Welcome to Social WorkStories, a podcast exploring social work practice through stories and criticalreflection.
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But fornow, on with theepisode.
Andhello, welcome to the Social Storiespodcast.
My name is Liz Murphy and over there in Gadigal Country I think isDr.
MimFox.Hello,Mim. That'sright.
Hi,Liz.Hi,everyone. Hope everyone's well outthere.
I'm in a Warradery countrytoday,Mim.
And I feel very blessed to be here in this beautiful sunnyday.
And I want to actuallylook,Mim, I think we've got a bit of catching up to do with our listeners because lastOctober, we didn't drop anepisode.
No,well, we kindof,yeah, didn't drop anepisode, dropped theball.
It gotCOVID.Yeah, I gotCOVID.
That'sright. I got COVID for the first timeever.
And every symptom that I have heard peopledescribe, but pretty well gotthat.
And you knowwhat,Mim, happyto, because it was myturn.
It was the least I could do was to get it onthis.
I don't know what round we're up to in Australia at themoment.
You were a bitlate, late to the party on thatone,Liz.
Like, you're about three years toolate, myfriend.
Iknow.But, but I feel like I've taken my for the teamnow.
And I feel like I'm partof, I'm not in the Novod group as I havebelieved, I believe they get called Novodgroup.
I've moved from Novod to the COVIDgroup.
And so that's why I couldn't record inOctober.
Welcome to mypeople,Liz.
I'm very definitely in the COVID group and have been for a good couple of yearsnow.
Well, that's yourexcuse.
My excuse is that I have just come back from the Gold Coast in Queensland because I was therefore the ANS was symposium thisyear, the Australian New Zealand Social Work Education and ResearchSymposium.
And our regular listeners will know that we have been there the last fewyears,podcasting.
And this year I didn't do a lot ofpodcasting, but I did do a lot ofhearing, amazing work that people were doing all over theplace.
And had some excellent discussions about social workeducation, about social workresearch, about changes in practice and how we translate that into theclassroom.
Just absolutely inspiringstuff.
Soyeah, I always come out of that so blownaway,Liz, by the incredible stuff that people are working on outthere.
And I had imagined that we might hear a little bits and pieces of the answer conference maybe over the next fewmonths.
Whoknows? You and I will certainly chat aboutit.
But this is our last episode for 2023 in terms of a story with ourreflections.
And I am beside myself with excitement around this one because this is one that I've been wanting to record for months and it is on voluntary sisterdying.
And why I feel passionate about this is it's just about to be rolled out in New South Wales where we both live on the 28th ofNovember.
So this is a change of legislation that's being rolledout,Liz,right?
So effectively decriminalisingit.
The change of legislation happened in2019.
So it's taken a while to rollout.
I thinkagain, COVID had some kindof, youknow,again, a pause init, but the roll out in terms of in health and in thecommunity, voluntary sisterdying.
We're the last state inAustralia,MIM, that is actually rolling out voluntary sisterdying.
So there's a history that we have that's taken place over the last few years across ourcountry.
And I know that in some countrieselsewhere, they've had voluntary sister dying fordecades.
Absolutely. For Australia and for us in New SouthWales, this isbig.
And also in terms of our social workpractice, so I'm reallyexcited.
We can listen to this wonderful storytoday.
Yeah. And the story is from a Victorian social worker who has been working in the voluntary sister dying space for fouryears.
So she'd be one of the first Australian social workers to be actively working in thisarea.
And I feel so privileged that she has shared a story withus, because that's a learning especially for us in New SouthWales, from this story that sheshares.
Yeah. I think it's fantastic that she was able to share this story withus,Liz, because we've got so many social workers in health at the moment who are really wondering what this is going to mean forthem,right?
Who are really sittingwith,well, is this achange?
Is it still my skills just in a differentspace, a different scope ofpractice, or is it a completely new way ofworking?
And I think the beauty of this story is that we get a bit of insight into what that actually lookslike.
And I love that this is a story that has a very much a de-identifiedperson, but it is a sweet story of an older man who has a big say in the death that he actually is able to have with the support of daughter and this socialworker.
So let's listen toit,me, with our listeningfriends, and then let's comeback, because I know you and I are chomping at a bit to kind of reflect on various elements of this story andbeyond.
Absolutely. Soundsgood.
Today, I'm sharing the story of a man namedBob, who I supported through his process of accessing voluntary assisteddying.
Bob was an elderly man who lived in the Addis Aburbs of Melbourne and he contacted our service here in Victoria and he asked for help to access voluntary assisteddying.
During the time that I supportedBob, I drove to his house about three or threetimes, infact.
