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Human Services


Barbara Benoliel


Hospice social workers are in an ethical conundrum due to the contrast between honoring clients’ self-determined life closure and hospice organization prescribed non-participation in requests for physician-assisted death. The National Hospice and Palliative Care Association and the International Hospice and Palliative Care Association have issued position statements that the hospice philosophy of care is to provide comfort and reduce suffering, not to hasten death. Social workers are bound by a code of ethics to honor patient choice in end-of-life decisions. This generic qualitative study gives voice to hospice social workers in the Pacific Northwest regarding their motivations and responses to such patient requests considering the organizational policy of non-participation in physician-assisted death. The research was guided by self-determination theory of intrinsic and extrinsic motivators of behavior and decision making. Through one-on-one semi-structured interviews, data were collected from 10 hospice social workers who have received patient requests for physician-assisted death. Data were analyzed through content analysis by coding and categorizing using an inductive approach. Findings indicate that hospice social workers are unclear about organizational policy regarding non-participation and how much support they can offer patients. Social workers also reported feeling lack of education regarding Death with Dignity legislation and how their organization supports them following patient completion of the process. This study can impact social change by raising awareness of the ethical conundrum placed on hospices regarding patient choice at the end of life.

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