--work that could also be characterized as having limited personal or professional satisfaction, but work that, nonetheless, must be done.

APA's burgeoning work on end-of-life issues

When the U.S. Supreme Court agreed to accept cases in which it was argued that individuals had a constitutional right to be assisted in dying or hastening their deaths, APA attempted to learn from our members how psychologists could appropriately become involved in such end-of-life situations. In 1997, APA's Rhea K. Farberman and I met with psychologists knowledgeable about these issues and she developed a public information brochure "Terminal Illness and Hastened Death Requests: The Important Role of the Mental Health Professional," which was later developed into an article published in Professional Psychology. The Supreme Court subsequently ruled that there was no constitutionally guaranteed right to hastened death, but that individual states were free to legislate in this area. As of this time only Oregon has done so.

Meanwhile, the Council of Representatives, urged by Dr. Mae Billet-Ziskin and with support of APA Past President Dr. Norman Abeles, created a working group to develop a report offering guidance to psychologists on issues related to end of life and assisted suicide. Drs. Silvia Canetto, Dolores Gallagher-Thompson, Judith Gordon (Chair), Therese Rando, Judith Stillion and James Werth were appointed to the work group in 1998 by the Board for the Advancement of Psychology in the Public Interest. Dr. David Clark was also appointed but was able to attend only the first meeting. About 40 other persons served as advisors. Dr. John Anderson, director of APA's AIDS office, served as the project's staff director.

Specifically, the working group was asked to look at psychology's role, if any, in end-of-life issues and assisted suicide, to suggest ways to make psychology more visible and recommend policy to APA on these matters. APA's council accepted the report last August. (It appears on APA's Web site: Now, policy resolutions on both assisted suicide and end-of-life decisions are being processed through APA's governance structure and should be voted on early in 2001.

Where are the psychologists?

Perhaps most intriguing about the report is the relative invisibility of psychology. As mentioned above, work in end-of-life situations and proximity to death and dying is probably well within the "heavy-lifting" category for psychologists, whether they are in education, research or practice.

The report highlights psychology's relative invisibility in end-of-life activities, but points out the profession's absolute absence on issues of assisted suicide or hastening death. In a search of the Uncover database with nearly 9 million articles, it is reported that 152 were found that addressed assisted suicide. None was in APA journals. The topic of end-of-life fared somewhat better based on a review of convention programming and continuing-education workshops, but neither dying nor end-of-life are mentioned in official documents such as APA's accreditation guidelines or Code of Ethics.

While these issues are not on APA's radar screen, they are being dealt with in other organizations, such as the Association for Death Education and Counseling, to which some psychologists belong. Yet it's clear that psychologists are not agitating to be included among those who research, educate or practice in matters having to do with end-of-life decisions. Ironically, as the report notes, psychology practitioners possess the skills needed to counsel and support individuals, families and others involved in this endgame of life. And our researchers and educators possess the required methodological and communications skills, but have not yet decided to focus them on such life-and-death issues.

APA's Council of Representatives' acceptance of the working group's report is a first step in a long organizational journey into an arena where psychology's potential contribution is enormous. A second step will be the response of APA governance to the resolutions being circulated for review and comment. Should those resolutions become APA policy, it is likely that interest in end-of-life activities will increase as the membership becomes more involved. The heavy-lifting factor might doom these issues to consignment in our organizational limbo. Or the report could spur our profession to provide some needed light at the end of a long and dark tunnel. I'm betting on the latter.