Bob had an advanced cancer and he satisfied all of the eligibility criteria in Victoria for voluntary assisteddying.
So this means that he had a prognosis of less than six months due to his advancedillness.
It also means that he had decision-making capacity and that he was an Australian citizen and a Victorianresident.
So Bob lived in his familyhome.
He was living alone when I methim.
He had two adult children and he had beenwidowed.
The home that he lived in was their family home and certainly when I visitedhim, it had the air of a place that had been lived in over a longtime, youknow, decades and people had grown up there and movedout.
It wasn't messy or clustered oranything.
Itwas, but it was his family home and there was lots of signs of that around thehouse, photos and bits and pieces from his life and his children's lives and his wife aswell.
Bob lived in the community where he worked and where he hadworked.
He was longretired, but he was well respected and he knew a lot ofpeople.
He knew a lot of people in his community and he talked really fondly about his work life and I think he felt quite proud of the contribution he had made throughout hislife.
So as is the case with most of the voluntary assistive dying laws inAustralia, there was and still is not an insignificant amount of paperworkinvolved.
So there's quite a lot of forms and things that need to be done exactly right in order for the process toproceed.
So Ihad, at thisstage, I had met Bob in his home and he had asked me to continue and support him to start the voluntary assistive dying assessmentprocess.
During the time that we were arranging thoseappointments, he had an admission tohospital.
And in order for his assessments tocontinue, he needed to locate some of his identificationdocuments.
So this was a very practical thing that needed to be arranged and this is what resulted in the first time that I had contact or an interaction with hisdaughter.
So he had already told me that he had two children and one of them lived in Melbourne and was available and willing to supporthim.
But it wasn't until this time that I actually had direct contact with hisdaughter.
And I guess that's an interesting experience for me prior to this having mostly worked in hospitalsettings.
I was unacustom to meeting people in their own home and I was also muchmore, much more used to meeting people when they're inhospital.
They're obviously not in their ownenvironment.
They've been unwell in some way and so their family are usually much moreaccessible.
They're often the ones that you talk with as much as thepatient, sometimesmore.
So it was a different experience for me to meet and get to know Bob relatively well before any ofhis, before I had met or was introduced to any of hisfamily.
As a socialworker, it was quite a welcome change in the dynamic of thatrelationship.
Bob seemed really at ease during our conversations and I guess what it made me realise was that that dynamic of having met and established a relationship with himfirst, where he was in control and he had initiated asking me forsupport.
It really allowed Bob to be the person who was in control of the process and what was goingon.
And indeed that is a really strong tenant of the voluntary assisted dyinglaws.
I'm sure elsewhere aswell, but inVictoria, the idea really is that it's thepatient, the person who wants to access this is the one who is continuing to push the process or say yes I want tocontinue.
So it shouldn't be and in my experience it isn't something that a patient asks for and then the process just carrieson.
They actually have to actively engage with it and actively choose to continue on at each stage of theassessments.
So Bob proceeded with his three voluntary assisted dying assessments and he became eligible to access an oralmedication.
Afterthis, there was a period of probably a few weeks where we had limited contact and again that's verydeliberate.
So the nature of the support that we provide for people accessing voluntary assisted dying is that we are always available and we try to make that clear that the person or their family are welcome to contact us at anytime.
But once they've becomeeligible, it's really important that there is no real or perceived pressure to use themedication.
So for a lot ofpeople, there is great comfort in knowing that it's there if they needit.
But for many people and inVictoria, that number is about athird, a third of all people who become eligible don't actually useit.
Soagain, that theme of control and I guess autonomy comes in where it's quite important that we have done what we can to support the person in theirwishes.
Once they have thatoption, we really try to step back and empower the person to come to us if theyneed, but not to continue that involvement where it may not be needed anylonger.
After that period oftime, Bob had one further hospital admission and I understand that it was during that time he said to his daughter that when he got home fromhospital, he was ready to use hismedication.
And so this set us on a path where his daughter contacted myself and the coordinating voluntary assisted dying doctor to talk about how to make thesearrangements.
The outcome in this case was that both myself and the doctor attended Bob's house on the day that he used hismedication.
As Imentioned,we, I had been there three times by then and the voluntary assisted dying doctor had been twice and Bob felt that we were the people who had supported him in thiswish.
That varies from person toperson, but in thiscase, it was not very long after the law had come intoeffect.
So there wasn't a lot of experience out there in the general health community of people who had supported patients through thisprocess.
So I do believe that that was part of the reason that Bob asked for the two of us to be there withhim.
For manypeople,they, if they're going to use their assisted dyingmedication, they do it in the comfort of their home with onlyfamily.
