The role of values and experience in determining social workers' attitudes toward euthanasia and assisted suicide

Characterizing Canadian Social Workers Willing to Be Involved in Medical Assistance in Dying for Persons Lacking Decisional Capacity

Medical assistance in dying (MAID) is available in Canada for competent persons meeting the legal requirements. Extending access to persons lacking decisional capacity is being considered. Social workers may be called upon to accompany these persons through the MAID process. As part of a larger survey, we asked social workers from Quebec whether they would be willing to be involved should advance requests for MAID be legalized. Of the 367 respondents, 291 replied that they would. Using multivariable logistic regression, we identified characteristics that distinguish them from the other social workers surveyed: importance of religious or spiritual beliefs, being born in Canada, having received assisted-death requests from families, professional experiences with MAID, and dreading the prospect of participating in MAID for persons lacking decisional capacity. These findings underline the need for educational interventions that would increase social workers' confidence in providing high-quality care to clients who opt for MAID.

Social Workers' Attitudes Toward Medical Assistance in Dying for Persons With Dementia: Findings From a Survey Conducted in Quebec, Canada

Canada has legalized medical assistance in dying (MAID) for mentally competent persons who satisfy the legal requirements. Debate is ongoing as to whether MAID should be accessible to no-longer-competent persons through an advance request. We conducted an anonymous vignette-based survey among 367 social workers from Quebec to (1) elicit their attitudes toward MAID in the context of dementia; (2) assess their underlying values and beliefs; and (3) compare their attitudes to those of nurses (n = 291) and physicians (n = 136). Acceptability of MAID among social workers ranges from 42% in the case where the person depicted in the vignette was still competent to request MAID herself, to 92% in that where she was incompetent, had requested MAID in writing before losing capacity, showed signs of severe distress, and was close to death. Acceptability tends to be higher among social workers than among nurses and physicians. Forty-one per cent of social workers dread the prospect of participating in the MAID process for a person lacking decisional capacity. Nonetheless, 83% would agree to be involved. Should MAID become accessible to persons lacking decisional capacity, social workers willing to be involved will need to be educated and trained in participating in this emotionally-charged process.

Psychometric evaluation of the Questionnaire on Attitudes Towards Suicide (ATTS) in Poland

The Questionnaire on Attitudes Towards Suicide (ATTS) is widely used to evaluate the views of an individual regarding acceptability of suicide and orientation towards suicide prevention. However, recent findings suggest that it requires some revision. The present study examines the factor structure of the ATTS questionnaire in two Polish samples, consisting of 239 students (sample one) and 128 students (sample two) of the helping professions. The previously-established 10-factor model was not supported by confirmatory factor analysis (CFA). Theoretical revaluation of the scale followed by factor analysis suggested that the best fit was provided by a five-factor model accounting for 48.2% of the variance. The adapted Polish ATTS questionnaire showed satisfactory reliability and validity; however, the factor loading patterns and factor structure varied from earlier studies. These improvements in the ATTS theoretical base and construct validity may enhance the utility of the revised scale.

Value Preferences of Social Workers

The current study examines value preferences of social workers in Israel. Using a theoretical framework of person-environment fit paradigm and theory of values, the study compared social workers (N = 641, mean age = 37.7 years, 91 percent female) with a representative sample of Israeli Jews (N = 1,600, mean age = 44.2, 52 percent female). Questionnaires included personal value preferences and sociodemographic variables (gender, age, education, religiosity, and immigrant status). Multivariate analysis of covariance showed that value preferences of social workers differed significantly from those of the general population. Analyses of covariance showed that social workers reported a higher preference for self-transcendence and a lower preference for conservation and self-enhancement values. Results have significance for the selection, training, and supervision of social workers. They suggest that it is important to assess to what extent selection processes for social workers are primarily recruiting social workers with shared values, thus creating an overly homogenous population of social workers. An understanding of personal value motivations can help social workers in their own process of self-development and growth, and to understand how the profession can fulfill their basic motivations.

Exploration of factors associated with social worker attitudes toward suicide

BACKGROUND

Social workers are expected to play important roles in suicide intervention. Caregiving behaviours of medical personnel to suicidal individuals have been reported to be influenced by their own attitudes toward suicide. In this context, only a limited number of studies have examined social workers' attitudes toward suicide.

AIM

The purpose of this study was to explore associations between personal or occupational factors of social workers and their attitudes toward suicide.

METHODS

A self-administered questionnaire was mailed to 2,999 study participants registered with the Tokyo chapter of the Japanese Association of Certified Social Workers. We adopted the Attitudes Toward Suicide Scale (ATTS) to measure attitudes toward suicide. MANCOVA was used to test for the effects of demographic, personal and occupational factors on ATTS sub-scale scores.

