By : Leonor Sierra, MSW candidate Stanislaus State University Physician-assisted end of life option act and California social workers: Are they ready: By : Leonor Sierra, MSW candidate Stanislaus State University

Leonor M. Sierra MSW graduate candidate at Stanislaus State University Education: Bachelor of Science in Criminal Justice Administration with a concentration in Management Experience: 17 years in Stanislaus County: Adult Services Child Protective Services Community: Founding Mother for a Latina Sorority at UC Berkeley: ELLA- focusing on giving back to minority communities

Why? Nicaragua – 02/2/2013 End of life care Family: Father Nicaragua – 02/2/2013 End of life care School: Stanislaus State University Social Welfare Policy & Services for Social Justice II- 2016 How to Die in Oregon? 2011 Documentary Work: Stanislaus County Adult Services In Home Supportive Services- 2016 Need in community……..

End of Life Self Determination California Social Workers The reality is that We are all born to die. Death is a part of every culture, religion and country. The population around the world is an aging one. Current had past movements for euthanasia have Strengthened public awareness of end-of-life decisions, and social workers can sometimes be at the Center of services for users’ who wish to cease living. Social workers offer a key resource in assisting client’s in understanding all options for choosing to end their lives. Social Workers

Physician-Assisted “Suicide” End of Life Euthanasia Physician-Assisted “Suicide” “Euthanasia (in which a doctor administers a lethal dose of medication to a patient) and physician-assisted suicide are illegal in most countries” There continues to be intense public debate and disagreement concerning the end of life options from a social, legal, and political perspective.

center of services for users’ who wish to cease living. The reality is that we are all born to die. Death is a part of every culture, religion and country. The population around the world is an aging one. Current and past movements for euthanasia have strengthened public awareness of end-of-life decisions, and social workers can often be at the center of services for users’ who wish to cease living. Social workers offer a key resource in assisting client’s in understanding all options for choosing to end their lives. Only the first 1:40 seconds of video

Support End of Life Options 8 –Western Countries 5-US States Belgium Canada Colombia Finland Germany Luxembourg The Netherlands Switzerland Oregon Vermont Washington Montana California Currently, there are only eight western countries (Belgium, Canada, Colombia, Finland, Germany, Luxembourg, The Netherlands, and Switzerland) that have legalized one or both of the practices (ProCon.org, 2016). Within the United States, there are only five states (Oregon, Vermont, Washington, California, and Montana) that offer physician-assisted suicide mandated by state law or a court ruling. On October 27, 1997, Oregon enacted the Death with Dignity Act which allows terminally ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. It took California 25 years to pass legislation allowing for the End of Life Option Act to pass in 2015, with the help of many clients, social workers, and legislators. (ProCon.org, 2016).

Self Determination Competence Autonomy Relatedness “A compassionate society does not allow people to suffer unnecessarily. It’s also about personal autonomy”, “This lets [people who are dying] make their own choices during the last stages of their lives,”. (Masci, 2013, p. 1-2). Talking point: Clients ? Family? SW involvement ?

The National Association of Social Work (NASW) Principle 1.02 Respect & Promote: Self Determination Identify & Clarify Goals Previous research has focused on misused practice and whether gaps exist in legislative safeguards. There is a need for further research on social workers' involvement and perceptions of clients' seeking death with dignity, retaining self-respect and a connection to their community in a person’s final days. The National Association of Social Work (NASW) Code of Ethics dictates that social workers’ ethical responsibilities to the client should utilize Principle 1.02 which encourages social workers to respect and promote the right of clients to self-determination and assist clients’ in their efforts to identify and clarify their goals. The previous research has focused on misused practice and whether gaps exist in legislative safeguards. There is a need for further research on social workers' involvement and perceptions with clients' seeking death with dignity, retaining self-respect and a connection to their community in a person’s final days. The National Association of Social Work (NASW) Code of Ethics dictates that social workers’ ethical responsibilities to the client should utilize under Principle 1.02 which encourages social workers to respect and promote the right of clients to self-determination and assist clients’ in their efforts to identify and clarify their goals. Talking points: Education? Resource? Partnership? Advocacy - ? Susan Eggman- SW

California Report: 191 referred to the medications. 111 prescribed patients opted to use end of life medication. 173 physicians wrote the prescriptions. No tracking –those who got denied Of those who died: 87% were 60 years or older 89.5% were white College educated Receiving hospice or palliative care and had health insurance Talking points: Took affect 06/2016- first six months since the law took affect Report: 191 to the medicine 111 prescribed patients opted to use end of life medication 173 physicians wrote the medications No tracking –those who got denied Of those who died 87% were 60 years or older Most were white College educated Receiving hospice or palliative care and had health insurance (California State Data on End of Life Option Act Confirms It is Working Well , 2017).

