Social workers are to be allowed to opt out of the proposed assisted dying process, the legislation’s sponsor has pledged.

Labour’s Kim Leadbeater has promised to work with fellow MPs to amend her Terminally Ill Adults (End of Life) Bill to ensure practitioners other than health professionals are allowed not to participate.

While social workers were originally not part of the bill’s process for assisted dying, they have been added to it through amendments made by Leadbeater during its recently-concluded committee stage.

Social workers to be involved in assisted dying panels

Under this, a panel comprising a senior lawyer, a psychiatrist and a social worker would consider requests for an assisted death that had been already signed off by two doctors, to check whether the statutory requirements had been met. These include that the person:

• has an inevitably progressive illness and is expected not to live beyond a further six months;
• has capacity to make the decision to end their life;
• has a clear, settled and informed wish to end their life;
• made the initial declaration that they wanted to end their life voluntarily and was not coerced or pressured into making it.

However, as the bill stands, only doctors and other health professionals have the right to not participate in helping a person to die and protection from detriment from their employer should they decide to opt out.

Lobbying from BASW

The British Association of Social Workers (BASW) had lobbied for social workers to be similarly covered and welcomed Leadbeater’s pledge, given last week, to introduce an amendment to that effect.

In a debate at the committee stage on 18 March, Conservative MP and prominent bill critic Danny Kruger put forward an amendment that would have extended the so-called opt-out provision to anyone potentially involved and in relation to any part of the assisted dying process.

He highlighted social workers’ current omission and quoted written evidence from BASW.

In response, Leadbeater said: “I would like to get it on the record that I agree with him: there should be no duty on any person to take part in the Bill’s provisions if they choose not to, for whatever reason. I will struggle to support his amendment because there are other issues with it, but on that principle I wholeheartedly agree, and I would be happy to work with him in sorting it out, before report, to that effect.”

This means she will devise an amendment to extend the so-called “conscience clause” more broadly to be considered at the next stage of the bill’s passage through the House of Commons, the so-called report stage.

‘A vital step towards parity between social workers and health professionals’

In response, a BASW spokesperson said: “BASW has engaged significantly with MPs on the assisted dying proposals since they were introduced to parliament, ensuring that social work’s role and voice is understood and represented throughout the process.

“Social workers not being included in the conscience clause in the initial drafting of the legislation was a serious omission that we have been raising with policy-makers since day one. It is paramount that all professionals potentially involved should be able to opt out of work relating to assisted dying without detriment.

“We were therefore pleased that MPs on the committee listened to our calls and gave their assurance that an amendment to this effect will now be brought forward. It is a vital step toward ensuring parity of legal protections between social workers, other non-healthcare professionals, and medical practitioners.”

By Denise Turner

The proposed assisted dying legislation, which is currently being debated in Parliament, recommends social workers are appointed to multi-disciplinary panels, making decisions about assisted dying requests, following sign-off by two doctors.

This is an important potential change in the social work role. However, death and dying have always been firmly embedded within the profession, either directly, through people who are terminally ill or have experienced the death of a loved one, or indirectly, through intergenerational grief and loss. In public consciousness, social work is also, perhaps, most commonly associated with high-profile child deaths.

In addition, rapidly advancing technology has transformed many aspects of death and dying, whilst challenges such as knife crime also require an understanding of the contemporary landscape. Moreover, an increasingly diverse population requires social workers to understand multi-cultural bereavement practices.

No mandated learning on death and dying

However, despite the prevalence of death and bereavement within social work, the current education curriculum does not mandate any specific form of learning in this area.

A previous study (Turner and Price, 2021) found a paucity of research specifically concerned with understanding the bereavement experiences of students from diverse cultural backgrounds and that this may then be reflected in their practice experiences. It found there was an increased need for specific bereavement training and support within social work programmes, alongside skills and knowledge around cultural diversity and the part this plays in the bereavement process.

Work by other academics in the field has highlighted an over-reliance on five stages theories of Kubler-Ross, which were developed in the 1960s.

