be counted on as the end nears. This can sometimes be indirectly demonstrated by the client who
may test the counselor's tolerance of anger; if the anger can be tolerated, perhaps the counselor
can be trusted to tolerate the client's death and feelings of fear.
Bargaining
Bargaining is the stage at which the individual commits to an uncommonly generous or
humanitarian act with the belief that she will be spared or miraculously cured if deemed "good
enough." The goal is a miraculous correction of the wrongs she has done, or possibly to buy
some valuable time for treatment or dealing with end-of-life issues. The obvious danger is that
most are not "cured" in that sense of the word, so what can happen is a loss of belief or faith.
Depression
Depression represents a loss of denial, and an acknowledgment that the information is accurate
and the situation and its consequences are unavoidable. As with clinical depression, the depth
and severity depends on the specifics of the situation, mitigating factors, available resources, and
the individual. This stage is marked by surrender to sadness; it is appropriate and adaptive. It is a
time to collect resources and energies so that more processing can occur at a later time.
Acceptance
This is the stage in which some come to terms with their situation and feel a welcomed release
from struggle and strife. Option formation and reality-based planning, given the circumstances,
become the focus. Acceptance occurs when there is agreement between the physical body, the
emotional heart, and the cognitive mind, that death will eventually be the outcome.
No code or do-not-resuscitate orders
The responsibilities for determining when, how, and under what circumstances to evoke or effect
no code or do-not-resuscitate (DNR) orders are properly the role of the family, or those with
power of attorney, and the physician. The order itself comes from the physician or from the
client through the physician. Although alcohol and drug counselors do not initiate discussion of
this topic, they should be aware of these terms and what they mean so that they can help prepare
and inform the client and his family of these options.
No code and DNR are terms used while a client is receiving care at an inpatient facility to
identify a client who does not wish to receive medical intervention to save his life. For example,
if a client has a DNR order and his heart stopped, he would not receive electric shock or
cardiopulmonary resuscitation. It is the framing of these decisions and the terms used to help
clients understand them that make all the difference. A counselor can help clients and their
families talk about these concerns by first normalizing the process. That is, to present issues as
no codes or DNRs, wills, and guardianship of minor children as decisions each person or family
must come to grips with--whether they are ill or not, HIV positive or not. Counselors can
approach and begin to discuss these issues within a context of "hoping for the best and planning
for the worst." The discussion, then, is not related to being terminally ill, but rather to choosing,
