What Their Terms of Living and Dying Might Be: Hospice Social Workers Discuss Oregon's Death with Dignity Act

Abstract

This article presents data from a qualitative study of nine social work hospice practitioners and experts as they discuss Oregon's Death with Dignity Act. Three themes emerged from the analysis: (a) values regarding physician-assisted death; (b) agency policies about the option; and (c) the role of hospice social workers with physician-assisted death. Three states now allow terminally ill persons to obtain a lethal prescription if criteria are met. Two other states are actively considering and may pass similar legislation over time. Hospice social work practitioners work with patients and families as they consider this option and their voices reflect the complexities and nuances of these interactions.

Implementation of Medical Assistance in Dying: A Scoping Review of Health Care Providers' Perspectives

“…Sixtyseven percent of the articles (22/33) described health care professionals' roles of providing consultation and support to patients about MAiD. This role was discussed in all 10 articles examining nurses' perspectives, 14e23 six articles discussing physicians' perspectives, 13,24e28 three articles discussing mental health providers' perspectives, 29e31 three articles discussing social workers' perspectives, 19,33,34 and one of four articles describing pharmacists' perspectives. 32 Generally, this role explored health care providers' responsibility for communicating information about the full range of end-of-life options to patients, alongside additional resources and information about MAiD for those interested in pursuing this alternative.…”

“…Six articles explicitly acknowledged the role of mental health providers as key resources for other practitioners to aid in competency evaluations. 29,30,35e38 Two articles discussed the role of hospice social workers in supporting physician decisions about MAiD in the context of Oregon's Death with Dignity Act in the U.S. 19,33 Only one article by Hughes acknowledged the role of the pharmacist in supporting physician decisions, who may be consulted to confirm lethal drug dosages/to dispense these drugs. 32 Administering the Lethal Drugs.…”

“…43,44 Three articles, two from nurses' perspectives 16,23 and one exploring mental health providers, 31 discussed health care professionals' roles in providing aftercare and support to bereaved family members of patients. Two articles, one discussing psychologists' perspectives 30 and one discussing social workers' views, 33 considered the importance of health care professionals as policy advocates for MAiD legislation, in addition to the development of public, institutional, and organizational policies. One article explicitly explored psychologists as researchers on the clinical efficacy of current models for MAiD, in addition to equity issues, such as whether assisted suicide is a function of gender, ethnicity, sexual orientation, disability status, age, education, income, and religion.…”

“…Absence of Clear Professional and/or Legal Guidelines and Role Ambiguity. Seventy-six percent (25/33) of articles discussed the absence of clear professional and/or legal guidelines framing MAiD, which traversed the nursing, 14e23 physician, 24e26,43,44 mental health, 30,31,35,36 pharmacy, 32,39e41 and social work 19,33,34 professions. The consequence of this absence was role ambiguity, whereby 42% (14/33) of articles discussed how their profession lacked clarity and consistency in practice.…”

Dutch Healthcare Professionals Experiences of Assisted Dying: A Constructivist Qualitative Study Conducted in a Chronic Disease Care Centre and Hospice.

“…Families were assessed by a social worker if one was available (Site A). Comprehensive knowledge of the role undertaken by social workers in assisted dying has been reported as lacking (30). However, in this study, the social worker was clear about the scope and boundaries of her role.…”