Navigating the Heart Wrenching Decision of Medical Assistance in Dying (MAID)

Few decisions carry the emotional weight of Medical Assistance in Dying (MAID).

For a person living with serious illness, the decision to explore MAID can bring complicated and sometimes conflicting feelings. There may be relief alongside sadness, certainty alongside doubt, or a sense of control alongside fear about what lies ahead. Family members can experience their own mixture of love, grief, worry, guilt, uncertainty, and even disagreement.

There is no single emotional response to MAID, and there is no single way for a person or family to experience this process.

At Authentic Living London, we believe people deserve a space where they can talk honestly about what they are feeling without being judged or pressured toward a particular decision. Counselling can provide a place to explore the emotional and relational aspects of this experience while medical and legal questions remain with the appropriate healthcare professionals.

What Is Medical Assistance in Dying?

Medical Assistance in Dying, commonly referred to as MAID, is a legal medical service in Canada for people who meet the applicable eligibility requirements.

The medical and legal aspects of MAID are complex and can change over time. Eligibility, assessment, consent, safeguards, and the process itself are matters for the person's healthcare team and qualified MAID assessors. A therapist does not determine whether someone is eligible for MAID and should not make that decision on their behalf.

What counselling can offer is something different: a place to talk through the human experience surrounding the decision.

For someone considering MAID, that may include exploring fears about suffering, concerns about family, questions about identity and dignity, changing hopes for the future, spiritual or existential concerns, or uncertainty about what they truly want.

MAID and palliative care are also not simply opposing choices. They are distinct approaches that can intersect within end-of-life care. Recent Canadian research emphasizes the importance of addressing physical, psychological, social, and existential dimensions of suffering when people are considering their options at the end of life (Pirzada et al., 2026).

Why Can the Decision Feel So Complicated?

A person may feel very clear about wanting control over how their illness progresses and still experience sadness about dying.

They may feel relief that an option exists while also feeling frightened by what that option means.

They may worry about becoming a burden on their family, feel guilty about the pain their death will cause, or struggle with questions about whether they are making the “right” decision.

These feelings do not necessarily mean that someone is confused or incapable of making an informed decision. Complex decisions can involve several emotions at once.

Counselling can provide room for those emotions without requiring them to be resolved immediately.

The goal is not to persuade someone toward MAID or away from it. It is to create a safe space where the person can understand what they are experiencing and consider the questions that matter most to them.

What About Family Members?

MAID affects more than the person receiving the service.

Family members may be deeply involved in caregiving, appointments, conversations, practical planning, and emotional support. At the same time, they may be trying to come to terms with the possibility of losing someone they love.

Research with Canadian family caregivers has found that the MAID process can involve significant emotional and practical complexity. Caregivers have described feeling as though they are racing against time, particularly when concerns about the person's health or capacity affect the process (Thangarasa et al., 2022).

Other Canadian research has identified experiences of guilt, judgment, and secrecy among family members involved with MAID. Some families may feel unable to talk openly about the decision because of concerns about how others will respond (Crumley et al., 2023).

These experiences can be particularly difficult because family members may feel that their own grief has to remain secondary to the needs of the person who is ill.

But their feelings matter too.

Pre-Loss Grief Can Begin Before a Death

Grief does not necessarily begin on the day someone dies.

When a loved one has a life-limiting illness, family members may begin grieving changes that are already happening while also anticipating the future loss. Researchers have described this as pre-death grief, which can include grief about present losses as well as fear and sadness about a future without the person (Singer et al., 2022).

A systematic review of caregivers of people with terminal illness found that higher levels of pre-loss grief and lower perceived preparedness for death were associated with more difficult adjustment after the death (Treml et al., 2021).

This does not mean that family members should try to “get their grief out of the way” before a death. Grief is not something that can be completed in advance.

It does mean that family members may benefit from support before the death occurs.

What Might Counselling Help With?

Counselling cannot answer the medical or legal questions surrounding MAID, but it can help with many of the emotional and relational questions that accompany them.

For the person considering MAID, therapy may provide space to explore fears, hopes, values, relationships, unresolved concerns, changes in identity, and the emotional impact of living with serious illness.

For family members, counselling may provide an opportunity to talk about grief, anger, guilt, fear, helplessness, disagreement, or the difficulty of supporting someone whose choices may be different from their own.

