Over the course of my career, I have been privileged to accompany countless individuals and families as they navigated a life-shortening illness and the realities of approaching death. Through counselling and the heartfelt conversations that ensued, I have listened to their hopes, fears, questions, and wishes for the end of life.
It is this final experience—and what it can teach us about autonomy, dignity, suffering, and love—that I would like to reflect on.
Medical Assistance in Dying, or MAiD, is one of the most profound, sensitive and misunderstood developments in Canadian healthcare in my lifetime. Since its legalization in 2016, it has invited intense debate in hospital corridors, family living rooms, and faith communities across Canada. I have come to hold a belief, grounded not in ideology but in 45 years of clinical experience witnessing, listening and learning about suffering: the person who is dying must be honoured and respected to have the final say in the manner of their death.
This is not a simple or heartless statement. Nor is it made without compassion for the family members, partners, children, and friends who are heartbroken and whose beliefs do not align with the idea of a chosen death. But when we fail to honour the voice of the person suffering, we risk compounding their suffering in ways that are, in my view, both unkind and unnecessary.
When a person has decided that the suffering of their life-shortening illness has become intolerable, that decision deserves to be received with love — not met with a wall of someone else’s fear and anxiety.
What Suffering Really Looks Like
In my clinical work utilizing the co-developed Illness Beliefs Model, I have long observed that it is not always the physical symptoms of illness that create the most suffering. It is the beliefs surrounding the symptoms and/or illness. The belief that the best days are gone and only pain remains. The belief that to continue living is to be robbed, slowly and without mercy, of everything that gave life meaning and purpose.
For patients who ultimately pursue MAiD, these beliefs are not distortions to be corrected. They are hard-won assessments of a reality that others may not fully comprehend from the outside. Suffering, as I have written before, is not partial to gender, age, or faith. It visits everyone. And only the person inside that suffering truly knows its depth.
I think of a woman I will call Margaret. She was in her late sixties, diagnosed with a progressive neurological illness, and fiercely independent throughout her adult life. By the time she first reached out to me, she had already decided to pursue MAiD. What she needed was not someone to change her mind. She needed someone to help her family accept her decision without fracturing family relationships.
Her adult son could not accept her decision. His illness belief — rooted in his religious upbringing — was that choosing death was not honouring the sanctity of life and also a form of abandonment. Of him. Of life itself. His suffering was real. But his suffering did not override his mother’s. What our therapeutic conversations helped him find, over weeks of difficult and authentic discussions, was the distinction between his belief and his love for his mother.
He was present at her death. She died knowing she was loved.
The Constraining Beliefs That Increase Suffering for Everyone
In my clinical work, I have identified certain illness beliefs that intensify suffering in MAiD situations — not just for the patient, but for the entire family system. I share them here not to assign blame, but because naming them is the beginning of softening them.
The constraining belief that agreeing with a loved one’s MAiD decision morally endorses it. It does not. You can stand beside someone without taking their side during this most delicate and sensitive time of living and dying.
The constraining belief that more time is always better. For many patients with incurable, degenerative illnesses, more time simply means more suffering. To insist on more time for your own comfort, when the person enduring that time is asking to be released, is a form of love that has become about the giver rather than the receiver.
The constraining belief that choosing MAiD is giving up. In my experience, the patients who pursue MAiD are among the most deliberate, courageous, and reflective individuals I have encountered. They have not stopped fighting. They have simply redefined what living looks like.
The constraining belief that unresolved grief will be easier to bear if the death was not chosen. This one quietly causes enormous damage. Families who resist a MAiD decision, and sometimes succeed in delaying or preventing it, can carry a particular form of guilt for years afterward. The question they live with is not ‘could we have done more?’ but ‘did we cause our loved one more suffering in the end?’
We cannot grieve well for someone we did not truly allow to be themselves in their final passage.
What Families Can Do: Facilitating Beliefs That Soften Suffering
In every family navigating a MAiD decision, there are also beliefs that soften suffering when they are invited forward and given room to breathe. The belief that love does not require agreement. The belief that the patient’s suffering is real, even when you cannot see it. The belief that saying goodbye well is a gift you give each other.
How we close a life together matters. The conversations that happen in the weeks before a MAiD death, when they are honest and tender and unrushed, are among the most healing I have witnessed in 45 years of practice. These are not conversations about death. They are conversations about life and love.
Families who have supported a loved one through MAiD often grieve in relative isolation, uncertain whether their community will understand or judge them. Counselling can provide the space they need to grieve without apology.
For Healthcare Professionals: Your Beliefs Matter Too
I want to speak directly to nurses, physicians, social workers, and others who encounter MAiD in clinical settings. Your illness beliefs about MAiD — including any moral or religious reservations — are legitimate and also need to be respected. You have the legal right to conscientious objection to not participate or be present at the time of a chosen death.
But I ask you to examine or better still to suspend your own beliefs that you carry into the conversations with patients and families who are exploring and/or considering MAiD. Subtle signs of disapproval or discomfort can add to the suffering of a person already navigating an incredibly difficult time of facing their own death, whether a chosen death or not. Curious compassion — a genuine, non-judgmental interest in the other person’s experience and beliefs — is perhaps the single greatest clinical gift you can offer.
My own faith community does not support MAiD, but I am able to rise above those beliefs to assist individuals/families in my care to not feel judged or criticized as they explore the possibility of or make a decision to request MAiD. Love without judgment.
A final reflection
Whose death is it? It belongs to the person dying. Our most loving act is to ensure that individuals in our care know we understand. And that we will accompany them on this journey without judgment.
If you are navigating a MAiD decision — as a patient, a partner, a child, or a parent — and you are not sure how to carry this alone, please know that healing conversations are possible. I would be honoured to be part of yours. I would also be honored to meet any family members who are suffering with the choice that a family member may be making about MAiD. Your voice is also to be respected and honored.
To book an end-of-life counselling session with Dr. Lorraine M. Wright:
Frequently Asked Questions
MAID stands for Medical Assistance in Dying. In Canada, it is a legal process by which a person with a serious and incurable illness may request medical help to end their life. It was legalized in 2016 and expanded under Bill C-7 in 2021.
Yes. Under Canadian law, the decision to pursue MAID rests solely with the eligible patient, who must provide informed, voluntary, and competent consent. No family member or institution can override that decision.
Supporting a loved one who has chosen MAiD begins with listening without judgment. Families can offer presence, practical help, and love without requiring agreement. Working with a counsellor experienced in end-of-life transitions can be enormously helpful.
Disagreement is common and deeply human. Therapeutic conversations can help family members process their grief and fear, and find a way to be present for their loved one even when they cannot agree. The goal is not to change your beliefs but to soften your suffering and that of your loved one.
Absolutely. Before a MAiD death, counselling helps the patient articulate their wishes and prepares family members emotionally. After a MAID death, grief counselling supports families through a form of loss that is unique and sometimes isolating.
Yes. Dr. Lorraine M. Wright offers end-of-life counselling that includes support for individuals and families navigating MAID decisions. Sessions are available online across Canada. Learn more at lorrainewright.com/consultations-about-end-of-life/
