Conversations at the end of life:the challenge to support patients who consider death with dignity in Oregon.

Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles.