Social Workers' Attitudes Toward Medical Aid in Dying: A Modified Systematic Review

Background and Purpose

Medical aid in dying (MAID) describes the procedure wherein terminally ill, competent patients self-administer a physician-prescribed medication to hasten their death. Currently, MAID is legal in 12 U.S. jurisdictions. Recent trends suggest legalization will expand. Although social workers (SWs) are core members of interdisciplinary care teams, there is limited research—and no systematic review—on their attitudes toward MAID. This paucity is concerning, since the primary drivers of MAID utilization are psychosocial in nature (e.g., self-determination) and since SWs specialize in the psychosocial aspects of care. To fill this gap in the literature, this systematic review posed three research questions: (RQ₁) What are SWs’ attitudes toward MAID? (RQ₂) How do SWs’ MAID attitudes compare to other professions’ attitudes? (RQ₃) What variables are associated with MAID support in SWs?

Methods

CINAHL, PsycINFO, and PubMed were searched (6/6/2020) using the following Boolean phrase: “social workers” AND attitudes AND (“aid in dying” OR “assisted death” OR “assisted suicide” OR “death with dignity” OR “euthanasia” OR “legally accelerated death” OR “medical aid in dying”). Inclusion criteria were (a) peer review, and (b) quantitative methods. Exclusion criteria were (a) fully qualitative methods, (b) not focused on MAID, (c) not focused on social workers’ attitudes, and (d) review, conceptual, or commentary papers.

All MAID attitude measures were researcher-constructed. Pertinent results were extracted. Descriptive results are presented. Raw metrics were converted to effect sizes for bivariate results. Article reporting prevented conversion for multivariate analyses.

Results

Ten studies (N = 3,390) met inclusion criteria. RQ₁ results indicated broad support for MAID—grouped into either “general and legal” (range = 46.8%–78.2%; S1, S3, S4, S6, S8, S9) or “ethical and moral” (range = 50.0%–74.2%; S1, S3, S8, S9)—in SWs. Circumstances conditioning support (e.g., physical vs. mental illness) and hesitations (e.g., potential repercussions) were noted. Three studies (S5, S7, S10) conducted difference testing by professional background (RQ₂). SWs were more supportive of MAID than nurses (d = 0.40–0.86; S7, S10) and physicians (d = 0.63; S10). S5’s results were nonsignificant. Due to article reporting, only two (S2, S3) of the four studies (S2, S3, S7, S9) assessing factors associated with MAID support through multivariate analyses could be compared (RQ₃). Standardized regression coefficients revealed that increased religiosity (β = −0.26–−0.24; S2, S3), increased concern about abusing MAID (β = −0.21; S2), and increased years working in long-term care (β = −0.12; S3) were associated with decreased MAID favorability. Increased attitudes toward SWs’ role in MAID (β = 0.57; S3), ethics training (β = 0.22; S2), MSW attainment (β = 0.19; S2), and increased attitudes toward voluntary end-of-life decisions (β = 0.10; S3) were associated with increased MAID favorability.

Conclusions and Implications

These results provide the first systematic review of SWs’ attitudes toward MAID. SWs appear more favorable than other professions. The factors associated with SWs’ MAID attitudes corroborate prior research with other professions. Measurement inconsistency complicated cross-study comparison. Future research should prioritize measurement development to further examine the factors associated with MAID attitudes.