Experiences of grief-bereavement after a medically assisted death in Canada: Bringing death to life

Abstract

Medical assistance in dying (MAiD) legislation was passed in Canada in 2016, yet the bereavement experience of family and friends is not well understood. Using interpretive description, we interviewed nine bereaved individuals. The time before the assisted death seems most impactful-an experience of bringing death to life shapes bereavement after death. We identified themes that inform this grieving: (1) certainty of date/time of deathintensifies a parade of lasts, initiates a countdown and affords time to say goodbye ; (2) active family engagement as planners supports sense-making; and (3) enacting MAiD as ceremony slows time to "digest" loss.

Grief and bereavement of family and friends around medical assistance in dying: scoping review

“…Ultimately, our review included 28 academic journal articles, including 6 published literature reviews and 22 empirical studies (tables 1 and 2). Most studies were published in Canada (n=15) 6 23–36. Other jurisdictions included Switzerland (n=3),37–39 Netherlands (n=3),16 40 41 USA (n=2),42 43 Australia44 or multiple jurisdictions or not specified (n=4) 5 7 10 32 45.…”

“…Other jurisdictions included Switzerland (n=3),37–39 Netherlands (n=3),16 40 41 USA (n=2),42 43 Australia44 or multiple jurisdictions or not specified (n=4) 5 7 10 32 45. Of the 22 identified empirical studies, almost half employed exploratory qualitative methodology (n=13),23–26 28 30 31 33 34 36 37 43 44 with the remainder being either observational quantitative studies (n=6)29 38–40 42 44 or mixed-methods studies (n=3) 6 27 35. All 13 qualitative studies conducted interviews, the quantitative studies used validated questionnaires or specifically designed surveys, and the mixed-methods studies employed the above methods as well as focus groups and unstructured conversations.…”

“…All 13 qualitative studies conducted interviews, the quantitative studies used validated questionnaires or specifically designed surveys, and the mixed-methods studies employed the above methods as well as focus groups and unstructured conversations. There were seven studies among the empirical studies that reported ethnicity of participants, and all were Caucasian 6 23–25 31 42 43. The empirical studies had study populations that most often consisted of family, friends or caregivers (n=17).…”

“…Confusion and inconsistency in EOL planning adds anxiety and increases complicated grief 7 27. Although physicians often deal with clinical symptom management of the individual receiving MAiD, a more diverse group of HCPs are needed to provide psychosocial support to family/friends 6 23 30. Bereavement support includes facilitation of communication around death, and counselling or physician referrals if necessary 6.…”

“…29 Therefore, many studies suggested that additional roles and responsibilities can be addressed by an interdisciplinary care team, which includes social workers, spiritual care providers, specialised nurses or even 'death doulas'. 23 24 36 Ultimately, when considering how HCPs can 'support the circle of support,' 24 greater structure, funding and resources are needed. Currently, the full obligation and duration of the relationship between HCPs and family/friends is ambiguous and variable.…”