The Controversy Around MAID: Compassion, Choice, and Concern

Medical Assistance in Dying (MAID) is one of the most complex and emotionally charged issues in Canadian healthcare. For some people experiencing serious and incurable illness, MAID represents an option for responding to suffering and maintaining a sense of autonomy. For others, the expansion of MAID raises important concerns about vulnerability, disability, social inequality, access to healthcare, and how society responds to people who are suffering.

These perspectives can exist alongside one another.

Research involving patients, families, healthcare professionals, and ethicists demonstrates that MAID decisions are rarely simple. They can involve physical symptoms, psychological distress, relationships, identity, quality of life, fears about the future, and deeply held personal values (Oczkowski et al., 2021; Smolej et al., 2023).

At Authentic Living London, counselling can provide a space to explore these complicated experiences without judgment. Counselling is not about persuading someone toward or away from MAID. Instead, it can help individuals and families understand what they are experiencing, clarify their values, communicate with one another, and navigate the emotional dimensions of an extraordinarily difficult period.

Understanding MAID in Canada

MAID became legal in Canada in 2016 following changes to the Criminal Code. Since then, Canadian legislation and clinical practice have continued to evolve.

The development of MAID in Canada has involved ongoing discussion about two important principles: autonomy and protection from harm. On one hand, individuals may wish to make decisions about their own bodies and lives in the context of serious suffering. On the other, healthcare systems have a responsibility to consider whether decisions are informed, voluntary, and made without coercion or undue pressure (Lazin & Chandler, 2022).

This tension is one reason MAID remains such a significant ethical issue.

Research examining Canadian healthcare policies has found that MAID practice involves considerations including informed choice, eligibility and safeguards, dignity, confidentiality, conscientious objection, and multidisciplinary care (Frolic & Miller, 2022; Mills et al., 2023).

MAID therefore cannot be understood solely as a medical procedure. It is also a deeply personal, relational, ethical, and social experience.

Why Some People Consider MAID

People who request MAID may have very different experiences and reasons for doing so. Research with Canadian patients and families suggests that the experience can involve concerns about suffering, loss of function, quality of life, independence, future decline, and the desire to have some control over what happens next (Oczkowski et al., 2021).

For some individuals, the ability to make decisions about the circumstances surrounding death can be closely connected to personal values and dignity.

Importantly, understanding why someone is considering MAID does not require agreeing with their decision. It means creating enough space to understand the person's experience rather than reducing the decision to a single explanation.

For healthcare professionals, this requires careful assessment and attention to the individual's circumstances, values, medical condition, and decision-making capacity (Gupta & Blouin, 2022).

Why MAID Is Controversial

The controversy surrounding MAID largely reflects competing understandings of autonomy, vulnerability, suffering, and protection.

Some researchers and ethicists emphasize the importance of respecting an individual's ability to make decisions about their own life. Others question whether autonomy can always be considered separately from the social circumstances in which a person is making a decision.

For example, someone experiencing disability, poverty, isolation, inadequate housing, limited access to healthcare, or insufficient social support may be making decisions within circumstances that significantly constrain their available choices. This does not automatically mean that such a person's decision is coerced or invalid. Rather, it highlights the importance of understanding the broader context surrounding the decision (Lazin & Chandler, 2022).

This is one of the central challenges in MAID discussions: how can autonomy be respected while also ensuring that vulnerability, unmet needs, and potential sources of pressure are carefully considered?

The Importance of Palliative and Other Supportive Care

Exploring MAID should occur alongside consideration of other forms of care and support.

Patients and families participating in Canadian research have emphasized the importance of coordinated, patient-centred care throughout the MAID process (Oczkowski et al., 2021). Palliative care, medical treatment, psychological support, social services, and practical assistance may all be relevant depending on an individual's circumstances.

This does not mean that accessing palliative care automatically eliminates a person's desire for MAID. Rather, comprehensive care can help ensure that people understand and have access to available options when making decisions about serious illness and suffering.

The broader social context also matters. Researchers have raised important questions about how structural vulnerabilities and inadequate access to resources should be addressed within discussions about MAID (Christie et al., 2024; Lazin & Chandler, 2022).

These questions are part of responsible clinical and ethical decision-making.

The Emotional Experience of MAID

A MAID decision can affect more than the person making the request. Family members and close friends may experience a complicated combination of emotions, including sadness, fear, acceptance, uncertainty, guilt, disagreement, or relief.

Research involving Canadian family members has identified experiences of guilt, judgment, and secrecy surrounding MAID (Crumley et al., 2023). Other research has found that family caregivers may have their own support needs while accompanying someone through the MAID process (Smolej et al., 2023).

The procedure itself can also be emotionally significant for families. In a recent Canadian study, caregivers described the day of the MAID procedure as potentially both meaningful and unsettling. Preparation, communication with healthcare providers, the environment, opportunities for participation, and the pacing of the process all influenced their experiences (Thangarasa et al., 2024).

These findings highlight an important point: MAID affects relationships as well as individuals.

When Family Members Disagree

Not everyone in a family will necessarily feel the same way about a MAID decision.

A person considering MAID may feel certain about their wishes while a spouse, parent, adult child, sibling, or close friend may feel frightened or opposed. Others may support the decision while experiencing significant grief.

These differences can place considerable strain on relationships.

Research suggests that family members may struggle with questions about whether they are doing the right thing, whether they should encourage or discourage the decision, and how they can support their loved one while managing their own emotional responses (Crumley et al., 2023; Smolej et al., 2023).

