‘Assisted dying is our area, social work needs to own this’

Human rights abuses and unnecessary deaths could occur if social work is not at the heart of assisted dying legislation, the Scottish Association of Social Work (SASW) has warned.

SASW briefed MSPs before they voted on the Assisted Dying for Terminally Ill Adults (Scotland) Bill which passed an initial vote at Holyrood last month.

It warned the bill viewed assisted dying “exclusively through a health lens” which fails to acknowledge the “complex social contexts and potential inequalities” that could influence decisions.

Alison Bavidge, SASW’s national director, said as a result, psychosocial perspectives and understanding of people’s lived experience could be lost, presenting significant safeguarding risks.

“People should be having some kind of social work assessment to the process of assisted dying,” she said.

“We have specialist social workers attached to mental health detentions. In the justice system, if you are facing prison for the first time or are a younger adult, you have to have a social work assessment.

“We think it is potentially dangerous having only NHS and medical health governance of this. Where such important decisions are being made, there should be oversight from elsewhere. 

“Social workers are the experts in safeguarding. We can pick up on things like coercive control, and internalised feelings of lack of self-worth, when you coerce yourself because you have an ableist view of disability which makes you feel you should stop being a burden.”

In England and Wales, an amendment by bill sponsor Kim Leadbeater places decision-making in the hands of an expert panel, to include a social worker, instead of a High Court judge.

Scotland’s bill requires two doctors to independently verify someone is both terminally ill and has mental capacity to make a decision to end their life.

However, Bavidge said: “Protection issues and the complex dynamics of relationships and family life are not their bag. Social work needs to own this. We need to say, ‘This is not just a medical or health bag. 

“Social workers have these skills, the profession needs to own it and get really good at supporting people to work through really difficult decisions quickly and sensitively.”

Bavidge questioned whether there could be a danger of biases, particularly at a time of increased pressure on public finances. 

“The option of assisted dying can become easier than having conversations about all your options: what you still can do; how are you living; [asking] are there things that would give you less pain and just a little bit more joy today to make life worth living or bearable.”

Assisted dying legislation is passing through all UK parliaments, apart from Northern Ireland, with the Isle of Man set to be the first to legalise it.

Bavidge said it was vital social workers across the UK made their voice heard to ensure the legislation is safe.

“Everyone is convinced it is a health issue,” she said. “The diagnosis and terminology and discussions around capacity and the means of death are medical. 

“But everything else – the decision-taking, the working with families and loved ones – is a social work process. We need to own what is ours. 

“If you don’t do it properly there is risk of human rights abuse and unnecessarily early deaths. This is new work. With that comes the need for resources and training.”

Scotland’s bill, introduced by Liberal Democrat MSP Liam McArthur, was voted through at the first stage by 70 votes to 56 last month.

During the debate, Labour MSP and wheelchair user Pam Duncan-Glancy expressed concern that it could become “easier to access help to die than help to live”.

However, McArthur responded: “Denying dying Scots more choice will not enhance the lives of those with a disability.”

He also refuted concerns of a “slippery slope” widening the criteria of eligibility to assisted dying over time, stressing there would be a “strict eligibility criteria”.

Bavidge said such debates over the bill were vital and had raised real concerns.

“A year ago I thought people should simply be able to make their own decisions and have control of their own death,” she said. 

“However, having to think about what it really means – and the population that social work often has connection with, people who may be vulnerable and who have often led lives of trauma and poverty – I have more doubts about it being that simple.”

She added SASW would work with MSPs to introduce amendments to the bill to promote social work’s role.