RESULTS

Participants with a history of suicidal thoughts had stronger attitudes regarding the right to suicide than those with no history; these attitudes were not affected by a history of participating in suicide-prevention training.

CONCLUSIONS

Our findings suggest that suicide education should incorporate programmes directed at altering permissive attitudes toward suicide.

Social work and end-of-life care: reviewing the past and moving forward

This paper reviews the professional literature with respect to the social work profession's involvement in end-of-life care. The search process was conducted by entering key words in various combinations to electronic databases. Eligible articles were required to address one of the following: roles and activities of social workers in providing end-of-life care; core principles valued by social workers in the provision of end-of-life care; and barriers to provision of effective end-of-life care. The literature from 1990 through July 2004 was searched most rigorously. Based on this review, suggestions for where the profession of social work should focus its energies are offered. These key areas include focusing on generating empirically-based knowledge for practice and policy analysis and developing a system of social work education that addresses the unique knowledge and skills needed to participate in end-of-life practice as competent and informed professional practitioners. Current initiatives with regard to critical areas are summarized.

"We just happen to live here": two social workers share their stories about Oregon's Death with Dignity Law

This article is written more like a conversation with the reader rather than a strictly academic piece. The purpose is to share from a more personal perspective the unique circumstances and challenges faced by two social workers in Oregon as they grappled with the Death with Dignity Law. The law has been in effect for six years and a May 2004 decision from the Ninth U.S. Circuit Court allowed the law to remain a legal end-of-life option. Each writer has a unique voice on the process of social work involvement in practice, research, and policy since the law was originally passed in 1994.

Attitudes and experiences of Oregon hospice nurses and social workers regarding assisted suicide

BACKGROUND

When the Oregon Death with Dignity Act (ODDA) legalizing physician-assisted suicide was enacted into law in 1997, Oregon hospice clinicians were uncertain how involved they would be with patients who wanted this option. However, 86% of the 171 persons in Oregon who have died by lethal prescription were enrolled in hospice programmes.

METHOD

A mailed questionnaire was sent to all hospice nurses and social workers in Oregon in 2001 (n=573) to assess their attitudes about legalized assisted suicide and interactions with patients concerning this issue. Responses from 306 nurses and 85 social workers are included in this report.

FINDINGS

Almost two-thirds of respondents reported that at least one patient had discussed assisted suicide as a potential option in the past year. Social workers were generally more supportive of both the ODDA and of patients choosing assisted suicide compared to nurses. Twenty-two per cent of all respondents were not comfortable discussing assisted suicide with patients. Ninety-five per cent of both groups, however, favoured hospice policies that would allow a patient to choose assisted suicide while enrolled in hospice and allow hospice clinicians to continue to provide care.

INTERPRETATIONS

Nurses and social workers in hospices and other settings can expect to encounter patient questions about physician-assisted suicide, whether legalized or not, and must be prepared to have these discussions. Most hospice professionals in Oregon do not believe that assisted suicide and hospice enrollment are mutually exclusive alternatives.

Washington State social workers' attitudes toward voluntary euthanasia and assisted suicide

This study examines attitudes and experiences concerning voluntary euthanasia (VE) and assisted suicide (AS) among 862 professional social workers from Washington State, USA. Although AS has been portrayed as more acceptable than VE, social workers make only a minor distinction in their support for the legalization of such acts (VE 72.4%; AS 77.6%). Only 26.6% agreed with the US Supreme Court's ruling that assisted suicide is not a constitutional right. More than 75% believe that social workers should be involved in the decision-making process with clients who are considering VE/AS. About 20% of social workers report being consulted about VE/AS issues either by clients or in their personal lives. Social workers employed in medical settings are more than twice as likely to be consulted about VE/AS than those employed in non-medical settings. Religious commitment explains some opposition to VE/AS for Protestants and Catholics, but not for other faiths. A small number of social workers (19) admitted to assisting the death of a patient by VE and 5 admitted to AS.

Take some time to look inside their hearts: hospice social workers contemplate physician assisted suicide

This article presents a subset of data from a larger study that explored the impact of the legal choice of physician assisted suicide (PAS) on hospice providers. Eight social workers shared their personal and professional voices about a very controversial and difficult issue. Oregon is the only place in the country where PAS is legal and these social workers practice in an environment where the choice of PAS has been an option for two years. Three overarching themes emerged from the data: (1) the dilemmas that arise from the hospice philosophy; (2) the conflicts that emerge between the choice of PAS and social works' cardinal values and practice principles; and (3) the struggles with personal values and PAS.