Dying, Death, and Bereavement in Social Work Practice

Dying, Death, and Bereavement in Social Work Practice: Decision Cases for Advanced Practice

Terry A. Wolfer
Vicki M. Runnion
Copyright Date: 2008
Pages: 280
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  • Book Info
    Dying, Death, and Bereavement in Social Work Practice
    Book Description:

    Practitioners who work with clients at the end of their lives face difficult decisions concerning the client's self-determination, the kind of death he or she will have, and the prolongation of life. They must also remain sensitive to the beliefs and needs of family members and the legal, ethical, and spiritual ramifications of the client's death. Featuring twenty-three decision cases based on interviews with professional social workers, this unique volume allows students to wrestle with the often incomplete and conflicting information, ethical issues, and time constraints of actual cases. Instead of offering easy solutions, this book provides detailed accounts that provoke stimulating debates among students, enabling them to confront their own responses, beliefs, and uncertainties to hone their critical thinking and decision making skills for professional practice.

    *Please note: Teaching Notes for this volume will be available from Electronic Hallway in Spring 2010.

    To access the Teaching Notes, you must first become a member of the Electronic Hallway. The main Electronic Hallway web page is at https://hallway.org/index.php. To join, click Become a Hallway Member in the Get Involved category or point your browser directly to https://hallway.org/involved/join.php and provide the required information.

    After your instructor status has been confirmed, you will receive an e-mail granting access to the Electronic Hallway. Once logged on to Electronic Hallway as a member, click Case Search in the Cases and Resources category on themain web page. Enter "death, dying, bereavement" (without the quotation marks) in the search box, select "all of the words" in the drop down menu, and click Submit. The search process will generate a list of Teaching Notes for cases from Dying, Death, and Bereavement in Social Work Practice: Decision Cases for Advanced Practice.

    eISBN: 978-0-231-51262-6
    Subjects: Sociology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. To Instructors
    (pp. vii-viii)
  4. To Readers
    (pp. ix-x)
  5. Preface and Acknowledgments
    (pp. xi-xiv)
  6. Introduction to the Cases
    (pp. 1-12)

    FOR MORE THAN 100 YEARS, social work instructors have used cases in the classroom to educate students (Fisher 1978; Reitmeier 2002; e.g., Reynolds 1942; Towle 1954). Over time, these cases have taken many forms, ranging from brief vignettes only a few sentences or paragraphs long to complex, book-length accounts.

    Merseth (1996) identifies three basic educational purposes of using cases: as examples or exemplars to illustrate practice, as foci for reflecting on practice, or as opportunities to practice decision making. For the first purpose, cases provide concrete and specific examples of how professional theories or interventions apply in practice situations and...

  7. Case Summaries
    (pp. 13-26)

    Born with severe hydrocephalus, Timmy Jenkins was expected to die soon but survived to age fourteen, though he was unresponsive to stimuli. Timmy’s mother, facing multiple life stressors, sought the help of hospice staff to obtain a Do Not Resuscitate (DNR) order to stop nursing home staff from treating Timmy’s chronic infections. Kathy Scott, the hospice social worker, was not sure how to assist her.

    Hospice of Bayview developed a new program, Living Alone, to extend its usual hospice services to patients without primary caregivers. However, team members experienced increasing anxiety while serving Ms. Altman, their first Living Alone patient....

  8. 1 The Request
    (pp. 27-39)
    Mary Hylton and Terry A. Wolfer

    AS THE MEETING AT PINECREST Intermediate Care Facility for the Mentally Retarded ended, hospice social worker Kathy Scott had more questions than before the meeting began. To judge by the expressions on their faces, her hospice colleagues were equally perplexed.

    As she wedged her notebook into her briefcase, Kathy thought about Evelyn’s request. She was torn about whether or not the hospice should support Evelyn’s demand for termination of all life-prolonging treatments for her fourteen-year-old son, Timmy Jenkins. It had seemed to Kathy since her first meeting with Evelyn that Evelyn wanted Timmy to die. More than one family had...

  9. 2 ResponseAbilities
    (pp. 40-48)
    Sarah Cearley and Vicki M. Runnion

    “HAVE YOU GOT A MINUTE?” Sharon Taylor looked up from her desk and saw Kathy Holder, a recent addition to the social work staff, looking shyly around the half-open door. Sharon nodded and Kathy stepped into the friendly, light-filled office and sat down. Sharon was the director of social services at Hospice of Bayview, where she had worked for a total of eight years. She liked her job, and was proud of the diversity, collegiality, and strengths of the social work department. Sharon cared about the social workers in the hospice program as peers and friends, having been a colleague...

