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A large number of Americans would rather rely on family and friends more than their physicians about end-of-life care and decisions. Moving beyond traditional clinical ethics and its dyadic focus on the physician-patient relationship, this article presents an approach to ethical decision-making at the end of life that is more inclusive of the patient's family and has the potential to advance social work practice in end-of-life care. Initial attention is given to how psychosocial and bioethical perspectives and practices interact to shape understanding of moral issues in end-of-life decisions. Morally relevant principles are then adapted from contextual therapy as being useful for including more of a family focus and viewing ethical decision-making at the end of life as a family process. Specifically, focus is on exploring the ethical dynamics of family systems that impact the decision-making process and translating psychosocial insight into ethical discussions that are supportive of families. The case of a patient with sudden and unexpected brain death and without advance directives demonstrates one family's unresolved grief and illustrates how its members were helped to reason morally about end-of-life choices. Contributions of a social worker and bioethicist are illustrated. [ABSTRACT FROM AUTHOR]

Social workers, physicians, and nurses from a major urban teaching hospital were assessed and compared regarding their attitudes toward the rationing of health care. Responses to eighteen statements of considered moral judgments in the rationing of health care resources were analyzed in terms of levels of agreement with each. All three professional groups rejected rationing based on patient age and socioeconomic worth. However, social workers and physicians were more likely than nurses to consider such factors as cost-benefit ratios, quality of life, relative strength of a patient's moral claim, and scarcity of resources in rationing decisions. Study findings appear to portray social workers and physicians as being more utilitarian and nurses more egalitarian in rationing decisions. Implications for practice in a managed care environment are presented. [ABSTRACT FROM AUTHOR]

A needs assessment survey of 268 polio survivors residing in Maine explored the incidence of postpolio syndrome as well as perceived need for and access to social and health care services. A large proportion reported experiencing postpolio syndrome. Although knowledgeable of their condition, a majority perceived that they had no access to knowledgeable physicians or social and health care services and most were having difficulty coping. Findings indicate that polio survivors' self-appraisal of their illness status is related to their perceived need for and access to social and health care services. The need for community-based services, including medical, rehabilitative, educational, and social work services, is indicated. [ABSTRACT FROM AUTHOR]

This narrative reflects on a paradigm case for understanding how in an era of managed care when values and economics appear so indivisible, one health care team united and provided non-costworthy care to a terminally ill patient who needed to live until the first day of the month. The ethical dilemma of treatment effect vs. treatment benefit in end of life decision making becomes a drama. The article chronicles events leading to the first day of the month and underscore the power of story and metaphor in creating common ground and common understanding in patient care. [ABSTRACT FROM AUTHOR]