How Medical Aid in Dying Affects Family Members

5 min read

Studies show that people who participate in Medical Aid in Dying (MAiD) often report benefits that center on autonomy, relief from suffering, and preservation of dignity. For many, the option provides psychological comfort and peace of mind even if they ultimately decide not to use it. ^{7, 8}

Public opinion in the United States tends to favor the option of MAiD: polls indicate that roughly 74–85% of Americans support allowing terminally ill patients the legal option to hasten death under strict safeguards. ^{1, 3, 6} Despite this support, only a limited number of U.S. states (11 states plus Washington, DC, at the time of some reports) have legislation that allows “Death with Dignity.”

While there are clear benefits and broad theoretical support for MAiD, the lived experience can present significant moral and emotional challenges for family members. Stories collected in research highlight a wide range of reactions—from relief to deep distress—illustrating the complexity of family responses.

In “Unacknowledged Pain and Disenfranchised Grief,” Serota et al. (2023) share several family accounts that capture this emotional duality. One family member, Gloria, described an unexpected sense of relief when she witnessed her husband’s MAiD death:

The doctor explained exactly what was going to happen, … I said I love you [long pause], and then he died [crying]. And the interesting thing was, I looked at him and I had kind of an involuntary smile. I think there was a lot of things going on. Relief for him and for me, that he wasn’t suffering any longer, and he wasn’t in pain. … Oh my goodness, it’s over. The suffering and for him to be at peace, and that was a surprise.

Gloria’s reaction demonstrates how relief and grief can coexist: even amid sorrow, witnessing the end of prolonged suffering sometimes brings a complex form of consolation.

Not every account is peaceful. Other family members report intense moral distress and prolonged complicated grief. For example, Faye described her brother’s MAiD death as traumatic; she opposed his eligibility and found herself isolated and overwhelmed by the experience:

Terrible, absolutely devastating … I couldn’t eat, I couldn’t do anything. … I went back to my therapist, who I hadn’t seen in a long time. So, yeah, that’s what it was like—really hard—and I’m not okay today. I’m still not okay, and I don’t think I ever will be. I’ve never been through such trauma.

Faye’s story underlines the importance of acknowledging and supporting family members who disagree with or struggle to accept MAiD decisions.

Emotional Impact on Family Members

Family members who support loved ones through MAiD experience a spectrum of emotions. Some studies show reduced grief symptoms and greater acceptance compared with families experiencing natural deaths, and caregivers sometimes report improved mental health outcomes and less regret about the death. 1 2

At the same time, a significant minority of caregivers—around 20% in some reports—experience notable distress or depression, which can equal or exceed levels reported by patients themselves. Caregivers may also face relational strain within families when opinions about MAiD differ. 3 4

Family Members’ Perception of Quality of Death

For many families, MAiD is viewed as a way to honor a loved one’s wishes and to preserve their dignity. It can be experienced as a final act of respect, allowing the dying person to maintain control and avoid prolonged suffering. Retrospective reflections often highlight appreciation for the perceived dignity MAiD provided, though some caregivers continue to wrestle with unresolved emotions about their role in the process. 1 2 3

Challenges in Organizing MAiD

Arranging MAiD can be logistically and administratively challenging. Families often encounter complex paperwork, coordination with healthcare teams, and state-specific legal requirements that vary across jurisdictions. This complexity can amplify stress, particularly when family members are simultaneously managing caregiving responsibilities and anticipatory grief. Scheduling difficulties and last-minute medical changes—such as infections or sudden cognitive decline that affect eligibility—can add to the emotional burden. State laws and clinical requirements frequently shape the timeline and logistics of MAiD, creating additional uncertainty for families. 3

Reconciling Beliefs with MAiD

Religious and moral beliefs can complicate family responses. Some people equate MAiD with suicide and experience guilt, shame, or a sense of betrayal when a loved one chooses assisted dying. Others find ways to reinterpret their faith in light of suffering, compassion, and respect for patient autonomy. Support from spiritual leaders, prayer, or reflective conversations can help some family members reconcile conflicting feelings, while others continue to struggle. Discussing distinctions between end-of-life decisions and suicide can also be an important part of this process. 2

Families navigating MAiD need a robust support network: mental health care, peer support groups, doulas, and empathetic clinicians all play critical roles in helping loved ones through this complex journey.

If you would like to deepen your ability to support families through Death With Dignity decisions, consider enrolling in an evidence-informed course in ethics and psychotherapy for end-of-life care.

Register for our End of Life Ethics & Psychotherapy 6 Hour Ethics CE Course

Date: 12/6/24, 9AM–4:30PM EST (Live Webinar)
Can’t attend live? When you register, you’ll receive access to the recording for one year.
CE Credits: 6 Ethics CE Credits / 6 CMC Contact Hours
Approved by: ASWB, APA, NBCC, NACCM, CAMFT

What you’ll learn in this practical, ethics-focused course:

How to differentiate desire to hasten death from suicidality
Clear understanding of Death With Dignity and Medical Aid in Dying, illustrated with real case stories
Ethical approaches to supporting patients in end-of-life decisions
Strategies for advance directives, especially in dementia care
Three evidence-based end-of-life psychotherapy modalities
How to address health disparities in end-of-life care