Social Work Speaks Abstracts

Client Self-Determination in End-of-Life Decisions

NASW does not take a position concerning the morality of end-of-life decisions but affirms the right of the individual to determine the level of his or her care. Social workers should be free to participate or not in assisted-suicide matters or other discussions concerning end-of-life decisions depending on their own beliefs, attitudes, and value systems. However, it is inappropriate for social workers to deliver, supply, or personally participate in the commission of an act of assisted suicide while in their professional role. At the same time, if a social worker is unable to help with decisions about assisted suicide or other end-of-life choices, he or she has a professional obligation to refer patients and their families to other competent professionals. The appropriate role of social workers in end-of-life matters is to help patients express their thoughts and feelings, to facilitate exploration of alternatives, to provide information to make informed choices, and to deal with grief and loss. Options include, but are not limited to, pain management, counseling, hospice care, nursing home placement, and advance health care directives. In working with clients on end-of-life decisions, social workers also must recognize the factors that affect people’s ability to choose among viable alternatives, including rationing of health care based on socioeconomic status and policies of both the government and providers.