And that's absolutely finetoo.
Again,it's, it's whatever is the person feels comfortable with and what feels right forthem.
Andequally, we need to be clear that asprofessionals, we have a think about our ownboundaries.
Ihad, had thought about that well ahead oftime.
And myself and my colleague had had really frank conversations about the fact that it'snot, it shouldn't be agiven, it shouldn't be an automatic thing that you would bepresent, but that if a person raised that and askedyou,you, you need to go through a process of thinking why are they asking you to bethere?
Do you feelcomfortable?
And if those things lineup,then, then the answer would beyes.
So forme, as a social worker and a healthcareprofessional, it was important that I had had some thoughts about those boundaries before beingasked.
I didn't want to be confronted with trying to work through that in real time when a personwas, was waiting for ananswer.
So on the day that Bob used hismedication, hewas, he was at home with his daughter for theday.
As far as I couldtell, there wasn't anything particularly extraordinary about theday.
Aside from the fact that as father anddaughter, they spent the day together and Bob's daughter looked after him throughout theday.
The doctor and I arrived in the mid afternoon and by then Bob was already in his recliner chair in the living room and that was where we had met him on the other occasions aswell.
The afternoon proceeded relatively straightforward and and Bob told us a few more stories and and did a few morereflections.
He actually said something which I didn't register as being overly significant at the time that was really important to his daughter and what he said was that she'd done all right and she'd done a goodjob.
And it was avery, I wouldsay, it was a compliment that was pretty representative of the generation that Bob belongedto.
I thinkhe, it was heartfelt for him and it meant a lot to his daughter but listening to it from theoutside, you wouldn't have necessarily recognised that butwe, it's something that his daughter talked about afterwards that to her that was really high praise from herdad.
So Bob used his oral medication and he died in hishome.
It was a home as Isaid, he'd lived in for many decades and a community that he'd lived in and worked in for that long aswell.
I think in considering both mine and the doctor's role but in considering my role as a socialworker, this process was about accompanying Bob for something that was important tohim.
He, as weknow, he was going to die from his cancer and had voluntary assisted dying not beingavailable.
I feel quite confident that Bob would have had a comfortabledeath.
He had wonderful healthcare team around him including oncology and palliative careservices.
He had a supportive daughter and he also had the ability to communicatehis, his wants andneeds.
So this was not something that was the be all and end all if he hadn't used voluntary assisteddying.
I think he would have likely had a very comfortable death either way but it was a process that he decided to do and once I'd met hisdaughter,she, she explained to me after a period of time that the student surprised her atall, that her father had always been a man who made his own decisions and liked to be in control ofthings.
He wasvery, he was very polite and very cordial all throughout but she said if he's decided on something then that's what's going tohappen.
Forme, one of the lessons from this case in supporting Bob is about the fact that for me because it wasearly, early in the time that voluntary assisted dying wasavailable, there was still a lot of commentary about the ethics of it and there was still some political concern about the implementation going smoothly and that was certainly felt by people who were working in that area to the want for it to be as smooth and as non-controversial aspossible.
However, this experience was for me a very pure one of a man at the end of hislife, youknow, being supported by his daughter and dying in the family home in a way that he had chosen and at a time that he hadchosen.
I think a big part of thatis, is the experience of meeting the person where theyare.
ForBob, this wasn't a hugedeal, it wasn't something that he grappled with when he knew that voluntary assisted dying wasavailable.
He felt like that was the right thing for him and as Isaid, his daughter really reflected that that accorded with his personality and the way he had lived hislife.
He didn't grapple with it overtime, he justthought,yep, this is right forme.
Following Bob'sdeath, it was important that we were available to support hisdaughter.
Again, I wouldn't say that there was a huge amount of complexity in terms of herbereavement,however, it was thenewness.
So there weren't a lot of people in the community who had experiencedthis.
Andagain, the role that we had was to make sure that she had someone who knew what she had gone through and who she could just bounce things off and express how she wascoping.
There wasn't any red flags that she wasn't going to cope in the long term or that she was going to have prolonged grief from myassessment.
Butagain, the best word I would use for this is that it was an accompanyingprocess.
This was something really new and it was important that for Bob and especially his daughter after the fact that there was someone there who understood partially what she'd been through and who just their role was to listen and allow her space toreflect.
So as with alldeaths, it's important that we consider the bereaved person's needs and their support needs in their time ofgrief.
So in thiscase, as with all ofus, I followed up with Bob'sdaughter.
She certainly initially wanted to talk a little bit about what had happened on the day and that was a quite important process of her confirming the narrative and reflecting with someone who had been there and been a small part of thatday.
