A Social Worker’s Role at End of Life


Kevin Kozin, MTS, LICSW, is a clinical social worker and therapist and formerly worked as a hospice social worker. He’s currently a board member of the National Association of Social Workers in Massachusetts and serves as the Chair of the Mental Health and Substance Abuse Committee. He works with adolescents, adults, couples, and families through psychotherapy and grief counseling, which lead to healing results.

The New England Journal of Medicine published an article this April titled, “Implementing a Death with Dignity Program at a Comprehensive Cancer Center”. This well-written article takes a candid look at the demographics and experience of a particular cancer center in Washington state, where the Death with Dignity Act has been in effect since March, 2009. Death with Dignity refers to the Washington and Oregon statutes which allow individuals who have six months or fewer to live (as determined by two physicians) and have the capacity to make medical decisions the option to request prescribed medication which allows for a peaceful and painless death.

The article’s conclusion states, “Overall, our Death with Dignity program has been well accepted by patients and clinicians.” As a practicing clinical social worker and former hospice social worker, this comes as no surprise to me. The National Association of Social Workers in Washington continues to be a strong proponent of the Death with Dignity law Washington passed in 2008. As a board member and Chair of the Mental Health and Substance Abuse Committee of the National Association of Social Workers in Massachusetts, I know our chapter also worked in support of legislation through a ballot initiative here and the initiative lost by less than 1%. The ballot measure was modeled on the assisted dying laws in place in Oregon and Washington. Why would our organization of social workers support this legislation so enthusiastically? Because social workers stand for giving people—especially the dis-empowered—as much self-determination as possible.

Perhaps one element of this New England Journal of Medicine article which was highly edifying to me is the role of the social workers at the Seattle Cancer Care Alliance. In practice, a social worker is assigned to each individual who’s considering requesting the medication allowed under the Death with Dignity Act. The social workers’ role, as advocate, is to assist the individuals in understanding their options as well as providing a safeguard to ensure decisional capacity, screening out clinical depression and anxiety, and coordinating across multiple disciplines. The social workers coordinate with family, friends, pharmacists, physicians, care staff, attorneys, insurance companies, and anyone involved in the process to help the individual make a clear and thoughtful decision. The role of a hospice social worker in Massachusetts is very similar in that we’re constantly looking to empower those who are dying with whatever resources are available to them and enable them to make their own decisions, when possible. Hospice social workers are experts in care coordination and hearing all of the various stakeholders in the care of the dying individual, making sure all voices are heard, and ensuring the dying individual’s choices are respected.

In reading “Implementing a Death with Dignity Program at a Comprehensive Cancer Center” in the New England Journal of Medicine, I’m once again reassured the small percentage of dying individuals in Washington who qualify for assisted death are getting excellent care, and social workers are playing a strong role in ensuring these individuals’ choices are respected. I look forward to a greater understanding of Death with Dignity throughout the United States—one which isn’t based on fear but on compassion—and allows for more options and self-determination for those at the end of their lives.

View full post on Death with Dignity National Center

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