Ethical Issues in the Social Worker's Role in Physician-Assisted Suicide

Manetta, Ameda A., Wells, Janice G., Health and Social Work

This article presents the results of an exploratory study of social workers' views on physician-assisted suicide (PAS), situations in which PAS would be favored, and whether there is a difference in education or training on mental health issues, ethics, or suicide between social workers who favor PAS and those who oppose PAS. A questionnaire was administered to a convenience sample of 66 social workers in South Carolina. The authors raise questions about the training in mental health issues, ethics, and suicide that social workers have received to prepare them to work with clients making this end-of-life decision. Implications for social work practice and suggestions for future research are presented.

Key words

end-of-life decisions

ethics

physician-assisted suicide

policy

social work education

Physician-assisted suicide (PAS) occurs when a medical doctor provides the means for death to occur and the patient self-administers it (Hendin, 1998). Even though medical doctors provide the means of death, social workers could become involved as they assist patients with end-of-life decisions (Csikai, 1999). Involvement with PAS presents an ethical dilemma, which in this article refers to a situation in which social workers think they have no definitive guidelines for professional behavior, when values governing professional behavior conflict, or when practice guidelines have not evolved to match technology (Reamer, 1998). Social workers have long been involved in ethical conflicts (Reamer). Even though disagreements are voiced within the professional body, individual social workers tend to avoid issues that might create conflict (Jansson & Dodd, 1998). Avoidance of controversy may be one of the reasons that social work researchers have conducted scant research on social workers' views of PAS (Jansson & Dod d). To address this gap, a survey was designed to examine social workers' views on PAS and to determine whether university courses or training regarding suicide, mental health issues, and ethics may have influenced their views.

LITERATURE REVIEW

PAS and Society

PAS currently is one of the most frequently debated issues in American society (Bachman et al., 1996; Foley, 1997). Abundant information indicates Americans are divided on the issue (Egendorf, 1998; Hendin, 1998; Kamisar, 1998; Scharlach & Kaye, 1997). The debate puts forth such arguments as preservation of life; autonomy and the self-determination of individuals; older people using up expensive medical services (Spong, 1998); the slippery slope that PAS will eventually lead to involuntary deaths (Gostin, 1997); and issues of ethical and moral complicity such as proxy deaths of children (Komp, 1998). Most people agree that PAS should be reserved for people who are dying from terminal illness (Egendorf, 1998). Proponents of PAS believe dying people are in intractable pain and should be allowed to end their lives and thus their pain. Opponents argue that underutilization of narcotics for pain control leaves terminally ill people in pain (H.R. 4006, 1998). Edwin S. Schneidman, founder of the American Association of Suicidology, maintains that dying is not painful; it is the illness that causes the pain. However, an individual does not have to have a terminal illness to have intractable pain, to which many people with conditions such as arthritis and fibromyalgia will attest (Kelley & Clifford, 1997).

Research on PAS

Little research has been conducted on the etiology of actual cases of PAS. The majority of available data is on suicide among individuals who acted alone. The clinical research, for example, has focused on predicting which people are likely to choose suicide as a means of ending their lives (Leenaars, 1995). Predictors of suicide include prior suicide attempt, suicide of a family member, recent loss of a loved one, pain, and psychiatric illness (Leenaars; Lester, 1992). Depression is one of the most salient features of individuals who contemplate or complete suicide (Beck, Brown, & Steer, 1989; Manetta, 1997; Osgood & Manetta, 1998). It has also been found that when individuals received mental health treatment for the depression, the desire to kill themselves diminished (Ellis & Newman, 1996; Sullivan, Ganzini, & Youngner, 1998). In addition, according to Leenaars, when people are experiencing personal difficulties or have lowered coping capacity, they are at risk of suicide. Having a terminal illness (often cited as a reason for PAS) may precipitate depression and reduced coping capacity; however, terminally ill people are rarely …

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Publication information: Article title: Ethical Issues in the Social Worker's Role in Physician-Assisted Suicide. Contributors: Manetta, Ameda A. - Author, Wells, Janice G. - Author. Journal title: Health and Social Work. Volume: 26. Issue: 3 Publication date: August 2001. Page number: 160. © 1999 National Association of Social Workers. COPYRIGHT 2001 Gale Group.

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