What role does the healthcare social worker play in the decision to perform euthanasia on a patient who is being influenced by third parties?

In jurisdictions where euthanasia is legal, strict safeguards are in place to ensure that the decision to end one’s life is made autonomously by the patient and not under pressure. The patient’s explicit, voluntary consent is an essential legal and ethical requirement. For example, Dutch law specifies that “only the patient can request euthanasia” and that any request “must have been made without undue influence from others,” with physicians required to verify no such influence is present (government.nl). Nevertheless, patients may sometimes be vulnerable to influence or coercion from family members or others in their social circle. This raises a critical ethical dilemma: how to ensure the patient’s choice is truly voluntary. Healthcare social workers play a pivotal role in this context. As members of multidisciplinary teams, they are tasked with safeguarding patient autonomy, assessing voluntariness, and intervening if there are signs that a patient’s wish for euthanasia is being influenced by third parties. This report examines the ethical responsibilities of social workers in such scenarios, the legal frameworks and safeguards in countries that permit euthanasia, practical approaches (including case examples) for handling suspected coercion, and international perspectives on addressing this issue.

Ethical Responsibilities of Social Workers: Ensuring Autonomy and Voluntariness

Social work ethics emphasize respect for the client’s self-determination and informed consent. The National Association of Social Workers (NASW) Code of Ethicsexplicitly states that “Social workers respect and promote the right of clients to self-determination” (socialworkers.org). In end-of-life decision-making, this means the social worker must ensure that a patient’s desire for euthanasia is truly their own choice, made with full information and capacity, and not the result of external pressures. Social workers have a duty of care to verify that the patient’s consent is informed and voluntary. NASW policy guidelines on end-of-life care underscore that in jurisdictions allowing assisted dying, laws should “provide clear criteria to determine whether the individual considering [assisted dying] is providing free, informed consent and is not being subjected to coercion” (socialworkers.org). Likewise, policies call for safeguards so that life-ending procedures occur only when the patient gives fully informed, voluntary consent (socialworkers.org).

In practice, upholding autonomy involves thorough psychosocial assessment and advocacy. Social workers are trained to evaluate the patient’s mental capacity, understanding of alternatives, and the influence of psychosocial factors on decision-making. They must be alert to signs that the request for euthanasia might stem from treatable conditions like depression, unmanaged pain, or external pressures rather than the patient’s genuine, enduring wish. Standards for social work practice in palliative care stress that social workers should assess and address depression, anxiety, cognitive impairments, and family dynamics in end-of-life cases (researchgate.net). Indeed, comprehensive guides such as Chochinov & Breitbart’s Handbook of Psychiatry in Palliative Medicine (2009) emphasize evaluating psychosocial factors and decision-making capacity in patients considering hastened death (researchgate.net). By identifying such factors, social workers fulfill their ethical responsibility to ensure the patient’s decision is well-informed and free of undue influence.

Another key ethical responsibility is protecting vulnerable patients from harm. While respecting autonomy is paramount, social workers must also intervene if a patient’s choice appears to be coerced or not truly voluntary. The NASW Code of Ethics permits limiting self-determination when a client’s actions pose a serious risk of harm to self or others (socialworkers.org). In the context of euthanasia, if a social worker suspects that a patient is being manipulated by others (for example, a frail elder feeling pressured by family to “not be a burden”), the social worker is ethically bound to act – this could mean pausing the decision process, alerting the healthcare team or an ethics committee, and, if necessary, involving protective services or legal authorities. Ensuring voluntariness is thus a core part of the social worker’s advocacy for the patient’s rights and well-being. As one social work scholar noted, social workers in jurisdictions with assisted dying see their role as “fostering the client’s self-determination” by empowering clients to make autonomous end-of-life decisions while providing information and support (Zaleski, 2010) (journals.library.columbia.edu). In summary, the ethical mandate for social workers is to uphold the patient’s autonomous choice and dignity, and to prevent any form of coercion from undermining that choice.