California-End of Life Option Act Patient 18 years or older Resident of California Diagnosed w/terminal illness with 6-month prognosis by the primary physician & confirmed by a consulting physician Individual has the physical & mental ability to self-administer the aid-in-dying drug Aid-in-dying drug A drug determined & prescribed by physician for a qualified individual, which the qualified individual may choose to self-administer to bring about his or her death due to terminal disease Primary Physician Must communicate all other options to the patient Recommend they inform their family of their decisions Give guidance on self -administration Talking points- What is missing? How do we educate? What do we know?

Social Worker What can we offer? Who do we serve? How do we engage? Pro active vs reactive? Talking points: What can we offer? Who do we service? How do we engage? Pro active vs reactive?

Research Questions: The purpose of this study is to both explore and describe California Social Workers perceptions and comfort levels regarding supporting clients who decide to end their lives with physician-assisted death (PAD). What are the attitudes of California social workers toward physician-assisted dying laws? Do California Social Worker feel prepared to have conversations and assist in decision making with patients that request PAD and why? What is their awareness and involvement in End of Life Option Act in California ? The purpose of this study is to both explore and describe what Californian Social Workers perceptions and comfortability level are regarding supporting clients who decide to end their lives with physician-assisted death (PAD) are. The study will address three research questions: 1) What are the attitudes of California social workers toward physician-assisted dying laws? 2) Do Californian Social Worker feel prepared to have conversations and assist in decision making with patients that request PAD and why? 3) What is their awareness and involvement in End of Life Option Act in California? Talking points: IHSS/ APS CPS Community Partners

Perception of preparedness Purpose of Survey Understanding attitudes knowledge involvement Factors Perception of preparedness All social workers, regardless of practice settings, will inevitably work with clients’ facing terminal illness, death, grief, and bereavement. Social Workers use their expertise, culture, awareness and education to engage this population by providing support, education, resources, and intervention appropriately. This study examines the social worker’s perception and knowledge of the End of Life Option Act passed in 2015 in California, authorizing an adult who meets certain qualifications, and who has been determined by his or her attending physician to be suffering from a terminal disease to make a request for a drug prescribed pursuant for ending his or her life (End of Life Option Act, 2016). Talking points: Social Justice- ? Advocacy Education? Outreach?

Are you ready? Why important? I ask you, Are California social workers Ready? What is missing? What we need to improve Who are we missing- younger generation? Minorities? Uninsured?

CCASSC & Partners Thank you !!!!!!! Contact information : lsierra1@csustan.edu

References California State Data on End of Life Option Act Confirms It is Working Well. (2017, June 27). Compassion & Choices, p. 1. Retrieved from http://www.prnewswire.com/news-releases/california- state-data-on-end-of-life-option-act-confirms-it-is-working-well-300480790.html. Care New England. (2014, April 11). Fear of End-of-Life Care Discussions [Video file]. Retrieved June 26, 2017, from https://youtu.be/A25c15PVl-8. CBS Sacramento. (2016, June 08). California End-of-Life Law Begins on Thursday [Video file]. Retrieved June 26, 2017, from https://youtu.be/ZODWNriHljc. Masci, D. (2013, November 21). To end our days. Pew Research Center's Religion & Public Life Project, p. 1-2. Retrieved from http://www.pewforum.org/2013/11/21/to-end-our-days/#.

Now This. (2015, October 30). Where Are the Best Countries To Die Now This. (2015, October 30). Where Are the Best Countries To Die? [Video file]. Retrieved June 26, 2017, from https://youtu.be/urxt0BOnvuo. ProCon.org. (2016, July 20). Euthanasia & physician-assisted suicide (PAS) around the world. Retrieved from http://euthanasia.procon.org/view.resource.php?resourceID=000136