Supporting choice, preventing harm: Social workers’ knowledge gaps and ethical challenges with assisted dying in Aotearoa New Zealand

Authors

DOI:

https://doi.org/10.11157/anzswj-vol37iss2id1233

Keywords:

assisted dying, medically assisted dying, social work ethics, MAiD

Abstract

INTRODUCTION: This study is the first of its kind to explore social workers’ perspectives on assisted dying following the legislation of the End of Life Choice Act 2019 in Aotearoa New Zealand. The topic is ethically complex and legally regulated, making social workers’ perspectives particularly valuable since they may increasingly engage with people facing end-of-life decisions in settings like hospitals, hospices, aged care facilities, and palliative care programmes.

METHOD: Data were collected through an anonymous online qualitative survey from September to December 2023, capturing a diverse range of views from 120 social workers in Aotearoa New Zealand.

FINDINGS: Three themes were constructed from the data using Proudfoot’s (2023) hybrid thematic coding strategy: 1) “some semblance of choice”: navigating client autonomy, 2) “be careful”: managing ethics, coercion and risk, and 3) “just my own research”: limited knowledge and training. Participants noted the tension between upholding clients’ rights to choose while being mindful of personal and external pressures that may influence decisions, especially among vulnerable groups. Participants also expressed a need for more precise guidelines and more training to handle the ethical dilemmas posed by assisted dying in a manner that is thoughtful, competent, and appropriate.

IMPLICATIONS: These findings suggest that social workers play a crucial role in mediating between client autonomy and protection. By understanding the ethical challenges and systemic barriers in assisted dying, social workers can better advocate for transparent policies and improved training, equipping them to provide better support to clients in their end-of-life decisions.

Downloads

Download data is not yet available.

Author Biographies

  • Laura Ann Chubb, School of Social Practice University of Auckland, Aotearoa New Zealand.
    Laura is a Senior Lecturer at the University of Auckland. With over 14 years of community research experience, she focuses on the intersection of social and cultural issues in global health, wellbeing, education and community development. Laura specialises in creative approaches to data collection and analysis that emphasise the representativeness of participants.
  • Harriet Nickels, School of Social Practice University of Auckland, Aotearoa New Zealand.

    Harriet Nickels is an undergraduate student completing a Bachelor of Social Work at the University of Auckland who held a summer research scholarship as student researcher for this study.

  • Liz Beddoe, School of Social Practice University of Auckland, Aotearoa New Zealand.

    Liz is a Professor of Social Work at the University of Auckland in New Zealand. With 14 years in health social work, Liz’s teaching and research interests include critical perspectives on social work education, professional supervision, feminist social work, and reproductive justice.

  • Georgina Guild, School of Social Practice University of Auckland, Aotearoa New Zealand.

    George is the Programme Director for the Bachelor of Social Work at the University of Auckland. With approximately 20 years of social work experience, her teaching spans key areas such as people in context, theories and skills, ethics, and professional supervision.

  • Eileen Joy, School of Social Practice University of Auckland, Aotearoa New Zealand.

    Eileen is a Registered Social Worker, Counsellor, Professional Teaching Fellow and a current Royal Society Te Apārangi Mana Tūāpapa fellow at the University of Auckland. Eileen is an expert in how knowledges are used in child welfare work and policy. Her research interests include mother blame, intersectionality, critical developmental psychology, gender and sexuality, and feminist and queer theory.

References

Althubaiti, A. (2016). Information bias in health research: Definition, pitfalls, and adjustment methods. Journal of Multidisciplinary Healthcare, 9, 211–217. https://doi.org/10.2147/JMDH.S104807

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

Aotearoa New Zealand Association of Social Workers (ANZASW). (2021). Position statement: End of Life Choice Act 2019. https://www.anzasw.nz/public/150/files/Resources/EoLCA-Position-Statement-v1.pdf

Beddoe, L., & Stanfield, D. (2022). Is it time to reconsider professional development and continuing education for social workers twenty years after registration in Aotearoa New Zealand? Aotearoa New Zealand Social Work, 34(4), 1–5. https://doi.org/10.11157/anzswj-vol34iss4id1024