Legal Safeguards in Euthanasia Laws Against Third-Party Influence

Countries that have legalized euthanasia or physician-assisted dying have built in strict legal criteria to protect patient autonomy. These legal frameworks explicitly prohibit third-party induced or coerced decisions. Healthcare social workers must be knowledgeable about these laws to ensure all safeguards are observed (researchgate.net). Below is an overview of how several countries address voluntariness and third-party influence in their euthanasia laws:

Netherlands

The Netherlands’ Termination of Life on Request and Assisted Suicide (Review Procedures) Act (2002) sets out stringent due care criteria. A central requirement is that the patient’s request be “voluntary and well-considered” (government.nl). Dutch law makes it clear that onlythe patient can initiate the request: “A request for euthanasia made by another person on behalf of the patient cannot be granted” (government.nl). Physicians must ensure the request is made free of any outside pressure: “The request must have been made without any undue influence from others. The physician must be satisfied that there has been no such influence.” (government.nl). In practice, Dutch physicians typically have multiple discussions with the patient (often in the presence of a social worker or other team members) to ascertain that the wish to die is consistent and internally motivated. The law also requires involvement of at least one other independent physician to confirm that criteria are met (government.nl), which provides an additional check on voluntariness. Healthcare social workers in the Netherlands support this process by contributing psychosocial insights – for instance, they may help evaluate family dynamics or the patient’s emotional state to ensure the request is not a result of subtle familial pressure. Dutch euthanasia review committees retrospectively assess all cases, and any indication that a patient was under third-party duress would mean the due care criteria were not fulfilled (potentially exposing the physician to legal consequences). Thus, the Dutch system relies on both front-line safeguards (the attending physician’s careful assessment, often informed by a social worker’s input) and oversight mechanisms to enforce the principle that euthanasia is performed only when the patient’s autonomy is intact.

Belgium

Belgium’s euthanasia law (enacted 2002) is similarly explicit about voluntariness. Under the Belgian Act, a physician may perform euthanasia only if a range of conditions are met, first and foremost that “the patient’s request is voluntary and not the result of any external pressure”. The law further requires that the request be well-considered, repeated, and made in writing (Smet et al., 2010) (pmc.ncbi.nlm.nih.gov). In other words, Belgian law recognizes that a single off-hand request could be made under momentary influence, so it mandates that the patient confirm their wish multiple times, including in a written document, to prove persistence and independence of the decision (Smet et al., 2010) (pmc.ncbi.nlm.nih.gov). The “no external pressure” clause directly addresses the concern of third-party influence: if a physician even suspects the patient is being coerced or unduly swayed by family, the legal criteria are not satisfied and euthanasia cannot proceed. To bolster this safeguard, Belgium requires a second physician (and a third in non-terminal cases) to be consulted to double-check that all conditions – including the absence of coercion – are met (Smet et al., 2010) (pmc.ncbi.nlm.nih.gov). Research by Tinne Smets and colleagues (2010) reviewing euthanasia cases in Belgium found that substantive due care requirements (like voluntariness of the request and the patient’s medical condition criteria) were almost always adhered to (Smet et al., 2010) (pmc.ncbi.nlm.nih.gov). This indicates that Belgian physicians, often working with healthcare teams, take steps to ensure the request truly originates from the patient’s own free will. Social workers in Belgium’s palliative care teams play a supportive role by, for example, engaging with the patient privately to explore their motivations and by observing family interactions. If a social worker detects familial pressure (e.g., a relative repeatedly suggesting that the patient “would be better off” ending their life), they have a professional obligation to raise this concern with the medical team. The Belgian law’s emphasis that the request “must not result from external pressure” (Smet et al., 2010) (pmc.ncbi.nlm.nih.gov) provides legal backing for social workers and doctors to halt the euthanasia process if any doubt arises about coercion.

