Self-determination, the right to die, and culture: a literature review.
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, Roc...