Family communication can be particularly important during this time. Research on end-of-life communication suggests that conversations about goals, values, preferences, and care can help families navigate difficult decisions, although these conversations are not always easy and can be affected by emotional and relational barriers (Jung & Matthews, 2021).

Counselling may also provide a place to think about what needs to be said while there is still time to say it.

Finding Meaning During a Difficult Time

When someone is approaching the end of life, ordinary priorities can change.

People may want to revisit important memories, repair relationships, express love or gratitude, share stories, create meaningful rituals, or simply spend quiet time together.

There is no prescribed way to create meaning. For one person, it might involve talking openly with family. For another, it might involve spirituality, music, photographs, writing letters, or simply being present with the people they love.

Research on end-of-life communication and psychosocial interventions suggests that conversations about values, preferences, relationships, and meaning can play an important role in helping people and families navigate serious illness (Gonella et al., 2023; Jung & Matthews, 2021).

Sometimes meaningful moments are carefully planned. Other times, they happen quietly in the middle of an ordinary day.

What If Family Members Disagree?

MAID can bring differences in beliefs and values to the surface.

A family member may strongly support the person's wishes. Another may feel frightened, angry, or unable to accept the decision. Someone may have spiritual or ethical beliefs that make MAID particularly difficult to understand.

These differences can be painful without necessarily meaning that the family does not love one another.

Counselling can provide a place to acknowledge those differences while keeping the focus on respectful communication. It can help family members express what they are feeling without assuming that everyone has to reach the same conclusion.

The person making the medical decision remains at the centre of their own healthcare process, while family members may need support of their own as they navigate their relationship with that decision.

Support Before, During, and After MAID

Support can be valuable throughout the entire experience, not only while a decision is being considered.

Before MAID, a person and their family may be coping with uncertainty, anticipatory grief, changing health, difficult conversations, and practical decisions.

During the process, family members may experience a wide range of emotions and may have questions about what to expect. Canadian research examining the experience of caregivers on the day of an assisted death found that the day itself can carry significant emotional complexity and that caregivers may have important informational and support needs (Nissim et al., 2024).

Afterward, grief continues.

Research examining Canadian caregivers whose loved ones died by MAID suggests that bereavement can involve both the ordinary pain of losing someone and experiences specific to the circumstances surrounding an assisted death (Hashemi et al., 2021).

There is no single “correct” way to grieve a death by MAID.

Some people may feel sadness. Others may experience relief that their loved one is no longer suffering. Some may feel guilt or question whether they could have done something differently. Others may feel certain that they supported the person's wishes while still experiencing profound grief.

These feelings can coexist.

What About Palliative Care?

Palliative care deserves to be part of conversations about serious illness and end-of-life care.

Palliative care focuses on quality of life and on relieving physical, psychological, social, and existential suffering. It can be provided alongside other forms of medical care and can help patients and families understand and manage the challenges of serious illness.

Importantly, discussing palliative care does not mean that a person's questions about MAID should be dismissed. Similarly, discussing MAID does not mean that palliative care has failed.

A 2026 review of MAID and palliative care in Canada emphasized the importance of addressing both physical and non-physical dimensions of suffering and ensuring that people have access to appropriate care and support when considering end-of-life options (Pirzada et al., 2026).

Your medical team is the appropriate source for questions about palliative care, MAID eligibility, medical options, and the specific procedures involved.

How Counselling Can Support You and Your Family

Counselling around MAID is not about telling someone what choice to make.

It is about creating space for the person and their loved ones to be honest about what they are experiencing.

You may want to talk about fear of dying, fear of suffering, guilt, family conflict, anticipatory grief, spiritual questions, changing relationships, or what you want the remaining time to look like.

You may not know exactly what you feel yet.

That is okay too.

A counsellor can listen, help you organize complicated thoughts and emotions, and support you in having difficult conversations without taking the decision out of your hands.

MAID Counselling With Jeanette Leroux at Authentic Living London

At Authentic Living London, Jeanette Leroux provides counselling support for individuals and families navigating grief, end-of-life concerns, and the emotional complexities surrounding MAID.

Jeanette offers a calm and compassionate space where clients can talk openly about difficult emotions, anticipatory grief, family concerns, meaning, and the uncertainty that can accompany end-of-life decisions.

Her role is not to tell you whether MAID is the right choice. Instead, counselling can provide a place to explore what this experience means to you and to work through the emotions and relationships surrounding it.