Luxembourg

Luxembourg legalized euthanasia and assisted suicide in 2009 (Law of 16 March 2009 on the Right to Die with Dignity), taking much of its inspiration from the Belgian model. The law requires that the patient be an adult with decision-making capacity and that their request is made voluntarily, after due reflection, and on multiple occasions, and “does not result from external pressure.”According to the Luxembourg Chamber of Deputies summary, a physician must ensure “the request is voluntary, thought through, and repeated and does not result from external pressure.” (loc.gov)

Only if all these conditions (as well as medical criteria of incurable, unbearable suffering) are fulfilled can the act proceed (loc.gov). The law also instituted a National Commission for control and evaluation, which reviews cases after the fact (loc.gov). For healthcare social workers in Luxembourg, their role aligns with these legal safeguards: they help ascertain that the patient has considered the decision carefully over time and is not acting under duress. Practically, a social worker may, for instance, talk with the patient about their reasons for the request – ensuring reasons like “my family wants me to” or signs of fear of being a financial burden are brought to light. If such issues do emerge, the social worker can address them (perhaps by arranging family meetings to discuss the family’s feelings openly, or connecting the family with resources to alleviate caregiver stress) rather than allow those unspoken pressures to push the patient toward euthanasia. The clear legal prohibition of externally pressured requests empowers social workers to be firm in advocating for the patient’s true wishes.

Spain

Spain is one of the more recent countries to legalize what it terms “help to die” (euthanasia and physician-assisted suicide were legalized by Organic Law 3/2021, effective June 2021). The Spanish law contains robust language about ensuring the decision’s freedom. It explicitly states that the legal framework is designed to “safeguard the absolute freedom of the decision, ruling out external pressure of any kind.” (wfrtds.org). In the law’s preamble, Spanish legislators emphasize that a request to end one’s life must occur with “absolute freedom, autonomy and knowledge,” protected from “pressures of all kinds that may come from unfavorable social, economic or family environments, or even from hasty decisions.” (wfrtds.org). To uphold this, Spain’s process for approving euthanasia includes multiple steps and oversight: a patient must make two formal requests (with a brief interval between), undergo evaluation by two doctors, and the case is reviewed by an interdisciplinary Guarantee and Evaluation Commission in the autonomous region (nbcbayarea.com). This commission – essentially an external assessment panel – looks at each case to confirm that legal criteria (including absence of third-party coercion) are satisfied before giving the final go-ahead. From a healthcare social worker’s perspective, Spain’s approach means that by the time a case gets to the commission, the social worker should have been involved in supporting the patient and flagging any concerns. Social workers in Spanish hospitals or clinics will often be part of the care team helping the patient navigate the request process, ensuring the patient understands they have alternatives (such as palliative care) and that they are under no obligation to choose euthanasia for anyone else’s sake. The explicit mention of potential family or economic pressures in Spain’s law (wfrtds.org) acknowledges the real-world factors a social worker is vigilant about – for example, an elderly patient might feel compelled to request euthanasia due to feeling like a burden on their children or due to financial hardship. The law requires a “qualified and external assessment” of each request (wfrtds.org), which in practice means social workers may sometimes present their psychosocial findings to the evaluating commission or contribute documentation about the patient’s social context. By embedding these checks, the Spanish system formally recognizes and institutionalizes what social workers strive to ensure: that the decision to die is the patient’s own, free from subtle or overt coercion.

Legal Safeguards Summary: Across these countries, despite differences in procedure, the common thread is a legal commitment to patient autonomy and voluntariness. All require that the request for euthanasia be made by the patient, multiple times (to show consistency), and be free of third-party influence (Smet et al., 2010) (pmc.ncbi.nlm.nih.gov) (loc.gov). Typically, at least two physicians evaluate the request, and often there is an additional layer of review (regional committees or commissions). These measures are intended to screen out situations of coercion or undue influence. For healthcare social workers, knowing the law is not just academic – it directly informs their practice. The laws effectively give social workers a mandate to be on the lookout for family or social pressures: if such pressures exist, proceeding with euthanasia would violate the law, and the social worker must advocate for delaying or cancelling the procedure. In this way, legal frameworks and ethical social work practice converge on the same point: the patient’s uncoerced choice is sacrosanct.

