“It was one of the most complex experiences I’ve ever gone through. It came with a horrific sense of impending doom, while simultaneously trying to support her and trying to sort out how I even felt about her choosing to die. It was a horrible mix of grief and gratitude; both tragic and magic at the same time.”

That is how Michelle (name changed for anonymity) felt about the grief experience when her grandmother chose to die by medical assistance in dying.

Medical assistance in dying (MAiD) allows people with eligible severe health conditions to legally have a doctor administer a substance that causes their death. Worldwide, MAiD is legal in many countries throughout Europe, Australia, Canada, and 10 states in the US. In Canada alone, rates of people dying through MAiD increased from 1,018 people in 2016 to 13,241 people in 2022, which means that more family and friends will go through the grief of losing someone by MAiD. How does the experience of having a loved one die by MAiD impact family members’ grief?

Research shows mixed results. One study showed that people whose loved ones died by MAiD had fewer traumatic and ongoing grief symptoms than people whose loved ones died from gynecological cancer. Other studies found no differences in grief levels when loved ones died by MAiD compared to natural death with palliative care, but identified certain factors that complicate or ease grief from MAiD. However, as other studies have reported, the research might show fewer long-term impacts of MAiD on grief because those who are struggling with the complexities of grief might not enroll in studies.

Tekla Hendrickson, the Executive Director of MAiDHouse, a non-profit organization that supports families through MAiD and conducts research on grief and MaiD explains that certain factors can make the grief more complicated or prolonged.

If the family member feels conflicted over the loved one’s decision to die by MAiD, they report more grief challenges. Grief might also differ depending on how sick their loved one seemed. Research shows that some people were opposed to their family member dying by MAiD until they witnessed the loved one’s suffering, and they ultimately felt relief that their loved one no longer had to suffer. However, if the loved one’s suffering is invisible, it can be harder for the family to accept them choosing MAiD.

Family members have reported feeling resentment over their loved one choosing to die prematurely. Feeling anger about this may cause complicated grief, which occurs when something interferes with the person’s ability to adapt to grief.

In an interview with Chantal Perrot, a family physician and psychotherapist who provides MAiD assessments and procedures, she explains, “I think the differences [in reactions] would depend on the readiness to the person’s death. The people left behind may feel more actively abandoned or left behind because the person is ‘choosing to die’ or ‘choosing to leave them’, and I have seen that in families over the years.”

Even more, there are reports of families who didn’t know their loved one was going to die by MAiD or didn’t know when they would die because the patient kept it confidential, leaving the family in shock.

Sylvia Henshaw, a retired nurse and the Communications Officer at Dying with Dignity Canada understands this grief, as her husband died by MAiD. The main factor that she sees impacting loved ones’ grief is religious and moral beliefs related to MAiD. Family members are forced to not only grapple with the loved one dying, but also grapple with their beliefs about assisted death at the same time. A study and first-hand accounts show that if someone is morally or religiously opposed to their loved one dying by assisted death, they experience more distress than those who agree or have come to terms with this way of dying.

Another complicating factor is the stigma that surrounds this type of death, as noted by both Hendrickson and Henshaw. Research shows that some people are unable to express grief fully because they don’t disclose the mode of death to those around them due to stigma. This causes isolation and disenfranchised grief. Disenfranchised grief occurs when someone feels they don’t have a right to grieve, or they feel prevented from grieving or having social support amidst grief.

Research also shows that a unique component of MAiD is the profound anxiety, anticipatory grief and sense of impending doom of scheduling a loved one’s death for a certain date. Hendrickson explained, “It’s a lot to process that you know what the exact date of death is going to be. Many people are planning celebrations and parties and goodbye moments and then it kind of hits you that this person is going to die. It’s a big experience for people.”

At the same time, the process of MAiD has factors that are not just tragic but also magic, which ease the grief associated with MAiD. First-hand accounts and studies show that families appreciate the opportunity to say goodbye, and value the intimacy of being present at the end of life.

Uniquely to MAiD, the patient is sometimes still fully aware and able to say goodbye more deeply than someone who is dying naturally. While being able to discuss the impending death openly with the person who is dying can be emotionally gut-wrenching, research shows that these open conversations can ease grief and that people who discussed it openly coped better.

While the anticipatory grief of planning for death can be very difficult, on the other hand, research also shows that family and friends feel their grief was easier because they were able to plan for the death and be prepared with social support and grieving rituals.

A study that interviewed families found that grief was easier when the family finds comfort in honouring the dying person’s wishes, and feels that their loved one is at peace and is spared from future suffering. As well, the dying person’s acceptance of their death can help the family be at peace with the death too.

As rates of MAiD increase, and more people experience this form of grief, it’s crucial to talk about grieving a death through MAiD to reduce stigma and support people going through this unique experience. Speaking openly about it can help people grappling with complex grief to move forward.

– Lauren Rudolph, Contributing Writer

Image Credits:

Feature: Min An, Pexels, Creative Commons

First: Mike Labrum, Unsplash, Creative Commons

Second: Lauren Rudolph, used with permission