Medical social workers play an integral role as  support for patients and their families at the end of a patient’s life.  Most physicians are not equipped to handle the emotional aspects at the  end of life. Therefore, more often than not, medical social workers are  the principal health care professional involved in educating, mediating,  and coordinating end of life plans. In this capacity, medical social  workers are charged with informing patients and their families about  end-of-life decisions and providing counseling around these issues.  Medical social workers must understand the terminology, technology, and  legal issues that can dictate end-of-life care.

Consider the following cases:

End-of-Life Care: Case 1

Roger is a 43-year-old African American male  diagnosed with HIV/AIDS and renal failure. He was recently admitted to  the intensive care unit and put on a ventilator due to medical  deterioration. The doctors inform his wife that there is no chance that  his condition will improve and explain that he is being kept alive by  the machines. Roger’s wife is distraught but knows that Roger did not  want to be kept alive by a machine. The medical social worker goes to  Roger’s chart and finds his medical power of attorney. Roger’s wife is  listed as his agent; however, the document was not signed by two  witnesses as required.

End-of-Life Care: Case 2

Margaret is a 72-year-old female with severe  cardiovascular disease. She is admitted to the hospital after a stroke.  There is no indication that she will recover and, if so, to what level  of functioning. The doctors have informed her family that she is  experiencing cardiac issues that might lead to heart failure. Should  this happen, the doctors will have to take efforts to resuscitate her.  The medical social worker and the doctor meet with the family to discuss  a do not resuscitate order. The family is completely overwhelmed. They  do not fully understand what the doctor is saying and they are in  disagreement about what to do.

To prepare for this Discussion, review this week’s resources including the case studies. Select one of the cases. Think about the end-of-life issues including living wills or medical power of attorney.

Post an explanation of how you  as a medical social worker would handle the case you selected. Explain  the services you might offer to the family within the applicable laws  and your scope of practice. Explain the methods and practices you might  employ to educate this family regarding the legal issues surrounding the  case. Then, explain the purpose, benefits, and legal ramifications of  living wills, medical power of attorney, and advance directives.  Finally, explain the advocacy role you might play on behalf of the  patient and patient’s family in this case.

Be sure to support your postings and responses with specific  references to the resources and the current literature using appropriate  APA format and style.

Gehlert, S., & Browne, T. (Eds.). (2012). Handbook of health social work (2nd ed.). Hoboken, NJ: Wiley.
Chapter 23, “End-of-Life Care” (pp. 627–642)

Buckey, J. W., & Abell, N. (2010). Life-sustaining treatment decisions: A social work response to meet needs of health care surrogates. Journal of Social Work & End-of-Life Palliative Care, 6(1–2), 27–50.
Note: Retrieved from Walden Library databases.

Cagle, J. G., & Kovacs, P. J. (2009). Education: A complex and empowering social work intervention at the end of life. Health and Social Work, 34(1), 17–27.
Note: Retrieved from Walden Library databases.

Johnson, K. S., Kuchibhatla, M., & Tulsky J. A. (2008). What explains racial differences in the use of advance directives and attitudes toward hospice care? Journal of the American Geriatrics Society, 57(10), 1953–1958.
Note: Retrieved from Walden Library databases.

National Association of Social Workers. (2004). NASW standards for social work practice in palliative & end of life care. Retrieved from

Peck, M. R. (2009). Personal death anxiety and communication about advance directives among oncology social workers. Journal of Social Work in End-of-Life & Palliative Care, 5(1–2), 49–60.
Note: Retrieved from Walden Library databases.

Silveira, M. J., Kim, S. Y., & Langa, K. M. (2010). Advance directives and outcomes of surrogate decision making before death. New England Journal of Medicine, 362(13), 1211–1218.


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