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.

The duty to protect a client identified as “suicidal” has been clearly established in the mental health literature. We propose that (a) the duty to protect should apply whenever a client is engaging in a behavior that may lead to serious self-harm or death within a reasonably short period of time and (b) the best method of meeting the duty to protect is to assess for impaired judgment and then fashion appropriate interventions depending on the result of this evaluation. If implemented, this proposal has significant implications for conduct when working with clients making end-of-life decisions: a mental health professional would have an initial duty to protect, through conducting a thorough assessment, with every individual who is making a decision that may affect the manner and timing of death and this duty would be in effect until a determination is made that the person's judgment is not impaired. This would eliminate basing the determination of whether a client's behavior engenders the duty to protect on the counselor's perception of the intent and motivation of the client or the counselor's values, while also providing a mechanism by which people can follow through with end-of-life decisions. Guidelines for the determination of whether the duty applies and an outline of an assessment protocol are provided. [ABSTRACT FROM AUTHOR]