Academic journal article Social Work

Self-Determination, the Right to Die, and Culture: A Literature Review

Academic journal article Social Work

Self-Determination, the Right to Die, and Culture: A Literature Review

Article excerpt

Self-determination is a primary ethical principle underlying social work practice, and social workers in health care settings use it as a guiding principle in decision making with their clients (NASW, 1997, 2004). Since the 1970s, a right-to-die movement has been advocating for changes in laws regarding a right to die, and it shares the social work dedication to self-determination. This movement is a loosely coordinated civil rights movement comprising 40 organizations in 26 countries (see http://www.worldrtd.net/). These organizations uphold the principle that individuals have a right to make their own decisions regarding the amount of medical care they want and the circumstances and timing of their death (Humphry & Clement, 2000).

The right-to-die movement has grown and now enjoys the support of a large majority of Americans. In January 2006, following a survey of 1,500 adults, the Pew Research Center reported that 84 percent of Americans supported right-to-die laws that give patients the right to decide whether they want to be kept alive through medical treatment. This was up from 79 percent in 1990 (Pew Research Center, 2006).This positive attitude toward a right to die has affected social workers. Hospice social workers report that clients make statements to them about a desire to die (P.J. Miller, Hedlund, 8: Soule, 2006). There are also social workers in a variety of settings who are now subject to questions about end-of-life issues (NASW, 2004).

The positive views of ordinary citizens toward self-determination regarding a right to die may not be shared by their state legislatures, and in many states, individual beliefs now seem to be ahead of changes in law. With the exceptions of Oregon and Washington--which passed citizen initiatives in 1995 and 2008, respectively--state laws do not allow for physician aid in dying. Legislatures in 38 states passed laws to prohibit physician-assisted suicide, and seven others ruled it homicide (Public Agenda, 2001).

These laws may also have an effect on attitudes about end-of-life care among both health care providers and family members of patients in intensive care units, affecting the decisions that are made about treatment and withdrawal of life-sustaining treatment (Cook, Rocker, Giacomini, Sinuff, & Heyland, 2006). Social workers in health care settings have been aware of the need to address end-of- life care needs and views on suicide as part of their initial assessments with clients and their family members (P. J. Miller, Hedlund, & Murphy, 1998).

Current end-of-life care practice in the United States is not solely limited by law; it is influenced by culture as well. The right-to-die perspective has been criticized as lacking cultural awareness and applicability with people from a variety of ethnic and racial backgrounds (Kwak & Haley, 2005). The role of culture in the approach to the end of life is an important component of end-of-life care practice guidelines for professional social workers (NASW, 2004).

My purpose in this article is to provide a brief description of the right-to-die movement and to review selected literature addressing self-determination and cultural competence in social work practice at the end of life. My analysis of this information attempts to frame a principled response from social workers to the right-to-die movement that is based on professional ethical and cultural competence guidelines.

RIGHT-TO-DIE MOVEMENT

The right-to-die movement originated in the context of technological advances following World War II. Development of antibiotic treatment for bacterial illness and equipment such as the ventilator and the kidney dialysis machine helped medical doctors extend the lives of people who would certainly have died in the time before these advances. The medical community rapidly adopted these new technologies. The iron lung, used for treating polio patients in the 1950s, evolved into the modern respirator, also called a "ventilator. …

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