Should social workers have a safeguarding role in any future assisted dying process?
- Yes, this would help protect people against coercion (46%, 321 Votes)
- Perhaps, but I would worry about our capacity to take on this role (37%, 261 Votes)
- No, the existing safeguards in the assisted dying bill are sufficient (17%, 122 Votes)
Total Voters: 704
Loading ...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.
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Just a thought, is anyone considering the fact some people who are given months to live is only estimate not a fact. Also, that their are people given end of life prognosis and go on to continue to lead healthy lives? I am aware of at least six individuals that I worked with who defied eol medical prognosis when they truly believed and others around them they would die, but still happy to be alive today. This is also an ethical dilemma for Christian practioners who could not participate in the assistance of ending the life of an individual, being gods creation and also against scripture? This may also be true for other religions. I appreciate we need to be practioners that do not allow our values to interfer or overshadow our practice, but there are limits to this, with mortal sin being one of them.
Exactly Baker.
Your write up has been my thoughts all this while. Hhmmmmm.
Dear Editor,
I am writing as an independent palliative care social worker to contribute to the discussion around the proposed assisted dying legislation, as detailed in Community Care and reflected upon in the Association of Palliative Care Social Workers (APCSW) position statement.
The APCSW’s decision to neither endorse nor oppose the legislation is rooted in its commitment to advocate for holistic and compassionate care for individuals and families at the end of life. However, I believe this neutrality risks diluting our obligation to champion the foundational principles of palliative care and safeguard against the erosion of accessible end-of-life services for all.
First, the proposed role of an Approved Palliative Care Professional (APCP) is formulated to help address ethical concerns around safeguarding and informed decision-making. This is already central to what we do whatever the state of mind or intention of the individual before us. There is a risk that to specialise these functions will signal acquiescence with the prevailing ethic. It also raises practical questions about the strain on an already overstretched workforce. Social workers, especially those in palliative care, are at the heart of multidisciplinary teams, supporting individuals holistically amidst complex psychosocial, spiritual, and existential challenges. Adding the APCP role, even if phased in, will divert resources away from our core mission of enhancing the quality of life without hastening or delaying death.
The current landscape of palliative care provision in the UK is troubling. Recent redundancies in a nationwide palliative care charity—including the dismissal of all social workers, face to face counselling, and spiritual care leads—highlight systemic vulnerabilities. Without substantial investment in services, we risk creating a two-tier system where assisted dying becomes the default option for those unable to access comprehensive care. This scenario fundamentally contradicts social work values of equality and justice, particularly for vulnerable populations facing compounded end-of-life pressures in relation to their social role and sense of value.
Research from countries like Belgium and Canada demonstrates the risk of “scope creep” in assisted dying laws, where initial safeguards expand to encompass non-terminal conditions or psychological distress. In my view these developments are inevitable and although not immediate, they will inadvertently shift societal attitudes towards end-of-life care.
Finally, there is the matter of professional identity. Palliative care social workers excel in fostering trust, advocating for the vulnerable, and navigating ethical complexities. Taking a clear position against assisted dying, as opposed to neutrality, would allow the profession to uphold these values unequivocally. It would also signal a collective commitment to improving palliative care access and quality, rather than being seen as tacitly accepting practices that could undermine these efforts.
I accept that the debate around assisted dying is nuanced and am pleased that Community Care has created a space for these discussions. However, I urge the profession to reflect critically on the broader implications of neutrality. By opposing the legislation while advocating for safeguards and improvements in palliative care, we reaffirm our dedication to protecting vulnerable individuals and maintaining the integrity of our practice.
Yours sincerely
David Williams
Independent Palliative Care Social Worker
Some good points raised and much to think about.
Personally , I worry about the dire circumstances of palliative care services , or what’s left at least. I agree that there have in my experience been a lot of people who are told they do not have long to live who do in fact live and live with some quality of living .
The work force we have cannot hope to cope with any new role and so I fear many people who may be at a critical and vulnerable point in life may wish to end it without the best support being available , and this giving them the broadest choice available.
Any role created would have to be uber neutral and very specialised with the best training we have available and palliative care services need a huge boost in funding .
I bumped into two workers recently raising funds on their day off for the local hospice which is brilliant . We need to have a rethink – like urgently , this is no way to run services . You cannot bring in such an Act without a proper ethically constructed and considered provision of care and support to those who may be at such a vulnerable point in their life . There are of course concerns about those who can afford the best services and support and have the best clinical advice , and those who will not and this affecting — driving your decision .
We will certainly have to rethink safeguarding as a start .
This is a minefield