Practical Approaches to Suspected Coercion: Social Work Interventions and Case Examples

Healthcare social workers employ a variety of practical strategies to ensure a patient’s euthanasia decision is voluntary and to intervene if coercion is suspected. These strategies are grounded in clinical skills (assessment, counseling, mediation) and often follow the ethical and legal principles discussed above. Some key approaches include:

Comprehensive Psychosocial Assessment: Social workers conduct in-depth assessments of the patient’s mental, emotional, social, and familial situation. This involves evaluating the patient’s decision-making capacity and looking for red flags of undue influence. For example, the social worker will assess if the patient is suffering from depression or feelings of guilt and burdensomeness that might be clouding their judgment. Research shows that a “sense of burden to others” is a significant concern for many terminally ill patients (reported by 19–65% of patients in one review) (Wilson et al., 2005) (semanticscholar.org). If a patient expresses a wish to die primarily because “I don’t want to be a burden on my family,” a social worker recognizes this as a potential sign of indirect coercion (internalized pressure). The social worker can then address this by working with the patient and family to alleviate the burden (e.g. arranging additional caregiving help or counseling the family to reassure the patient of their willingness to care). In one case example from Canada, a social worker recounts how many requests for assisted death have a “psychosocial dimension,” and that social workers are “uniquely equipped to understand the personal and contextual factors informing the choice” (Antifaeff, 2019). By understanding context, the social worker can differentiate between a well-considered autonomous wish and a wish driven by problematic factors.
Private, Ongoing Conversations with the Patient: It is standard practice for social workers (and other team members) to speak with the patient one-on-one, without family present, at multiple points during the decision process. These conversations provide a safe space for the patient to voice any ambivalence or external pressures. The social worker might gently ask questions like, “How did you come to this decision? What do your loved ones feel about it? Have you felt anyone pushing you in either direction?” The goal is to discern the authenticity of the patient’s wish. If a patient hints that a relative has been encouraging euthanasia (or conversely, pressuring them not to choose it against their will), the social worker will recognize a need to pause. As Jose W. B. Melo (2023) describes, “social workers make sure that all legal and moral rules are followed” and “stop family members, healthcare providers, or other outsiders from forcing the patient to do something”. This protective function may involve informing the rest of the medical team of the undue influence and recommending psychological evaluation or an ethics consultation to further explore the situation.
Engaging an Ethics Committee or Safeguarding Team: Most hospitals or healthcare systems have ethics committees or case conferences, especially for difficult end-of-life decisions. If a social worker suspects coercion that is not resolved by initial counseling (for instance, a domineering family member who continues to insist on the patient choosing euthanasia), the social worker can refer the case to an ethics panel. This interdisciplinary panel (often including ethicists, physicians, social workers, pastoral care, etc.) can meet with the patient (and sometimes the family) to ensure the decision is voluntary and ethically justifiable. Bringing in an ethics committee serves two purposes: it provides a broader support to the patient (so the patient hears reaffirmation that their own wishes are what matter), and it sends a clear message to any coercive individuals that the healthcare team is monitoring for undue influence. In severe cases of suspected abuse or exploitation – for example, if a family member appears to be coercing the patient for financial gain (perhaps anticipating an inheritance or relief from caregiving duties) – the social worker may activate formal safeguarding protocols. In many jurisdictions, social workers are mandated reporters of elder abuse or exploitation. Coercing someone into euthanasia could fall under such mandates. The social worker might confidentially inform adult protective services or analogous authorities, who can then investigate or take protective action while the healthcare team puts the euthanasia request on hold.
Counseling and Mediation with Family: Family members are often part of end-of-life discussions – sometimes they are supportive of the patient’s wishes, and other times they may disagree or exert influence. Healthcare social workers are skilled in family counseling and mediation. If a family member is (perhaps unintentionally) pressuring the patient (e.g., repeatedly saying things like “Don’t you think it’s time to let go?”), the social worker can intervene by having a frank but compassionate discussion with that family member. The social worker would explain the importance of allowing the patient to decide free from influence, and help the family member process their own fears or grief that might be leading them to push the patient. On the other hand, if family members oppose the patient’s euthanasia wish and attempt to guilt-trip them into continuing treatment, the social worker also helps navigate that conflict – reinforcing to the patient that it is their decision while trying to address the family’s concerns. In all cases, open communication facilitated by the social worker can reduce the likelihood of covert coercion. As part of this process, social workers often provide emotional support and education to families, helping them understand the patient’s perspective and the legal rights of the patient. This family-focused work can neutralize potential sources of pressure, creating a more supportive environment for whatever the patient ultimately chooses.
Assessment of Capacity and Ensuring Comprehension: Because voluntariness is only meaningful if the patient has decision-making capacity, social workers also work with physicians to ensure the patient is cognitively capable of making the euthanasia decision. They may use capacity assessment tools or involve neuropsychologists if needed. If any doubt exists about the patient’s capacity or susceptibility to undue influence (for example, a patient with early dementia who has a very forceful caregiver making suggestions), the team may delay the decision and seek further evaluation. Social workers advocate for the patient’s voice to be heard clearly in these situations – if capacity is borderline, that’s a signal to be especially cautious. As a practical measure, social workers might suggest the patient speak for themselves in a recorded manner (such as writing a personal statement or letter about why they want euthanasia) at a time when they are free of outside contact, to have evidence of their unpressured intent.