  10. 3 Family Matters
    (pp. 49-57)
    Terry A. Wolfer

    WHEN LOU MONTGOMERY, a social worker with Lutheran Hospice, first met Barbara Reeves at Lexington Hospital in October 1998, she felt both surprised and relieved. The referral form had indicated that Barbara was only eighteen years old; in person, she appeared to be in her mid-forties. Caring for a dying parent was always difficult, but at least this woman would have more life experience than an eighteen-year-old.

    Still, something seemed odd about Barbara’s relationship with her dying father.

    Founded by Lutheran Homes in 1992, Lutheran Hospice (LH) served South Carolina through local offices in Greer, Columbia, and Charleston. Each of...

  11. 4 Drug Interactions
    (pp. 58-73)
    Terry A. Wolfer

    IT WAS A THURSDAY in early November 2001, and already past 5:00 p.m. Leaving the nurse to finish up a few last details of the admission process, hospice social worker Cheryl Peak stepped outside Frank Barr’s apartment. It was still warm, though the days were getting noticeably shorter.

    “Please stop.” Frank’s roommate, Ted White, had followed Cheryl outside. “I need to tell you something.”

    “Yes,” Cheryl replied, trying to hide her fatigue, “what is it?”

    “I’m not sure I should tell you,” Ted hesitated.

    “It sounds like you want to tell me,” Cheryl prodded.

    “But I don’t know whether to...

  12. 5 Whose Will When?
    (pp. 74-87)
    Vicki M. Runnion

    SOCIAL WORKER MARIANNE THORNWELL came out of Mr. Robinson’s room at Holly Hills Nursing Home ready to blast someone. His bright blue eyes had burned right into her heart. On her way to get his chart to try to sort out what had happened, and why, she was fuming: This isn’t right! Why in the world do we have living wills and health care powers of attorney if people aren’t going to respect them?! Her instincts to advocate for this worn-out family were at war with her usual inclination to give the nursing home staff the benefit of the doubt....

  13. 6 Unusual Appeal
    (pp. 88-97)
    Rachel C. Parker and Terry A. Wolfer

    “YOU KNOW, I do sign your paycheck.”

    Cynthia Sanders was taken aback. She knew she was a good mitigation investigator. But had Diane Epps, her boss, a dedicated and talented lawyer, just threatened her job? Diane often joked around, but this time Cynthia sensed anger as well.

    Diane adamantly believed that the death penalty was wrong and had dedicated her career to preventing executions. Cynthia also opposed the death penalty, but she argued that their client might have a right to self-determination.

    Their client, a death row inmate named José Aranda, wanted to waive his right to appeal his death...

  14. 7 The Last Dose
    (pp. 98-103)
    Georgianne Thornburgh

    LISA PARKER’S THOUGHTS were racing. Jason Jones had just stopped breathing, and Lisa was acutely aware that she would never see the twinkle in the twelve-year-old’s eyes again.

    In her years of hospice social work with adults, Lisa had never experienced anything quite like this. What just happened here? Did I really see what I think I saw? Why isn’ t anybody saying anything about it? There are three other people in the room; did anybody else see? Maybe not—maybe everything is just fine, and I’ m reading things into it because of Janie.

    Children’s Hospital was part of...

  15. 8 No Place for Grief (A)
    (pp. 104-108)
    Rachel C. Parker and Terry A. Wolfer

    THE ROOM WAS SILENT. The wide eyes of seven middle school students were riveted on Deb Weston, their mouths agape. A tear slipped down Deb’s face, too late for her to wipe away undetected.

    As a social worker for School District 4 in Fort Mill, South Carolina, Deb was responsible for providing grief counseling in the aftermath of a school tragedy. She had just told the group she was working with that Shane McKinsey, their fellow student, who had died in a four-wheeler accident over the weekend, was her nephew-in-law. The words had slipped out of her mouth, and as...

  16. 9 Right Before Their Eyes
    (pp. 109-113)
    Rachel C. Parker and Terry A. Wolfer

    ONE MONDAY IN SEPTEMBER 2002, school social worker Caroline Eastman was sitting at her desk in the school district office, finishing paperwork, when her phone rang. The agitated voice of Don Osmar, the principal of Goldsboro High School, implied something was seriously wrong.

    “Caroline, we have a situation over here. This morning, we had a bus full of students coming to school and when they stopped to pick up Marie Boswell, Marie’s ex-boyfriend, Joe Shipley, stepped in front of the bus and blew his brains out. A lot of the kids saw it happen.”

    Principal Osmar’s words set Caroline’s heart...

