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This article reviews legal and ethical considerations that mental health professionals will want to consider when being involved with people who are considering end-of-life care options and making end-of-life decisions. The author discusses legal issues (case law and state statutes), ethical issues (professional codes of ethics, ethical metaprinciples, cultural considerations, and ethical decision-making models), and standards of care (attitudes of mental health professionals, positions of large national mental health professional associations, and acceptable actions in end-of-life situations) related to end-of-life care and decision making.

This article contains the full transcript of an interview with a woman shortly before her death. Although details (e.g., where her children reside) have been altered to protect the identity of the interviewee, the main points in her responses have not been changed. The authors hope that the transcript will be used by others in educational efforts, to develop other research projects, and to improve the care provided to people who are dying and their loved ones.

End-of-life public policy has the potential to affect everyone. The purpose of this article is to provide an overview of recent significant policy activity. The authors begin by reviewing the Medicare and Medicaid hospice benefit and the Patient Self-Determination Act, highlighting state-level developments, and noting significant court cases. They then discuss common concerns with Medicare, advance directives, hospice, and pain management and provide proposed remedies for the concerns. The article ends with recommendations for advocacy by behavioral and social science professionals.

The heath care system in the United States is based on specific cultural beliefs that are sometimes inappropriate with groups that have different belief systems. These cultural differences can be seen in various end-of-life situations. To familiarize providers with some of the ways that culture can influence end-of-life care and decisions, the authors focus on the following three individual characteristics shown to be important in the literature: age, ethnicity, and gender. The article contains a broad overview of the (a) documented differences in the cultural interpretations of the ethical meta principles (e.g., autonomy and respect), (b) provision of medical service in general and pain management in particular to different groups, and (c) attitudes toward various end-of-life interventions and the use of advance directives. Finally, the authors summarize guidelines for making end-of-life care more culturally sensitive, which emphasize that each person must be interacted with as a unique individual.