From the Executive Director

After the End of Life Care

By Janlee Wong, MSW

Recent cases in the news involve a dead 13-year-old kept on a ventilator by her family and a 33-year-old dead Texas woman who was pregnant before her death and kept on a ventilator by the hospital. Politics have entered the discussion on these cases as they have become media sensations. How would social work view these cases?

The media and many of those involved have specified that these individuals are “brain dead.” While the established medical community equates brain dead with completely and irrefutably dead, others may believe that the “brain dead” aren’t dead because their bodies can be kept alive by artificial means.

In a review of NASW’s policy book Social Work Speaks, there is nothing that speaks to cases like this. There is a policy statement of “End of Life Care,” and the policy direction for social workers is that of client self-determination. In the case of the 13-year-old, legally, the parents have health care decision-making authority. In the Texas case, the husband says his late wife communicated her wishes that no heroic measures be taken but the hospital says state law takes precedent.

While the “End of Life Care” policy statement doesn’t address these situations, it does have some important guidance for social workers that may apply to these situations. They include facilitating family understanding of aspects and options in the situation; providing emotional, psychological, social and spiritual care and services; cultural diversity awareness; being knowledgeable about institutional and public policies; acting as a liaison with the health care team; self-awareness of personal values and feelings, and referral to services and resources.

What happened and what will happen in these case raises serious questions about after the end of life care. It’s a new frontier for everyone involved in social work. Unlike coma cases, these individuals are dead. We have the means to keep the body going long after death. Should we and why?