Butsubsequently, when I saw her for the secondtime, she reflected more on her dad's life as awhole.
So she talked about his roles as afather, as aprofessional, a member of thecommunity, certainly as a husband and his role in theirfamily.
And tome, that represented a quite normal and expected grieftrajectory.
She certainly was grieving for her father and was appreciative of the bereavementcare.
But in thiscase, I certainly didn't identify anything that was a red flag that indicatedpossible, complicatedgrief.
For somepeople, there are factors relating to the mode ofdeath.
So for somepeople, that can be a realstruggle, the fact that a person chose voluntary assisteddying.
But in thiscase, it was something that we were able to sit with his daughter and support her as she provided some reflection onthat.
And then relatively quickly moved through to grieving for her father and thinking about him in the setting of his life as awhole.
Sothat, tome, was an indicator of grief progressing and a normal griefreaction.
So I think one of the key things that comes up for me from this story and from this experience is that although voluntary assisted dying presents a very newprocess, and it's certainly a highly legislatedprocess, the things that patients and families go through when they're accessing voluntary assisted dying are things that social workers have the skill set to dealwith.
It's within what we knowalready, of course it'snew, and some of us are better at sitting with uncertainty thanothers, but I think getting used to the fact that we've got a new process available is one of the big tasks in the early times ofimplementation.
But by andlarge, what I have found is that the skills needed to work in thisspace, our skills that are possessed by social workers and the tasks are related to spending timereflecting, making sure that we know our own personal values and how we sit withthings.
And there's no doubt in my mind that doing those things will allow social workers to work really positively and really productively with people and families who are going through the voluntary assisted dyingprocess.
Liz, firstly I want to say how much I love thisstory.
And I've been waiting to hear a voluntary assisted dying story actually coming out of one of the other states that has already come round to this change in practice andlegislation.
So I'm very thankful for thisstory, but I wasthinking, as I was listening to what I was thinkingabout, how I have just come back from the ANSWASsymposium.
At thatsymposium, one of the professors from GriffithUniversity, DonnaMcCall-F, she gave her closing address and she said to the room that social work is a profession that is compelled to ask at all times what is the compassionateresponse.
And I've been sitting with that Liz since I heardit.
It's just been going around and around in my head and when something just sits with you and it starts to create a life in your mind and starts going down little pathways and what could it mean here and what could it meanthere.
And it wasn't until I heard this story where actually it made sense to me how all encompassing that statementis.
What is the compassionateresponse?
Because in thisstory, the compassionate response is clearly on so many differentlevels,right?
Like it's not just aboutBob.
It is about so much more thanBob.
That's what I was sitting with hearingthis.
And God restBob,Sol, he'll never knowthis, but I agree withyou.
But I'm going to start with Bob just before I get into thatspace.
Because I think I have a belief that we can die as welive.
Youknow, that often there are elements of ourdeath.
If we can actually have adeath, it can bereally, really valuable if it reflects elements of who we are in theliving.
And forme, this death that Bob co-created in someregard, we faced within thelegislation, he fitted a criteria that actually allowed him to have true agency around a death that represented how he lived in theworld.
He was a man we heard who was verydecisive.
Once he made up hismind, he stuck toit.
He got to decide on the where he wanted to die in the community and the home that he'd lived in for many years and with the people aroundhim.
And back to yourpoint,Min, back to the social work practice withinthat.
I see what you're saying because that's what I seetoo.
The compassion that was threaded throughout Bob's death in terms of the social workpractice.
It wasbreathtaking. And what you've just described is so reminiscent to me of the discussions we were having15, 20 years ago in palliative care around what is a gooddeath.
Youknow, likethat, I feel like those discussions aren't as present as they were at thatpoint.
We were grappling with it and howdoes, and there waslike, but it was almost like there was a definitive good death notion that sat out there somewhere that people might have to be able to subscribeto.
And what I love about this story is that itactually, a good death for Bob is what Bob determines a good death tobe.
And that's the compassionate response for Bob is actually being able to standthere.
And I think the social worker talks about a companioning Bob through thatprocess,right?
And companioning thedaughter.
And I think that'sright.
It's about being there as thecompanion, as thewitness, as the support through theprocess.
Yes. There was thecompanioning.
There was the bearing witness for both Bob and there was also the post-death support that I thought was really interesting where she said so much that resonated for me around thatdeath, the quality of that death allowed the daughter to grievein, youknow, although we avoid the word normalgrief.
She was already at that position as shesays,right?
Because so much of her grief was impacted by what hadhappened, by the fact that her dad had chosen the death to be in the way that hewanted.
And she also got to reflect on his death with someone who was also there present withher.