Beresford, P., Croft, S., & Adshead, L. (2008). ‘We don’t see her as a social worker’: A service user case study of the importance of the social worker’s relationship and humanity. The British Journal of Social Work, 38(7), 1388–1407. https://doi.org/10.1093/bjsw/bcm043

Blaschke, S.-M., Schofield, P., Taylor, K., & Ugalde, A. (2019). A common dedication to facilitating good dying experiences: Qualitative study of end-of-life care professionals’ attitudes towards voluntary assisted dying. Palliative Medicine, 33(6), 562–569. https://doi.org/10.1177/0269216318824276

Braun, V., Clarke, V., Boulton, E., Davey, L., & McEvoy, C. (2021). The online survey as a qualitative research tool. International Journal of Social Research Methodology, 24(6), 641–654. https://doi.org/10.1080/13645579.2020.1805550

Bravo, G., Delli Colli, N., Dumont, I., Bouthillier, M.-E., Rochette, M., & Trottier, L. (2023). Social workers’ experiences with medical assistance in dying: Survey findings from Quebec, Canada. Social Work in Health Care, 62(5), 193–205. https://doi.org/10.1080/00981389.2023.2210624

Butler, J. (2020). The force of non-violence. Verso.

Casey, J., & Macleod, S. (2021). The assessment of competency and coercion in the End of Life Choice Act 2019. The New Zealand Medical Journal (Online), 134(1547), 114–120. https://pubmed.ncbi.nlm.nih.gov/35728115/

Chowns, G., & Richardson, H. (2016). Social work practice in end of life care. Journal of Social Work Practice, 30(2), 115–120. https://doi.org/10.1080/02650533.2016.1168387

Close, E., Willmott, L., & White, B. P. (2021). Regulating voluntary assisted dying practice: A policy analysis from Victoria, Australia. Health Policy, 125(11), 1455–1474. https://doi.org/10.1016/j.healthpol.2021.09.003

Cootes, H., Heinsch, M., & Brosnan, C. (2022). “Jack of all trades and master of none”? Exploring social work’s epistemic contribution to team-based health care. The British Journal of Social Work, 52(1), 256–273. https://doi.org/10.1093/bjsw/bcaa229

Csikai, E. L. (1999). The role of values and experience in determining social workers’ attitudes toward euthanasia and assisted suicide. Social Work in Health Care, 30(1), 75–95. https://doi.org/10.1300/j010v30n01_05

Digby, R., McDougall, R., Gold, M., Ko, D., O’Driscoll, L., & Bucknall, T. (2022). Introducing voluntary assisted dying: Staff perspectives in an acute hospital. International Journal of Health Policy and Management, 11(6). https://doi.org/10.34172%2Fijhpm.2020.216

Downie, J., & Schuklenk, U. (2021). Social determinants of health and slippery slopes in assisted dying debates: Lessons from Canada. Journal of Medical Ethics, 47(10), 662–669. https://doi.org/10.1136/medethics-2021-107493

Feigin, S., Owens, R. G., & Goodyear-Smith, F. (2019). Helping a loved one die: The act of assisted dying in New Zealand. Mortality, 24(1), 95–110. https://doi.org/10.1080/13576275.2017.1382461

Foster, S., & Beddoe, L. (2012). Social work with older adults in primary health-is it time to move our focus?. Aotearoa New Zealand Social Work, 24(2), 37-48.

Frey, R., & Balmer, D. (2021). The views of Aotearoa/New Zealand adults over 60 years regarding the End of Life Choice Act 2019. Journal of Religion and Health, 1–16. https://doi.org/10.1007/s10943-021-01359-7

Fuscaldo, G., Gwini, S. M., Larsen, R., & Venkataramani, A. (2021). Do health service staff support the implementation of voluntary assisted dying at their workplace?. Internal Medicine Journal, 51(10), 1636-1644. https://doi.org/10.1111/imj.15285

Giles, R. (2016). Social workers’ perceptions of multi-disciplinary teamwork: A case study of health social workers at a major regional hospital in New Zealand. Aotearoa New Zealand Social Work, 28(1), 25–33. https://doi.org/10.11157/anzswj-vol28iss1id113

