With new medical advances in technology, there has been a push from the legal, medical and political communities to re-examine the policies of end-of-life-care. End-of-life-care (EOLC) is a term that refers to not only a patient’s final hours of life, but also the medical care of individuals with terminal illnesses or conditions that have become advanced and incurable. For the purpose of this paper, I will be referring to physician-assisted death and active euthanasia as forms of end-of-care. The Politics of End-of –Life-Care: Active Euthanasia and Physician-assisted Death examines the political disjuncture between the evidence presented in favour of active euthanasia (AE), physician-assisted death (PAD) and the current practice of refusing to grant AE and PAD legal status in Canada. It will examine the political dynamics underlying the disjuncture using political pressure groups, constructivism, rational choice, institutionalism and structuralism. There is empirical evidence that demonstrates support for the legalization of AE and PAD. Sixty-seven percent of Canadians support AE /PAD and 80 percent support allowing physicians to assist in AE and PAD (Angus Reid 2012) however, Parliament has not legalized AE/PAD and the CMA has not sanctioned AE /PAD. The two sides of the debate have clearly communicated their arguments. The arguments on each side are strong and have merit. Conversely, the arguments against AE and PAD appear to hold more weight with institutions than with the public. This thesis examines a number of different reasons for why AE/PAD remains illegal in Canada despite society’s widespread support for AE/PAD. The results of the research found no one method explains the disjuncture between the evidence presented in favour of active euthanasia and the current practice of refusing to grant it legal status. However, discursive institutionalism does help elites to generate and communicate the discourse of AE and PAD. It also explains how discourse can also occur from the bottom which results in a new discourse. For example, physicians, politicians, and the public who have deviated from the accepted discourse on AE and PAD can help to create a new discourse regarding AE and PAD policies.

Effective June 9, 2016, many terminally ill patients residing in the State of California will now have the legal option of terminating their life because of protections offered under The California End of Life Options Act. Social workers whose population of care includes terminally ill patients will likely be engaging in conversations about end of life options, including physician assisted death, with their patients. Little research exists addressing what factors may influence social workers perceived preparedness to discuss physician assisted death with patients, yet the expectation that social workers be prepared to discuss all available end of life options with patients is present. The purpose of this quantitative study is to explore the influence of demographic characteristics and experience with terminal illness on California social workers perceived preparedness to discuss physician assisted death as an end of life option with terminally ill patients. Convenience sampling was utilized which included sixty-two Master of Social Work level or higher social workers who are employed in medical social work positions and are providing direct care for chronically and terminally ill patients. Participants completed a voluntary paper survey that gathered demographic information, experience with terminal illness and perceived preparedness to discuss physician assisted death with patients through Likert Scale measures. The findings showed a positive relationship between California social workers who perceived themselves as prepared to discuss physician assisted death and the identification of their social work education as a source of their preparedness.

The goal of this thesis is to investigate the literature on physician-assisted death (PAD) in the United States and argue for the legalization of PAD. This thesis discusses the historical and contemporary legal literature of PAD as well as the concerns voiced by opponents of PAD. This thesis addresses the concerns of PAD opponents and invalidating some concerns and and attenuating others. Proper implementation of PAD is proposed via Mandatory Psychiatric Review (MPR) and other psychological services. Further improvements needed in PAD policy are discussed as well as the current benefits of PAD.

As aid-in-dying legislation expands across the United States, this study examines the dynamics influencing participation in Oregon’s Death with Dignity Act. In addition to data from secondary sources, this thesis analyzes field research data collected in Oregon, including 14 in-depth interviews with volunteers and employees of two advocacy organizations at the center of legalized physician-assisted death. Themes emerged including the conditions that motivate participation, the importance of both personal and professional autonomy, the significance of a good death, and the growth of open dialogues about end of life choices. This thesis concludes with a discussion of the impact Death with Dignity laws could have across the United States, with a specific focus on the state of Tennessee.