These interventions are illustrated in real-world scenarios. Consider a case example that highlights the challenges of detecting coercion: In Queensland, Australia (where euthanasia was illegal at the time), an elderly woman’s husband covertly pressured her into suicide for financial gain. After her death, it was revealed in court that he had manipulated her into thinking suicide was her only option and even assisted her in the act, hoping to claim insurance money (catholicweekly.com.au). He was convicted for this coercion. Notably, even a solicitor who had met the woman privately to discuss her will “did not think that she was being unduly influenced” at the time (catholicweekly.com.au), demonstrating how difficult it can be to recognize coercion when it is expertly concealed. While this tragic case did not occur under a legal euthanasia framework, it underscores a critical point for healthcare providers: subtle coercion can be easily overlooked if one is not vigilant. A healthcare social worker’s training in “assessing and managing risk, including the use of statutory powers… where no other options are adequate” is invaluable in such contexts (communitycare.co.uk). The social worker would be attuned to inconsistencies between the patient’s words and affect, or any signs of fear when certain individuals are present, which might have flagged the need for deeper investigation.

In regions where euthanasia is legal, we fortunately have formal processes to catch such situations – for example, multiple interviews and waiting periods that allow a pressured patient opportunities to speak out. Social workers bolster these processes by providing patients with reassurance that expressing any doubt or discomfort will not invalidate their worth or cause trouble; rather, it’s part of ensuring their true wishes are honored. In summary, the practical role of social workers involves acting as both detective and advocate – detecting undue influences in the patient’s social environment, and advocating for the patient’s authentic desires through counseling, team interventions, and if needed, legal safeguarding measures. As one UK social work association has outlined, this includes “making an independent assessment of the individual in the context of their wishes, values and relationships, and ensuring that they are 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,” as well as “taking timely and sensitive action to safeguard anyone who was subject to… coercion.” (communitycare.co.uk).

International Perspectives and Comparisons

Around the world, countries have approached the role of healthcare professionals (including social workers) in assisted dying with different frameworks, but the common challenge remains: how to safeguard against coercion while honoring patient autonomy. An international comparison reveals varying strategies:

Regulatory Systems vs. Prohibition: In countries where euthanasia or assisted suicide remains illegal (for example, most of the world, including the majority of U.S. states, many Asian and African countries), any assistance in dying happens covertly if at all. This lack of regulation poses risks that coercion could occur under the radar. As noted in a British Medical Journal analysis, “the secrecy in which [euthanasia] takes place in countries where it is illegal prevents the development of guidelines and standards for careful practice,” whereas legalization “involves the creation of a regulatory system for societal control and the defining of a standard for careful medical practice.” (Smet et al., 2010). In other words, countries like the Netherlands and Belgium, by legalizing and regulating euthanasia, have been able to formalize safeguards (mandatory second opinions, reporting requirements, review committees, etc.) that help detect and prevent third-party influence. In contrast, where it is banned outright, any cases of coerced death may be harder to detect or might only come to light in extreme cases like the Queensland example above. This perspective is echoed by ethicists who argue that well-crafted assisted dying laws actually protect patient autonomy better than a blanket prohibition, by bringing the practice into the open and under oversight (Merrell, 2023) (psychiatrictimes.com).
Role of Healthcare Social Workers in Different Systems: In countries with established euthanasia laws (e.g., Netherlands, Belgium, Luxembourg, Canada), social workers typically function as part of palliative or end-of-life care teams. Their role is not usually delineated explicitly in legislation, but in practice their involvement is considered best-practice to ensure holistic care. For instance, in Canada (which legalized medical assistance in dying in 2016), social workers often serve as MAID coordinators or support specialists, helping patients navigate the process and addressing psychosocial needs. Studies of Canadian social workers indicate that many have been directly involved in MAID cases – one survey found 141 of 367 social workers had participated in some aspect of MAID, ranging from providing information to being present at a hastened death (Bravo et al., 2023). Their presence provides an additional layer of communication and monitoring for voluntariness. By comparison, in the United States (in the handful of states that allow physician-assisted suicide, such as Oregon, Washington, etc.), the statutes don’t mandate a social work assessment – they focus on physician responsibilities. However, hospice social workers in those states often naturally step into a similar safeguarding role, ensuring the patient isn’t being unduly driven by family or economic fears. The ethos of social work – upholding client self-determination and welfare – remains consistent across these settings, even if the formal structure varies.
Emerging Debates and Proposals: In countries currently debating legalization, the role of social workers as safeguards against coercion is gaining attention. For example, in the United Kingdom (where assisted dying is not yet legal as of 2025), the Association of Palliative Care Social Workers has taken a proactive stance. In 2024, anticipating possible law changes, this professional body issued a position statement recommending that if assisted dying becomes legal, a dedicated “approved palliative care professional” role should be created – envisioned initially as a specialist social worker who would “assess and support people seeking an assisted death.” (communitycare.co.uk) The recommended functions of this role are explicitly aimed at preventing undue influence: verifying mental capacity, having in-depth discussions with the patient and those close to them, ensuring all alternative care options have been explored, and “ensuring ... fully informed decision without undue influence by others or as a result of concerns about ... caring for them,” plus taking action if any coercion or neglect is detected (communitycare.co.uk). These proposals underscore that the international social work community sees itself as integral to safeguarding autonomy in assisted dying processes. Even in places where the law has yet to change, social workers are preparing to fill a protective role. The UK proposal is notable for building in a social-work-led safeguard alongside medical assessments and even judicial review (the bill under debate also considered having a High Court judge verify criteria) (communitycare.co.uk). This multi-tiered approach – medical, psychosocial, and legal – could become a model in other countries deliberating similar laws, reflecting lessons learned internationally.
Cultural and Systemic Differences: Different countries also have cultural variations in family roles and decision-making, which affect how third-party influence is viewed. For example, some cultures place a strong emphasis on family consensus for major decisions, potentially blurring the line between support and pressure. Healthcare social workers must navigate these nuances. In the Netherlands and Belgium, individual autonomy is culturally and legally prioritized, so a social worker can fairly directly insist that the patient’s voice prevails. In cultures where family involvement is expected in healthcare decisions (such as in parts of Southern Europe or Asia), social workers may need to employ especially sensitive approaches to ensure the patient’s personal wishes are honored without alienating the family. International guidelines on end-of-life care, such as those from the World Health Organization or International Federation of Social Workers, consistently highlight the importance of informed patient consent and recommend training health professionals to detect signs of coercion regardless of cultural context. Social workers around the world share knowledge through conferences and literature to improve practices – for instance, case studies from Belgium or Canada (where assisted dying is practiced) are being discussed in countries like Germany or New Zealand that are considering legalization, to understand how to balance patient choice with protection of the vulnerable.

In summation, internationally there is a convergence on the principle that euthanasia or assisted dying must be a truly voluntary act, and that a combination of legal safeguards and professional diligence is needed to uphold that principle. Countries that allow euthanasia have implemented formal checks (multiple requests, independent assessments, review committees) that create a structure within which social workers operate as patient advocates. Countries without legalization are observing these models and increasingly acknowledging that should the practice be permitted, the inclusion of social workers in the process – particularly to address the social and ethical complexities – is not only beneficial but perhaps necessary. The cross-national dialogue in the field of palliative and end-of-life care continues to emphasize that protecting patient autonomy from undue influence is a universal concern, requiring ongoing vigilance and a compassionate, team-based approach.