  17. 10 Private Charity (A)
    (pp. 114-123)
    Miriam McNown Johnson and Karen A. Gray

    “THIS IS BILL. Can you come see me in my office?”

    “Sure, how about in twenty minutes?” Her boss’s unexpected call caught Melissa Sinclair by surprise, and she hoped to get through the first draft of a quarterly report before taking a break.

    “How about now?” Bill insisted.


    She walked briskly down the hall and into Executive Director Bill Cannon’s corner office. He motioned for her to take a seat across from him at his conference table.

    “How are you?” he asked.

    “I’m fine,” she said, knowing that her health certainly was not what he wanted to talk about....

  18. 11 Suicidal Co-ed
    (pp. 124-135)
    Jeanette Ucci and Terry A. Wolfer

    SILENCE HUNG IN THE AIR as social worker Lisa Conway tried to decide whether Mary Williams, her client on the other end of the telephone crisis hotline, was in imminent danger of hurting herself. Lisa sensed that Mary was hesitating in responding to her inquiries; she had been avoiding questions with either silence or vague “mmm-hmms.” She did speak about a letter that she was composing, yet she would not say directly whether or not it was a suicide letter.

    “Is it a suicide letter?”

    No answer.

    “Do you feel like you’re going to hurt yourself?”

    No answer.

    “By not...

  19. 12 What Can I Tell? (A)
    (pp. 136-143)
    Rachel C. Parker and Terry A. Wolfer

    CAROLYN JOHNSON, a case manager for Augusta Primary Care, was at her desk filling out paperwork when she heard loud footsteps in the hall. When she looked up, Karen White, a homeless client, was standing in the doorway, an angry look on her face.

    “Hi, Karen, why don’t you come in?” Carolyn offered.

    “Look, I need to know what’s up with Mark. What’s wrong with him?”

    Carolyn could smell the alcohol on Karen’s breath. She knew that Karen would not like what she had to say.

    “Karen, client medical information is confidential. You know I can’t tell you anything.”


  20. 13 Grief at Work
    (pp. 144-153)
    Laura Cox and Terry A. Wolfer

    MIKE OWENS SAT in the Franklin Center conference room, drumming his fingers on the table as he waited for his supervisee, Brian Stanfield, and his program supervisor, Brenda Shelley, to join him. He could feel the heat from the strong rays of the October sun filtering through the window. Feeling like he had been “punched in the stomach,” Mike tried to make sense of the two-month blur that led up to this point.

    As a new supervisor giving his first formal disciplinary action, Mike felt that his abilities were being tested. What began with an effort to accommodate a bereaved...

  21. 14 Dying on Time
    (pp. 154-162)
    Rich Schlauch and Terry A. Wolfer

    AS THE FOCUSED MEDICAL REVIEW shifted to the final case for the day, Bonnie Delaney, director of social services for Meadow View Hospice, noticed that social worker Miriam Goldstein’s face was furrowed into a tight frown. In September 1995, an eight-member committee had convened to review the justification for providing continued treatment services to several patients, including Jean Geddes. Jean had amyotrophic lateral sclerosis, or ALS (a.k.a. Lou Gehrig’s disease), and was one of Miriam’s patients. Recently, Jean had shown little decline—her symptoms did not seem to be progressing toward the terminal stage—and that, unfortunately, was a Medicare...

  22. 15 Just Thinking About It
    (pp. 163-170)
    Vicki M. Runnion

    AFTER SOME PRELIMINARY, casual conversation, hospice social worker Cindy Burnett shifted toward the real reason for her visit with Tiffany Walker, the nineteen-year-old mother of a terminally ill infant. “Tiffany, it wasn’t all that long ago that you were so upset that you cut your wrists and were in the hospital yourself. I know bringing Zoe home has taken up a lot of your time and thoughts. But I have to ask, have you thought about that anymore? About hurting yourself? Especially now that Zoe may have to go back in the hospital?” Cindy kept steady eye contact.

    “Well, yeah,”...

  23. 16 A Painful Predicament
    (pp. 171-180)
    Barbara Head

    DIALYSIS SOCIAL WORKER Mindy Callahan remained at Elliot Marshall’s bedside, talking softly and gently massaging his hands and arms. “I promise you, Elliott, I won’t let your death be in vain.” Just before leaving, she told him, “I will do everything in my power to make sure patients’ wishes aren’t ignored in the future.” These turned out to be her final words to Elliott. He died quietly that night. His brother and minister made the funeral arrangements.

    Located in Parkersburg, West Virginia, St. Anthony’s Medical Center served a town of 32,000. Farming and factory work were the occupations of most...

