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Value 1: Respect for Inherent Dignity and Worth of Persons
“Social workers uphold each person’s right to self-determination, consistent with that person’s capacity and with the rights of others” (CASW, 2005, p. 4)

“Social workers uphold the right of society to impose limitations on the self-determination of individuals, when such limitations protect individuals from self-harm and from harming others” (CASW, 2005, p. 5)
“Social workers respect the client’s right to make choices based on voluntary, informed consent” (CASW, 2005, p. 4)

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BC Supreme Court has handed down its decision on whether Gloria Taylor of West Kelowna has a right to physician assisted suicide. Castanet's Kelly Hayes reports.

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Conflict Theory: A Theoretical Orientation of Policy Development

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Conflict Theory: A Theoretical Orientation of Policy Development

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Conflict theory looks at the inequality between dominant and subordinate groups (McKenzie & Wharf, 2016).

There is inequality between those who are "able-bodied" and those who are not.

The powerful dictate the law and keep special interest groups such as those who are disabled from gaining control over important social institutions i.e., the health care system.

Policies are created in response to the competing interests of groups with different interpretations of right and wrong (McKenzie & Wharf, 2016).

MAID is an example of a legitimation policy since it provides relief for individuals with degenerative health conditions who previously did not benefit under the law (McKenzie & Wharf, 2016, p. 73).

Terminally ill patients were at a disadvantage to the policy makers who opposed the law since they did not experience suffering.

Social conflict theorists would promote equality but also focus their energy on issues related to financial and institutional abuses under the law and within health care.

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Suicide has been viewed differently throughout history. In early times, there was no distinction between euthanasia and suicide (Library of Parliament, 2013).  From the 2nd to 4th centuries, Christian churches opposed suicide (White & Kral, 2014).  The public would not tolerate suicide because it was seen as opposing God's will (Library of Parliament, 2013). It was not until the 6 th century that the law prohibited suicide (White & Kral, 2014). At this time, legislation would not allow families to have proper burials and the property of those who died by suicide was forfeited to the government (White & Kral, 2014).
In the mid 17th century, psychiatrists thought suicidal ideation and behaviours were related to mental and emotional difficulties (White & Kral, 2014). As a result, people who ended their lives were seen as victims rather than perpetrators of the law depending on the reasoning for their death. During this time, asylums emerged in Europe to manage a small number of severe mental health conditions (Horwitz, 2002).
In the 18th century, legal and religious discourses became less prevalent and the medicalization of the problem of suicide increased as time progressed. In 1844, psychiatrists considered suicide to be a chronic disease of the brain (Horwitz, 2002). Emil Durkheim and other sociologists suggested that social factors could cause suicide but psychiatrists continued to think that it was related to internal factors (White & Kral, 2014).
Sigmund Freud transformed people’s ideas about mental illnesses in the 19th century (Horwitz, 2002). His theory of psychoanalysis and dynamic psychiatry led to the recognition of neurotic conditions as opposed to a small number of psychotic conditions (Horwitz, 2002). It was at this time that the “[boundaries] between ordinary and pathological conditions greatly [expanded] the range of behaviors that mental health professionals might treat” (Horwitz, 2002).

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Pros

Cons
1. Suicide is a social and not just individual problem.  It is influenced by many factors and we know that people do not always want to die as much as they wish to end their suffering. Is it possible that people with incurable illnesses also want the suffering to stop more than they want to die? Can we separate these two ideas?

2. How can we ensure outside pressures are not influencing their decisions?

3. How can we work towards improving palliative and medical care so people die with dignity?
4. Is MAID ethical if it opens up the floodgates to more health care abuses?
5. Can we reconcile our social work value to protect individuals’ right to life if we support people in ending their own?
6. How would MAID affect dominant discourses about death, suffering and perseverance?

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The Death Debate - Assisted Death in Canada

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THE DEATH DEBATE tracks the story behind the recent landmark Supreme Court of Canada case on assisted dying. The story starts in 1993, when the issue was last heard, and picks up with where things are in 2011, when Canada's most celebrated civil rights lawyer, Joe Arvay, decides it's time for the issue to be revisited.

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Scientific and medical practices were increasing from the 19th century and onwards (Library of Parliament, 2013).  Individuals requesting medical assisted dying challenged the law under the CCRF (1982) (Library of Parliament, 2013).

1990- Janet Adkins

1991-In Victoria B.C., the Right to Die Society challenged the government to pass legislation on assisted dying

1992-Bill C-385 allowed physicians to assist terminally ill patients in dying upon their request but "the closing of the 34th session of Parliament prevented [the] bill from coming forward for debate."

1993- Sue Rodriguez vs. Canada

1995- The Special Senate Committee on Euthanasia and Assisted Suicide outlined ways to improve palliative care and end of life treatment

2011 - BC Civil Liberties Association reopened issue of assisted dying

2012- Gloria Taylor vs. Canada

BC Court of Appeal handed down the decision to the Supreme Court of Canada

2014-  The assisted dying law was passed in Quebec

2015 - Carter vs. Canada

The Supreme Court of Canada announced that Canadians had the opportunity to choose MAID

June 17, 2016

The federal legislation came into effect and a framework for MAID was created in Canada

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Individuals must:

Be eligible for health services funded by the federal government, or a province or territory

Be at least 18 years old and mentally competent

Have a grievous and irremediable medical condition

Make a request for MAID which is not the result of outside pressure or influence

Give informed consent to receive MAID

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Social Issues Associated with Medical Assistance in Dying (MAID)

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Social Issues Associated with Medical Assistance in Dying (MAID)

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There are multiple perspectives related to the social issue of Medical Assistance in Dying:

Economic

Legal

Health Care

Social Work

Religion

Individuals with irremediable and grievous medical conditions

The overarching debate is between the right to die on one’s own terms and the societal desire to preserve life and protect vulnerable individuals at all costs. Ultimately, the conflict of opinion resides in people's beliefs about whether or not they own their life as this will inform their right to choose life or death.

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Canadian Definitions of Medically Assisted Dying

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Canadian Definitions of Medically Assisted Dying

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Medical assistance in dying: A situation where a person seeks and obtains medical help to end their life.

Assisted suicide: Where a medical professional gives or prescribes a substance that an individual can self-administer to cause their own death.

Voluntary euthanasia: Where a medical professional directly administers a substance that causes the death of the person who has requested it.

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Social construction of death

Medicalization of death

Social contagion of suicide

Health care abuses (cost containment, error in prognoses and diagnoses and other external pressures)

Capacity and informed consent

Vulnerable populations at risk (elders, disabled)

Pro life sentiments that respect for life should be maintained:

"You are not your own, for you were bought with a price. Glorify God in your body" (NLT, 6:19–20).

Giving up on recovery too early

Logical discrepancy in fighting for autonomy and "limiting access to euthanasia to carefully regulated circumstances” (Godard, p. 317, 2015).

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Autonomy

Violation of section 15 of the Canadian Charter of Rights and Freedoms (1982)

Lack of effectiveness in alleviating the suffering of individuals in palliative care