Jeanette offers confidential counselling both in person in London, Ontario, and virtually.

You Do Not Have to Navigate This Alone

Medical Assistance in Dying can bring together some of life's most difficult questions: How do I want to live with the time I have left? What matters most to me? How do I talk to the people I love? How do I support someone whose decision I may not fully understand? And how will I cope with what comes next?

There may not be simple answers.

There can, however, be compassionate support.

If you or someone you love is considering MAID, counselling can provide a safe place to talk through the emotional experience without judgment or pressure. Your healthcare team can guide you through the medical and legal aspects of MAID, while a counsellor can support the human side of the journey.

At Authentic Living London, Jeanette Leroux is available to support individuals and families through this difficult and deeply personal time.

To learn more or arrange a confidential consultation, contact Authentic Living London at 226-224-0301 or info@authenticlivinglondon.com.

Social Worker, Jeanette Leroux, specializes in grief and MAID counselling

Jeanette Leroux, MSW, offers compassionate support for individuals and families facing the profound decision of Medical Assistance in Dying. With deep empathy and experience, Jeanette provides a safe space to explore emotions, values, and concerns surrounding this journey.

Jeanette works alongside clients to help process anticipatory grief, navigate complex feelings, and find meaning during this challenging time. Her gentle guidance and listening presence create comfort and clarity when it’s needed most.

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References

Crumley, E. T., LeBlanc, J., Henderson, B., Jackson-Tarlton, C. S., & Leck, E. (2023). Canadian family members' experiences with guilt, judgment and secrecy during medical assistance in dying: A qualitative descriptive study. CMAJ Open, 11(4), E782–E789. https://doi.org/10.9778/cmajo.20220140

Gonella, S., Dimonte, V., Arnone, Y., Albanesi, B., Berchialla, P., Di Giulio, P., & van der Steen, J. T. (2023). Interventions to promote end-of-life conversations: A systematic review and meta-analysis. Journal of Pain and Symptom Management, 66(3), e365–e398. https://doi.org/10.1016/j.jpainsymman.2023.05.001

Hashemi, N., Amos, E., & Lokuge, B. (2021). Quality of bereavement for caregivers of patients who died by medical assistance in dying at home and the factors impacting their experience: A qualitative study. Journal of Palliative Medicine, 24(9), 1351–1357. https://doi.org/10.1089/jpm.2020.0654

Jung, M. Y., & Matthews, A. K. (2021). A systematic review of clinical interventions facilitating end-of-life communication between patients and family caregivers. American Journal of Hospice & Palliative Medicine, 38(2), 180–190. https://doi.org/10.1177/1049909120929323

Nissim, R., Chu, P., Stere, A., Tong, E., An, E., Selby, D., Bean, S., Isenberg-Grzeda, E., Rodin, G., Li, M., & Hales, S. (2024). “Walk me through the final day”: A thematic analysis study on the family caregiver experience of the Medical Assistance in Dying procedure day. Palliative Medicine, 38(6), 660–668. https://doi.org/10.1177/02692163241248725

Pirzada, S., Kelly, C., Bolton, J., Roger, K., & Chochinov, H. M. (2026). Medical assistance in dying and palliative care in Canada: Clinical and ethical considerations in an evolving landscape. International Review of Psychiatry. Advance online publication. https://doi.org/10.1080/09540261.2026.2672609

Singer, J., Roberts, K. E., McLean, E., Fadalla, C., Coats, T., Rogers, M., Wilson, M. K., Godwin, K., & Lichtenthal, W. G. (2022). An examination and proposed definitions of family members’ grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliative Medicine, 36(4), 581–608. https://doi.org/10.1177/02692163221074540

Thangarasa, T., Hales, S., Tong, E., An, E., Selby, D., Isenberg-Grzeda, E., Li, M., Rodin, G., Bean, S., Bell, J. A. H., & Nissim, R. (2022). A race to the end: Family caregivers' experience of Medical Assistance in Dying (MAiD): A qualitative study. Journal of General Internal Medicine, 37(4), 809–815. https://doi.org/10.1007/s11606-021-07012-z

Treml, J., Schmidt, V., Nagl, M., & Kersting, A. (2021). Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review. Social Science & Medicine, 284, 114240. https://doi.org/10.1016/j.socscimed.2021.114240