Conclusion

Healthcare social workers serve as guardians of patient autonomy in the euthanasia decision-making process. Their role is multifaceted – part ethical steward, part counselor, part investigator. They are guided by a professional commitment to ensure that any decision to hasten death emerges from the patient’s own values and desires, free from coercion or manipulation. As illustrated, social workers actively uphold this commitment through careful assessment, patient and family counseling, and collaboration with medical and legal safeguards. In countries where euthanasia is legal (the Netherlands, Belgium, Luxembourg, Spain, and others), laws reinforce the social worker’s mandate by prohibiting externally influenced requests and requiring verification of voluntariness (government.nl) (Smet et al., 2010). Social workers in these settings work hand-in-hand with physicians to meet those legal and moral requirements, often uncovering psychosocial factors that physicians alone might miss. In scenarios where undue influence is suspected, social workers take decisive steps – whether it means convening an ethics review, delaying the process, or activating safeguarding authorities – to protect the patient. Internationally, there is a clear trend toward recognizing the importance of these measures. As more healthcare systems grapple with the ethics of assisted dying, the experiences from pioneering countries provide valuable lessons. One key lesson is that having skilled professionals like social workers involved in the process adds a layer of protection for patients, strengthening confidence that “voluntary” truly means voluntary.

In the final analysis, the presence of a diligent healthcare social worker can be one of the strongest assurances that a patient’s choice for euthanasia is an expression of their own autonomous will. By championing informed consent, speaking up against coercion, and supporting patients and families through the profound emotional journey of end-of-life decisions, social workers uphold both the ethical ideals of their profession and the humane values underpinning euthanasia laws. As a result, patients can be better assured that if they choose a “good death,” it is chosen freely – a decision respected and safeguarded by an attentive, caring team around them.

References

Library of Congress (2008). “Luxembourg: Right to Die with Dignity.” Global Legal Monitor. (loc.gov)

Merrell, D. A. (2023). “How Not to Think About the Autonomy-Based Argument for Physician-Assisted Suicide.” Psychiatric Times, 40(2).

Antifaeff, K. (2019). “Social Work Practice with Medical Assistance in Dying: A Case Study.” Health & Social Work, 44(3), 185–192. https://doi.org/10.1093/hsw/hlz002

Association of Palliative Care Social Workers (UK) (2024). Position Statement on Assisted Dying. (communitycare.co.uk).

Bravo G, Delli Colli N, Dumont I, Bouthillier ME, Rochette M, Trottier L. Social workers' experiences with medical assistance in dying: Survey findings from Quebec, Canada. Soc Work Health Care. 2023;62(5):193-205. doi: 10.1080/00981389.2023.2210624. Epub 2023 May 14. PMID: 37183409.

Chochinov, H. M., & Breitbart, W. (Eds.). (2009). Handbook of Psychiatry in Palliative Medicine (2nd ed.). Oxford University Press.

Government of the Netherlands (2019). “Is euthanasia allowed in the Netherlands?” Government.nl(government.nl).

National Association of Social Workers (2008). NASW Standards for Social Work Practice in Palliative & End-of-Life Care. NASW.

National Association of Social Workers (2021). NASW Code of Ethics. NASW.

Organic Law 3/2021 (Spain) – English Translation via World Federation of Right to Die Societies. (wfrtds.org).

Rodrigues, M. (2020). “Case reveals coercion to die.” The Catholic Weekly(Australia, July 1, 2020). (catholicweekly.com.au)

Smets, T., Bilsen, J., Van den Block, L., Cohen, J., Van Casteren, V., & Deliens, L. (2010). “Euthanasia in patients dying at home in Belgium: interview study on adherence to legal safeguards.” British Journal of General Practice, 60(573), e408-e414.

Wilson, K.G., Curran, D., & McPherson, C.J. (2005). A Burden to Others: A Common Source of Distress for the Terminally Ill. Cognitive Behaviour Therapy, 34, 115 - 123.

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