Why do people consider MAiD?
“This is no life. This is not me. I am just waiting and praying for it to be over."
“I didn’t know it was legal in Canada – I am not sure if I will do it - but I am glad it is an option …”
MAiD is relatively new in Canada and data around why people choose a medically assisted death is emerging. The Annual Reports on Medical Assistance in Dying in Canada (2019, 2020) list the nature of the suffering that led to the request for MAiD as follows:
- Loss of ability to engage in meaningful life activities
- Loss of ability to perform activities of daily living
- Inadequate control of symptoms other than pain (or concern about)
- Loss of dignity
- Inadequate control of pain (or concern about)
It is important to note the quality of the care the person is receiving has not been identified as a reason to opt for an assisted death. People seeking MAiD often express how good their care has been both from the health care team, their caregivers, and their family and friends.
If you or someone close to you is thinking about having a medically assisted death, you may be able to relate to these reasons, or there may be different reasons.
Suffering is a very personal experience. We cannot know what another person’s suffering is like for them. What each person can endure will be different. There are different types of suffering including:
- Physical suffering refers to symptoms such as pain and shortness of breath.
- Emotional suffering refers to feelings such as sadness, fear, and anxieties, such as fear of death or loss of dignity, and the grief of leaving loved ones.
- Spiritual or existential suffering refers to questions about faith, the meaning and purpose of life, beliefs, values.
There is also anticipatory suffering which is the distress a person is experiencing now because of worry about the future.
Even when people have met all the eligibility criteria and are approved for an assisted death, they may not be ready to set a date. For some, having MAiD as an option can relieve anxiety and allow them to relax and live as fully as they can for as long as they can. They may never choose a date and die without medical assistance. This can be for many reasons, including that their final days were not what they had expected.
Many people express that their illness or disability has taken away control of their life and they do not want it to “control” their death.
Dr. Madeline Li tells the story of a man who told her, “I need you to understand that I get the final say in how this ends. I need you to hear that my suffering must not go on. I refuse to allow the death of my consciousness to occur before the death of my body.” He did not want to die, but he knew he was dying. What he did want, like so many others, was to control when and how he died. Others have expressed that they wanted to die “while I am still me”.
 Li M., Kain D. The other side of sorrow: physician reflections on assisted dying. CMAJ. 2018 Feb 12;190(6): 169-170.
Loss of independence means different things to different people. It also changes over time. Being unable to perform activities of daily living (things like meal preparation, bathing, dressing, toileting, walking) is one of the reasons some people consider an assisted death. At other times, people find themselves adapting to not being able to do something themselves that they previously never imagined possible. For some people losing the ability to manage their own finances may feel more distressing than needing intimate personal care. Not everyone experiences suffering because of loss of independence, but for some having to rely on others to do things for them feels like an assault to their personhood (the sense of who they are and have always been).
Those seeking MAiD most often expressed that they were no longer able to engage in meaningful life activities. What makes a life activity meaningful is very personal and is not the same from one person to the next. It is very much tied to what makes life meaningful to that person.
While difficult to define, loss of dignity has been identified as a common reason that someone would seek an assisted death. Loss of dignity can come from having to rely on others for intimate personal care, or it can be related to losing independence, a feeling of being diminished, not feeling like “me”, or not feeling part of life. Loss of dignity is very personal and can be hard to explain.
You are likely feeling a range of emotions. You may feel great relief that MAiD is an option for you, but that does not take away all the feelings you may have about your life coming to an end and leaving the people close to you. You might be worried what others might think. You may be concerned about a particular person in your life and how they will manage after you are gone. You may feel grateful that MAiD is an option and that you have the support of your family to make your own decisions.
“I just wasn’t ready to let him go. I agree with the idea of MAiD but when it was my spouse, I just didn’t feel ready….”
“I agree with their choice, but ….”
You may feel you completely understand and support why your family member or friend is considering an assisted death. At the same time, you may be wishing they would not go ahead. What you may be really wishing is that they were not dying, or that they were not suffering. You may be experiencing what is known as anticipatory grief – feelings of grief that occur while the person is alive.
“I agree with the idea of MAiD, but I don’t understand why this person is choosing it…….”
You may find it hard to understand why this person is making this request. You may have been hoping they would improve, even when another part of you knows they won’t. You may want more time with them, even though you know they are suffering. It can be helpful to talk to each other about your feelings, thoughts, and fears. Knowing when someone will die provides an opportunity to have meaningful conversations that cannot or do not often happen in other circumstances.
Tell us what you think!
What is MAiD?
The application process for MAiD
Telling family and friends
Talking to children and youth about MAiD
Starting a conversation about MAiD with the person who is ill
Seeking information and starting the process
Capacity and consent and why they are important
Having the assessments
Choosing when and where
Planning for the time left
Planning the day of MAiD
A medically assisted death
Grief after a medically assisted death
For healthcare providers