Social workers will be integral to the assessment of mental capacity and risk to people choosing to end their life, if Scotland passes a bill to legalise assisted suicide.
MSPs are currently hearing evidence on the issue of assisted suicide as the End of Life Assistance Bill progresses through the Scottish Parliament.
The bill, which applies to people who are terminally ill or permanently physically incapacitated and find life intolerable, currently contains no mention of social workers.
However, independent MSP Margo Macdonald, who introduced the bill into parliament, plans to make changes that would put social workers at the heart of the assessment. She said: “The intention is to make sure that everyone who has been in contact with the person making the request is involved in that decision.”
She added: “Social workers are quite likely to have an even better knowledge of the person concerned [than other professionals].”
Under the bill, people must make two formal requests for help to end their life, both of which must be signed off by a “designated practitioner”, who is likely to be a GP, following the report of a psychiatrist on issues including the person’s mental capacity.
Macdonald said she was yet to decide if social workers would be mentioned explicitly within the bill or if this would form part of accompanying guidance. She emphasised that she was mindful to ensure that the process was not too arduous for those requesting an end to their life.
Kirsty Freeland, spokesperson for the Association of Palliative Care Social Workers, said she could see the benefits of including social workers in assessments explicitly within the bill. She added: “The GP was supposed to assess if the patient was under pressure from the family; well social workers do that all the time. We are used to looking out for that; a GP is not.”
Dr Stephen Potts, of the Royal College of Psychiatrists (RCPsych) in Scotland, said: “The bill as it stands assigns too great a role to psychiatrists, and a more limited role (or no role at all) to other professionals. The RCPsych believes there should be a reduction in the expectations placed on psychiatry, and agrees there is certainly a role to play for other professionals such as social workers.”
“Social workers should be a part of checks and balances for measuring risk because we understand more about that than the psychologists and psychiatrists, said Ruth Stark, manager for the British Association of Social Workers in Scotland.
But she raised concerns about the bill’s handling of mental capacity. Under current capacity legislation in Scotland, patients are assumed to have capacity until proven otherwise, but Macdonald’s bill assumes the reverse. Stark said the current methods for assessing capacity were still relatively new and had not been tested enough for there to be confidence when using them to make decisions about life or death.
Both Stark and Freeland said social workers’ involvement raised issues about working with families after someone had died. “If you have been involved in assessing if people have been able to take that decision that could be a very difficult working relationship,” Stark said.
Freeland said this situation arose in part because social workers could not opt-out of offering people care as they chose to end their life while doctors would be able to, as it could contradict the Hippocratic oath.
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