Head, B., Peters, B., Middleton, A., Friedman, C., & Guman, N. (2019). Results of a nationwide hospice and palliative care social work job analysis. Journal of Social Work in End-Of-Life & Palliative Care, 15(1), 16–33. https://doi.org/10.1080/15524256.2019.1577326

Hendry, M., Pasterfield, D., Lewis, R., Carter, B., Hodgson, D., & Wilkinson, C. (2013). Why do we want the right to die? A systematic review of the international literature on the views of patients, carers and the public on assisted dying. Palliative Medicine, 27(1), 13–26. https://doi.org/10.1177/0269216312463623

Hospice Rotorua. (2020, August 4). Euthanasia & the End of Life Choice Act: Rotorua community hospice’s organisational position on the End Of Life Choice Act. https://rotoruahospice.co.nz/2020/08/04/the-end-of-life-choice-act/

Hospice Whanganui. (n.d.). End of Life Choice Act: Our position on euthanasia and assisted dying. https://hospicewhanganui.org.nz/about-us/end-of-life-choice-act/

Larson, R. B. (2019). Controlling social desirability bias. International Journal of Market Research, 61(5), 534–547. https://doi.org/10.1177/1470785318805305

Lee, P. (2020). Mōku anō ēnei rā: The End of Life Choice Act and its compliance with Te Tiriti o Waitangi. Te Tai Haruru: Journal of Māori and Indigenous Issues 7, 144–162. https://www.nzlii.org/nz/journals/TaiHaruruJl/2020/9.html

Lilley, D., & Reid, K. (2023). Utilising literature and systems theory to explore the intersections between policy, practice and equity of access to palliative care for older adults in Aotearoa New Zealand. Aotearoa New Zealand Social Work, 35(1), 48–59. https://doi.org/10.11157/anzswj-vol35iss1id1006

Malpas, P. J., Anderson, A., Jacobs, P., Jacobs, T., Luinstra, D., Paul, D., Rauwhero, J., Wade, J., & Wharemate, D. (2017). “It’s not all just about the dying”. Kaumātua Māori attitudes towards physician aid-in dying: A narrative enquiry. Palliative Medicine, 31(6), 544–552. https://doi.org/10.1177/0269216316669921

Manson, L. M. (2021). Te Ao Māori: Māori nurses’ perspectives on Assisted Dying and the Te Ao Māori cultural considerations required to guide nursing practice (Doctoral dissertation, Auckland University of Technology). https://openrepository.aut.ac.nz/server/api/core/bitstreams/4df14498-b4be-4617-8287-e04fd2418a10/content

Mathison, E. (2020). Saying it don’t make it so: A response to Winnington and MacLeod. The New Zealand Medical Journal (Online), 133(1520), 104-7.

Ministry of Health. (2021, November). Assisted dying service: The assisted dying process. https://www.tewhatuora.govt.nz/assets/For-the-health-sector/Assisted-Dying/Public-information/The-assisted-dying-process-information-sheet-PDF239-KB.pdf

New Zealand Government (2019). End of Life Choice Act 2019. https://www.legislation.govt.nz/act/public/2019/0067/latest/whole.html

Norton, E. M., & Miller, P. J. (2012). What their terms of living and dying might be: Hospice social workers discuss Oregon’s Death with Dignity Act. Journal of Social Work in End-of-Life & Palliative Care, 8(3), 249–264.

Palliative Care Australia. (2025). FAQs. https://palliativecare.org.au/faqs/

Pockett, R., & Beddoe, L. (2015). Social work in health care: An international perspective. International Social Work, 60(1), 126–139. https://doi.org/10.1177/0020872814562479

Pockett, R., Walker, E., & Dave, K. (2010). “Last orders”: Dying in a hospital setting. Australian Social Work, 63(3), 250–265. https://doi.org/10.1080/0312407X.2010.497928

Proudfoot, K. (2023). Inductive/deductive hybrid thematic analysis in mixed methods research. Journal of Mixed Methods Research, 17(3), 308–326. https://doi.org/10.1177/15586898221126816

Pullman, D. (2023). Slowing the slide down the slippery slope of medical assistance in dying: Mutual learnings for Canada and the US. The American Journal of Bioethics, 23(11), 64–72. https://doi.org/10.1080/15265161.2023.2201190