  24. 17 ’Til Death Do Us Part?
    (pp. 181-188)
    Barbara Head

    STANDING WITH MR. ANDERSON, geriatric social worker Linda Nickels wasn’t sure how to respond. Mrs. Anderson had just left Fredonia Hospital on a stretcher. The ambulance would take her to Mount Meadows Nursing Facility, where hospice would follow her. Linda was covering for Michelle Humphrey, who had taken Friday off to enjoy a long weekend, and she hadn’t anticipated any problems with this discharge.

    “I would never have agreed to that surgery,” Mr. Anderson said, tears flowing down his ruddy cheeks, “if I’d known it would come to this. This is no way to spend the last days of our...

  25. 18 I Want to Talk to Your Supervisor!
    (pp. 189-203)
    Vicki M. Runnion

    HOSPICE SOCIAL WORKER Marie Vincent was just walking into the office when the receptionist said, “You’ve got a call here, Marie—it’s that same woman, and she’s really hot.”

    Marie picked up the phone rtly. Immediately, without introduction, Suzanne began, “What is this you told my mother about APS [Adult Protective Services] and going home? She was adjusting to being at Eastminster and you got her all stirred up. She isn’t competent to make these decisions, and certainly not to go home. I want to talk to your supervisor, and I don’t want you to visit her anymore.”

    Knowing there...

  26. 19 Drowning Sorrows (A)
    (pp. 204-212)
    Vicki M. Runnion

    “Howard,” hospice social worker Karla Thomas asked, “do you remember that you agreed not to be drinking before my next visit?”

    “Yeah, I remember,” Howard Harriman acknowledged.

    “Your voice sounds like you have been—am I right?”

    “Yeah.” Silence.

    Karla paused, wondering whether to stick with what she had told Howard at her last visit, and about the risk to his safety as well as her own.

    In 2001, Dandridge was a small town with a population just under 10,000. Located in Jefferson County, about 35 miles east of Knoxville, Tennessee, and a similar distance from Sevierville and tourist mecca...

  27. 20 Seizing Hope (A)
    (pp. 213-224)
    Gecole Harley and Terry A. Wolfer

    AS HE NAVIGATED rush-hour traffic, case manager Tim Reilly reflected on thirty-four-year-old Gilbert Shealy’s worsening situation. Gilbert lived in a group home for people with developmental disabilities. He suffered from repeated seizures and had near constant low-grade seizure activity in his brain. His various seizure medications offered limited control and, as it turned out, carried their own extreme side effects. Elizabeth Parsec, the administrator at Gilbert’s group home, had just proposed a risky and expensive solution. But first, Tim and Elizabeth had to decide whether and how to help Gilbert make a decision about it.

    “This is serious, Tim,” Elizabeth’s...

  28. 21 Gifts (A)
    (pp. 225-235)
    Gecole Harley and Vicki M. Runnion

    SOCIAL WORKER and group leader Phyllis Watts reflected on yet another monthly meeting of Mothers and Others, a support group for people whose loved ones were dying of AIDS. There were fabulous meetings, for example, when the group came together to organize a week’s worth of casseroles for a family whose loved one was in the final stages of dying, when someone in the group was processing what it meant to be a devout Christian and have a gay son, or when the group collectively offered counsel far exceeding any individual therapist’s best effort.

    But lately the group seemed stuck...

  29. 22 Patty’s Girls
    (pp. 236-245)
    Heather Bennett, Karen A. Gray and Terry A. Wolfer

    IT WAS JANUARY 5, 2004, the first day back at Chicora Elementary School after Christmas break, and Patty Morris felt excited about resuming her M.S.W. internship there. During the break, she had often wondered about the Dawkins girls, Dominique and Shante. Patty felt she and Dominique had made excellent progress in their last sessions, just before the holidays. Patty had new ideas for treatment and couldn’t wait to see the girls.

    Patty arrived at Chicora and headed toward her office. As she passed the principal’s office, his secretary called out, “Mr. Green wants to talk to you.”

    Patty assumed he...

  30. 23 I Don’t Want Them Mad at Me (A)
    (pp. 246-258)
    Vicki M. Runnion

    “DONALD, LET ME BE SURE I understand, okay?” hospice social worker Emily Prentice asked. “You want your brother Thomas, Thomas Jones, to be guardian for your girls after you’re gone, is that right?”

    “Yeah,” Donald said weakly.

    “But you told Betty Jane, the social worker who visited on Saturday, that you don’t want to tell the girls` about it?”

    “No,” he said, his eyes closing.

    Taking a deep breath, Emily pushed on. “Donald, I think it’s really important for them to know what you want for them, and why. You’re their dad, and they need to know what you think...

  31. Contributing Authors
    (pp. 259-260)