Counselling can provide a space where these emotions can be explored without requiring everyone involved to feel the same way.

How Counselling Can Help

Counselling is not a substitute for medical assessment, palliative care, or the formal MAID process. A therapist does not determine whether someone meets the legal criteria for MAID.

However, psychological support can be valuable alongside medical and palliative care.

For Someone Considering MAID

Counselling may provide an opportunity to:

• Explore fears, hopes, values, and sources of meaning

• Talk openly about mortality and the changes associated with serious illness

• Process grief related to changes in health, independence, identity, or future plans

• Explore emotional and relational concerns

• Identify sources of distress that may benefit from additional support

• Prepare for difficult conversations with family members

• Consider how personal values relate to different care options

• Develop ways of communicating wishes and boundaries

• Address unfinished relational or personal concerns

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Research on MAID care emphasizes the importance of patient-centred approaches and coordinated support throughout the process (Oczkowski et al., 2021).

Counselling can be one part of that broader support system.

Counselling for Family Members

Family members can also benefit from counselling, whether or not they agree with their loved one's decision.

Therapy may provide space to:

• Process grief and anticipatory grief

• Talk about fear, anger, guilt, sadness, or uncertainty

• Navigate disagreements within the family

• Communicate more effectively with a loved one

• Understand the emotional impact of caregiving

• Establish healthy boundaries

• Prepare emotionally for the death of someone they love

• Process the experience following a MAID death

Research has specifically identified the need for greater attention to the experiences and support needs of family caregivers involved in MAID (Smolej et al., 2023; Thangarasa et al., 2024).

Family-centred support is therefore an important component of compassionate care.

Counselling Is Not About Making the Decision for You

Because MAID involves deeply personal and ethical questions, counselling should provide room for exploration rather than pressure.

A therapist can help someone examine what they are experiencing, understand the emotional factors involved, and communicate more effectively with the people around them. They can also help identify areas where additional medical, palliative, social, or community support may be appropriate.

The goal is not to tell someone what decision to make.

The goal is to provide a thoughtful and supportive environment in which difficult emotions and questions can be explored safely.

MAID Is Both a Personal and Relational Experience

Much of the public conversation about MAID focuses on the individual requesting it. Research reminds us that the experience extends beyond that individual.

Patients, families, healthcare providers, and communities can all be affected by the process. Canadian research has identified the importance of patient-centred care, coordination, communication, and attention to family experiences throughout MAID-related care (Oczkowski et al., 2021; Thangarasa et al., 2024).

For families, the experience does not necessarily end when the procedure is over. Bereavement may bring its own questions, emotions, and challenges.

Providing support before, during, and after a MAID experience can therefore be an important part of compassionate care.

MAID Counselling at Authentic Living London

At Authentic Living London, Jeanette Leroux provides counselling for individuals considering MAID as well as family members who are affected by a loved one's decision.

Jeanette's approach is grounded in compassion, respect, and openness. Counselling can provide a space to explore the emotional and relational aspects of serious illness, clarify personal values, work through grief and uncertainty, and prepare for difficult conversations.

For family members, therapy can offer an opportunity to process complicated emotions and find ways to remain connected while navigating a difficult and deeply personal experience.

MAID decisions involve medical, legal, ethical, and personal considerations. Counselling is one form of support that can help people navigate the emotional dimensions of those decisions with greater clarity and care.

If you or someone you love is affected by a MAID decision, Jeanette offers a confidential and compassionate space to talk through what you are experiencing.

Book a free 15-minute discovery call today by clicking HERE.

References

Christie, T., et al. (2024). Medically assisted dying in Canada and unjust social conditions: A response to Wiebe and Mullin. Journal of Medical Ethics. https://doi.org/10.1136/jme-2023-109327 

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 

Frolic, A., & Miller, P. (2022). Implementation of medical assistance in dying as organizational ethics challenge: A method of engagement for building trust, keeping peace and transforming practice. HEC Forum, 34(4), 371–390. https://doi.org/10.1007/s10730-022-09485-9 

Gupta, M., & Blouin, S. (2022). Ethical judgment in assessing requests for medical assistance in dying in Canada and Quebec: What can we learn from other jurisdictions? Death Studies, 46(7), 1608–1620. https://doi.org/10.1080/07481187.2021.1926636 

Lazin, S. J., & Chandler, J. A. (2022). Two views of vulnerability in the evolution of Canada's medical assistance in dying law. Cambridge Quarterly of Healthcare Ethics, 31(4), 469–482. https://doi.org/10.1017/S0963180121000943 

Mills, A., et al. (2023). Medical assistance in dying and the meaning of care: Perspectives of nurses, pharmacists, and social workers. Health.

Oczkowski, S. J. W., et al. (2021). How can we improve the experiences of patients and families who request medical assistance in dying? A multi-centre qualitative study. BMJ Supportive & Palliative Care.

Smolej, E., Malozewski, M., McKendry, S., Diab, K., Daubert, C., Farnum, A., Scali, O., Reel, K., & Cameron, J. I. (2023). A qualitative study exploring family caregivers' support needs in the context of medical assistance in dying. Palliative & Supportive Care, 21(2), 254–260. https://doi.org/10.1017/S1478951522000116 

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 

Thangarasa, T., et al. (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. https://doi.org/10.1177/02692163241248725