Social workers are central health care professionals in working with patients, families, practitioners, healthcare agents, and surrogates in the health system, and in the communication and conflict resolution process that is integral to health care decision making. Their knowledge set and experience make them an essential member of end-of-life care. However, current health care practices fail to effectively utilize the social worker as a patient advocate in dealing with the multitude of patient needs that arise during, before, and after hospice care (Bomba, Morrissey, and Leven, 2011). With the technological transformation of medicine in recent decades, it is now possible to extend the life of terminally ill patients, allowing individuals to live in severely disabled states, and prolonging the dying process. Such an ability to extend life raises ethical issues about quality of life, individual autonomy, and the phenomenology of pain and suffering (Dickinson, 2005; Morrissey 2011; McCormick, 2011). In a study on the experience of social workers working with hospice patients with unmet needs at the end of life, the most frequently cited barrier to addressing and overcoming unmet needs was social and cultural issues related to death and dying (Arnold et al., 2006). Ethical problems are not random or isolated failures of the system but often fundamental products of that system (Dickinson, 2005). This essay will focus on the role of the social worker in end-of-life care, most notably hospice care, and the effect the social worker can have on improving quality of life for the patients and their families. I have chosen to focus primarily on social workers due to their role in assessing the psychosocial needs in hospice settings, and their usefulness in educating, treating, and acting as a patient advocate for individuals and their families during end-of-life care. I begin with an overview of ethical issues, primarily self-determination and a phenomenology of pain and suffering. From there I move the recent legislative measures enacted in the state of New York which focus on end-of-life care to show that social workers possess the experience and skill set to help individuals prepare and deal with the anxiety of death. SELF-DETERMINATION AND THE RIGHT-TO-DIE MOVEMENT
“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 patients” (McCormick, 2011). In the 1970s, the notion of life-sustaining technology and medicine became a topic of debate after the prolonged death of Karen Anne Quinlan. The 21 year old was severely injured in a motor vehicle accident and was unable to breathe without medical intervention. Karen’s parents requested that she be taken off the ventilator, however, her physician refused and the case was taken to court. Although the courts ruled in favor of Karen’s parents, the hospital refused to remove the breathing tube. Instead, they slowly weaned her off over a period of months, and she continued to live for another 10 years in a vegetative state (McCormick, 2011). This case, and others like it, led to the passage of the Patient Self-Determination Act in 1990. Its passage has reinforced the autonomy principle, which is now used as the rationale for full disclosure of diagnosis and prognosis to a patient, with the expectation they patients will work with physicians to make informed decisions (Wesley, 1996).
“Individual autonomy is an idea that is generally understood to refer to the capacity to be one's own person, to live one's life according to reasons and motives that are taken as one's own and not the product of manipulative or distorting external forces” (Christman, 2011). The principle of respect for autonomy implies that one should be free from coercion in deciding to act, in the...