Point of View


Point of View

Terminal Illness and the Choice to Die

By Ryan Howes

July/August 2019


California, Oregon, Washington, Montana, Colorado, New Jersey, Vermont, and Hawai‘i have all passed legislation allowing physicians to prescribe lethal doses of medications to terminally ill patients who request them. A mental health assessment is often part of this process, placing the issue on therapists’ doorsteps and raising the question of how we respond when clients with terminal illnesses express a wish to end their own lives.

Tracey Bush has been there. A medical social worker, Bush is at the forefront of end-of-life issues in California, where she’s responsible for best practices concerning the End of Life Option Act at healthcare behemoth Kaiser Permanente. An expert on the controversy, logistics, and clinical issues surrounding this topic, she’s spoken extensively about the bioethics of what she prefers to call medical aid in dying.

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Ryan Howes: How did you start working with end-of-life issues?

Tracey Bush: As a medical social worker, you deal with a lot of death and dying. In the beginning of my career, I worked primarily with pediatric AIDS patients, at a time when AIDS wasn’t as manageable as it is now. Years later, around the time that California passed the End of Life Option Act law, I started directing a clinical practice of medical social workers at Kaiser. The coordinators for that particular law are medical social workers, so Kaiser decided social workers would be the best people to…

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