The limitations of current social work education may render practitioners ill-equipped to deal with contemporary aspects of death and dying, resulting in a potentially poorer service for people they work with, as well as risks to social workers’ own wellbeing.

A new network on death and dying

In the light of this, the Social Work Approaches to Death and Dying network (SWADD) was set up by a group of interested social work academics, with the aim of improving practice through investigating and updating the social work curriculum as it relates to death and bereavement.

The SWADD group piloted a small quantitative research study, which was sent to higher education institutions offering social work education in the UK. We are still collecting data from this survey, but existing responses have already highlighted the lack of consistency in the social work curriculum, with consequent implications for social work practice.

Contemporary issues such as the impact of technology on the field of death and dying, contested topics such as assisted dying and the need to understand cultural diversity are not reliably covered within the social work curriculum.

A lack of consistency in the curriculum

Additionally, where there is education on death and dying, this is often down to the interests of specific lecturers, so students are not consistently learning from those with lived experience in this area, or from experts in other disciplines with relevant knowledge.

For example, in the pilot research, findings showed that teaching on death and bereavement was variously embedded within a theories module, or as a dedicated skills day, with some universities focusing on children’s bereavement, and others more specifically on the mental health aspects of bereavement.

The variations in the teaching of this core life experience mean that students may be leaving social work education with wide discrepancies in their knowledge and skills, with consequent implications for their practice, where death and loss are so prevalent.

Find out more

The SWADD group will be presenting its initial work at Social Work England’s Social Work Week, on Friday 21 March as part of the research spotlight session, which runs from 3pm-4.30pm.

Findings so far are extremely limited so the SWADD group is hoping to recruit further social work educators interested in this area and also to encourage further participation in the survey, which can be found here.

If you are interested in joining the SWADD group, please contact Professor Denise Turner at d.turner4@herts.ac.uk or sign up for our SWADD session on 21 March – we look forward to seeing you there.

Professor Denise Turner works in the school of health and social work at the University of Hertfordshire

Social workers would sit on three-person panels set up to review adults’ requests for assisted dying under a proposed amendment to the bill to legalise the practice.

Labour MP Kim Leadbeater, sponsor of the Terminally Ill Adults (End of Life) Bill, has proposed that the panels – which would also comprise a psychiatrist and a senior lawyer – should consider requests for an assisted death that had been already signed off by two doctors.

Role of panels including social workers

The panels’ role would be assess whether the statutory requirements for an assisted death had been met, including that the person:

• has an inevitably progressive illness and is expected not to live beyond a further six months;
• has capacity to make the decision to end their life;
• has a clear, settled and informed wish to end their own life;
• made the initial declaration that they wanted to end their life voluntarily and was not coerced or pressured into making it.

The panels would have to take evidence from at least one of the two doctors and may also hear from the person themselves or any other person.

Replacing court role

Under the bill as currently stands, this role would be carried out by the High Court. However, concerns have been raised about the impact this function would have on court capacity, at a time when the judicial system is already under significant pressure.

Under Leadbeater’s proposal, the social worker member would need to be a registrant on either Social Work England’s or Social Care Wales’s register.

The panels would be appointed by a Voluntary Assisted Dying Commissioner, a new role appointed by the prime minister that would be held by a senior judge. This would be provided for by another of Leadbeater’s proposed amendments to her bill.

The amendments will be discussed by the committee scrutinising the bill after Parliament returns from its current recess next week.

Argument over level of safeguards

In a committee debate last week, bill opponent Danny Kruger raised concerns that replacing the High Court with a panel would weaken provisions in the bill protecting people from being coerced into ending their lives.

In response, Leadbeater cited the evidence of the Association of Palliative Care Social Workers (APCSW) to the committee in arguing that the panels would consist of practitioners with expertise in tackling coercion.

Though neutral on the question of assisted dying, the APCSW and the British Association of Social Workers (BASW) welcomed Leadbeater’s plan.