Social Workers Registration Board. (2023). Annual social worker workforce report 2023: A high-level overview of the social worker workforce in 2023. https://swrb.govt.nz/workforcesurveys/

Te Whatu Ora. (2024, June 4). Contact the assisted dying service. https://www.tewhatuora.govt.nz/health-services-and-programmes/assisted-dying-service/contact-the-assisted-dying-service

Vungkhanching, M., & Tonsing, K. N. (2016). Social workers’ perceived role clarity as members of an interdisciplinary team in brain injury settings. Journal of Social Work in Disability & Rehabilitation, 15(3–4), 370–384. https://doi.org/10.1080/1536710X.2016.1220887

Wang, C. W., Chan, C. L. W., & Chow, A. Y. M. (2017). Social workers’ involvement in advance care planning: A systematic narrative review. BMC Palliative Care, 17(1), 5–5. https://doi.org/10.1186/s12904-017-0218-8

Winnington, R., Holroyd, E., & Zambas, S. (2018). The socio-political debate of dying today in the United Kingdom and New Zealand: ‘Letting go’ of the biomedical model of care in order to develop a contemporary Ars Moriendi. Societies, 8(3), 65.

Winnington, R., & MacLeod, R. (2020). The social consequences of assisted dying: A case study. University of Auckland, Public Policy Institute. https://www.ppi.auckland.ac.nz

Young, J., Dehkhoda, A., Ahuriri-Driscoll, A., Cheung, G., Diesfeld, K., Egan, R., Karaka-Clarke, T. H., Moeke-Maxwell, T., Reid, K., Robinson, J., Snelling, J., White, B., & Winters, J. (2024). Exploring the early experiences of assisted dying in Aotearoa New Zealand: A qualitative study protocol. BMJ Open, 14(10). https://doi.org/10.1136/bmjopen-2024-090118

Downloads

Published

2025-06-12

Issue

Vol. 37 No. 2 (2025)

Section

Original Articles

License

Copyright (c) 2025 Aotearoa New Zealand Association of Social Workers

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

By completing the online submission process, you confirm you accept this agreement. The following is the entire agreement between you and the Aotearoa New Zealand Association of Social Workers (ANZASW) and it may be modified only in writing.

You and any co-authors

If you are completing this agreement on behalf of co-authors, you confirm that you are acting on their behalf with their knowledge.

First publication

By submitting the work you are:

  1. granting the ANZASW the right of first publication of this work;
  2. confirming that the work is original; and
  3. confirming that the work has not been published in any other form.

Once published, you are free to use the final, accepted version in any way, as outlined below under Copyright.

Copyright

You assign copyright in the final, accepted version of your article to the ANZASW. You and any co-authors of the article retain the right to be identified as authors of the work.

The ANZASW will publish the final, accepted manuscript under a Creative Commons Attribution licence (CC BY 4.0). This licence allows anyone – including you – to share, copy, distribute, transmit, adapt and make commercial use of the work without needing additional permission, provided appropriate attribution is made to the original author or source.

A human-readable summary of the licence is available from http://creativecommons.org/licenses/by/4.0, which includes a link to the full licence text.

Under this licence you can use the final, published version of the article freely – such as depositing a copy in your institutional research repository, uploading a copy to your profile on an academic networking site or including it in a different publication, such as a collection of articles on a topic or in conference proceedings – provided that original publication in Aotearoa New Zealand Social Work is acknowledged.

This agreement has no effect on any pre-publication versions or elements, which remain entirely yours, and to which we claim no right.

Reviewers hold copyright in their own comments and should not be further copied in any way without their permission.

The copyright of others

If your article includes the copyright material of others (e.g. graphs, diagrams etc.), you confirm that your use either:

  1. falls within the limits of fair dealing for the purposes of criticism and review or fair use; OR
  2. that you have gained permission from the rights holder for publication in an open access journal.

 

How to Cite

Chubb, L. A., Nickels, H., Beddoe, L., Guild, G., & Joy, E. (2025). Supporting choice, preventing harm: Social workers’ knowledge gaps and ethical challenges with assisted dying in Aotearoa New Zealand. Aotearoa New Zealand Social Work, 37(2), 77–92. https://doi.org/10.11157/anzswj-vol37iss2id1233