taking control, and making difficult, responsible decisions.
It also is helpful for the client or the family to discuss with the physician changing the goal of
medical treatment. For example, at some point in the treatment process, when death is imminent
and further aggressive medical intervention will be futile, the goal of treatment could be changed
to "comfort care" from "no code."
Some States also permit a person who has been discharged from a hospital to home to have a
DNR, which can be tacked to the door. The drawback of home DNRs is when a client dies and
emergency medical personnel arrive, in most places they are required to try to revive the client.
A counselor should be familiar with State laws about home DNRs so that a client who wants to
die at home can be given the best information about this option.
Health care providers and counselors must maintain a sense of how their communication efforts
are affecting the people they are trying to help. A specific and practical example of this is in
discussions around no code or DNR orders. As health care providers discuss treatment options
with clients and their significant others and the possibility of changing the goal of treatment t o
comfort care, one distinction that can be helpful for some people is the difference between "life
support" and "death prolonging."
The current standard of care as defined by the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) states that providers should develop a framework for decisionmaking in
situations that may require the withholding of resuscitative services or the foregoing or
withdrawing of life-sustaining treatment. Decisionmaking in such cases should reflect the
Enhancing the client's comfort and dignity by addressing treatment of primary and
secondary symptoms
Effectively managing pain
Responding to the client's and his family's psychosocial, spiritual, and cultural needs
Many believe that decisions about medical treatment should not be based on "heroic" or
"extraordinary" measures, or on medical complexity. They should be based on the potential
outcomes and the benefits and burdens to clients and their support systems. An open and honest
dialogue with the client, followed by a similar meeting with the entire care team, can facilitate
decisions and move people to a place of comfort and resolution. Many States allow an individual
to designate someone to serve as their "Durable Power of Attorney" for health care. Staff and
clients should know what the State's regulations are.
Assisting Clients in Preparing Their Children for the Loss of a Parent
It is estimated that the number of children orphaned by HIV/AIDS will increase by 200 percent
in the next 20 years. Parents living with HIV/AIDS face a multitude of issues in preparing both
seropositive and seronegative children for the loss of their parents. Fortunately, the child care
system is developing credible guidelines on working with children with parents living with
HIV/AIDS. In addition, placing a focus on providing for the future care and maintenance of the