Social workers ‘uniquely qualified’ for role

The APCSW said: “The inclusion of social workers as core members of these panels shows that Kim Leadbeater and her colleagues have taken on board our arguments that social workers are uniquely qualified and equipped to undertake the complex and sensitive tasks of assessing mental capacity and safeguarding individuals who may be subject to any form of undue influence or coercion.”

It added: “The choices that people make as they approach the end of their lives are strongly influenced by their relationships with others and by the practical circumstances of their lives. This holistic perspective is our native ground as social workers.”

BASW issued a similar message, saying: “Individuals considering assisted dying, and their families, need holistic advice and support. The multi-disciplinary panel also potentially provides the framework to resolve issues of mental capacity and adult safeguarding, both issues which sit with social workers.”

Panels ‘would need to be backed by resource and training’

However, it added that the panels would require sufficient resource to ensure they were adequately staffed, while practitioners serving on them would need appropriate training and supervision to fulfil their roles.

There is a majority in favour of assisted dying on the committee, suggesting that the amendments will be agreed.

The bill will then return to the House of Commons for further debate and a final vote. Though MPs backed the bill in principle previously, the changes proposed by Leadbeater may lead to a weakening of support.

Celebrate those who’ve inspired you

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Do you have a colleague, mentor, or social work figure you can’t help but gush about?

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Nominate your colleague or social work inspiration by filling in our nominations form with a few paragraphs (100-250 words) explaining how and why the person has inspired you.

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If you have any questions, email our community journalist, Anastasia Koutsounia, at anastasia.koutsounia@markallengroup.com

Almost half of social workers believe they should have a role in any future assisted dying process, though others fear the sector would struggle to take on such a role, a poll has found.

This follows the Terminally Ill Adults (End of Life) Bill passing its second reading in the House of Commons in November 2024.

Under the legislation, a terminally ill person with no more than six months to live could choose to receive assistance to die, so long as they had the mental capacity to make the decision.

To be approved, they would need to be assessed by two separate doctors, and a High Court judge would need to confirm that the legislation’s requirements were met.

However, in light of concerns about people being or feeling coerced into an assisted death, the Association of Palliative Care Social Workers (APCSW) has proposed the establishment of a social work role to safeguard those going through the process.

But do social workers agree?

A Community Care poll with 700 votes found that almost half of practitioners (46%) believed they should be involved in future assisted dying processes. However, over one-third (37%) expressed concerns about the sector’s capacity to accommodate the additional work.

Proposed social work role

The approved palliative care professional position proposed by the APCSW would have the following functions:

• Ensuring that the person had the mental capacity to make this decision.
• Having in-depth discussions with the person, those close to them, the multidisciplinary team responsible for their care and any paid carers.
• Ensuring all reasonable care and resources had been provided and that no other forms of care or treatment could be offered which would alter the person’s choice of an assisted death.
• Making an independent assessment of the individual in the context of their wishes, values and relationships, and ensuring that they were making a fully informed decision without undue influence by others or by concerns about the pressure on others of caring for them.
• Taking timely and sensitive action to safeguard anyone who was subject to neglect, abuse or coercion.

What do you think about the proposed safeguarding role?

Celebrate those who’ve inspired you

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We’re expanding our My Brilliant Colleague series to include anyone who has inspired you in your career – whether current or former colleagues, managers, students, lecturers, mentors or prominent past or present sector figures whom you have admired from afar.

Nominate your colleague or social work inspiration by filling in our nominations form with a letter or a few paragraphs (100-250 words) explaining how and why the person has inspired you.

If you have any questions, email our community journalist, Anastasia Koutsounia, at anastasia.koutsounia@markallengroup.com

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Specialist social workers should be involved in safeguarding people going through an assisted death should legislation on the issue become law.

That was the message from the Association of Palliative Care Social Workers (APCSW) in a position statement on the issue, which was published before the second reading of the Terminally Ill (Adults) End of Life Bill in the House of Commons on 29 November 2024.

