Conversations at the End of Life

Abstract

Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles.

The Relationship of Palliative Care With Assisted Dying Where Assisted Dying is Lawful: A Systematic Scoping Review of the Literature

“…Titles and abstracts were reviewed against these criteria by S. M. G. and G. K., who then reviewed 105 full-text articles and in collaboration with all team members, agreed on the final 16 articles for inclusion. 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 To present the data, a spreadsheet was created with column headings denoting study design, date and location of data collection, population and setting studied, key findings, and explicit or implied relationship of assisted dying to palliative care. Findings from the studies were then extracted from the results, discussions, and conclusions.…”

“…About 95% of all surveyed report that hospices should be either supportive or remain neutral Explicit and implied: supportive, neutral, not mutually exclusive Most hospice professionals in Oregon do not believe that assisted suicide and hospice enrolment are mutually exclusive alternatives Miller et al. 43 Qualitative pilot project—exploring experiences of the three authors who are social workers After implementation of law. Year unspecified Oregon, U.S. Social workers in health systems, outpatient, and acute care settings Some concerns identified that the Death with Dignity Act is at odds with hospice philosophy, especially in religious institutions.…”

“…Nine of the included studies are from the U.S., seven from the state of Oregon, 32 , 33 , 37 , 38 , 41 , 42 , 43 and two from the state of Washington. 31 , 36…”