MPs voted to back the bill in principle, meaning it will now be considered in detail by a committee of membersbefore returning to the full House of Commons for a further vote.

The APCSW did not set out a position on whether the bill should become law or on the legalisation of assisted dying more broadly. Instead, it made a series of recommendations on what should happen were the bill to be approved.

These included amending the legislation to create the position of approved palliative care professional, to assess and support people seeking an assisted death, with the role initially being carried out by specialist social workers.

What assisted dying bill involves

Under Labour MP Kim Leadbeater’s private member’s bill, adults who are terminally ill and assessed as having no more than six months to live would be able to lawfully be given assistance to end their lives.

They would need to be assessed by two doctors, who would need to confirm that they met the eligibility criteria, including that they had the mental capacity to make the decision.

A High Court judge would then need to declare that the legislation’s requirements had been met, and then the person would have to make a further declaration that they wanted assistance to end their life before this could go ahead.

The bill has proved controversial, with critics, including health and social care secretary Wes Streeting, raising concerns about people feeling coerced into making the decision and not having a free choice because of the alleged inadequacy of palliative care.

Proposed specialist role

The proposed approved palliative care professional role appears designed to tackle some of these criticisms.

The association said it would have the following functions:

• Ensuring that the person had the mental capacity to make this decision.
• Having in-depth discussions with the person, those close to them, the multidisciplinary team responsible for their care and any paid carers.
• Ensuring all reasonable care and resources had been provided and that no other forms of care or treatment could be offered which would alter the person’s choice of an assisted death.
• Making an independent assessment of the individual in the context of their wishes, values and relationships, and ensuring that they were making a fully informed decision without undue influence by others or as a result of concerns about the pressure on others of caring for them.
• Taking timely and sensitive action to safeguard anyone who was subject to neglect, abuse or coercion.

Palliative social work skills

The association said the functions were particularly suited to the skills of social workers, particularly the specialist palliative care practitioners that it represents.

These included carrying out holistic assessments of people’s physical, social, psychological and spiritual needs, assessing mental capacity, supporting people to exercise choice and autonomy in challenging circumstances and safeguarding.

“We are trained in assessing and managing risk, including the use of statutory powers and legal proceedings where no other options are adequate,” it said.

For its recommendation to be implemented, the bill would need to be voted through on Friday and then be amended to include the approved practitioner role at a subsequent stage, most likely the committee stage that follows the second reading.

Ensuring adequate skills

The APCSW said the role, were it to be implemented, should initially be developed with and held by palliative care social workers before being rolled out to other social workers and relevant practitioners.

However, it said having assisted dying legislation on the statute books would require adequate workforce skills, knowledge and resilience across health and social care more generally.

It said palliative care should be a required element on all qualifying courses for doctors, nurses, allied health professionals and social workers, but also stressed that staff needed adequate psychological support were the bill to become law.

Workforce ‘already stretched to capacity’

“The issue is sensitive, personal and emotive and professionals involved will require relevant training and high quality, structured supervision and opportunity for reflective practice.

“In a workforce that is already stretched to capacity and experiencing unprecedented burn out, the introduction of assisted dying would need careful preparation.”

Any assisted dying policy would also need to respect the views of practitioners who were ethically opposed to it without obstructing those who chose an assisted death.

Concerns over state of palliative care

In an echo of Streeting’s concerns, the APCSW warned that the current state of palliative care risked leading people to choose an assisted death as “the only way to escape from unbearable suffering”.

It said that the majority of palliative care was delivered by charitable hospices, whose already limited funding from the NHS and councils had declined in recent years as donations had also dried up, leading to cuts and redundancies in some areas.

Introducing an assisted dying law in this context could “lead to a vicious and tragic downward spiral by reducing the number of people seeking or being referred to palliative care services”, cutting investment still further.

The association stressed that the legalisation of assisted dying would have to be accompanied by “sufficient funding to provide equitable access to high quality palliative care for everyone”.

Service improvements should be informed by a population-wide assessment of the need for palliative care, it added.