If a Loved One Chooses Aid in Dying: What Families Should Know and Feel

When someone you love is dying and decides to use medical aid in dying (MAID), you may feel many things at once, and you may feel them before, during, and long after. There is no single right response. This guide is for you, whatever you think about the choice. It doesn’t argue for or against it.

What might I feel?

Families describe a wide range:

• Relief that suffering will end, or that the person has some control
• Sadness and anticipatory grief, sometimes with a set date, which can feel strange and sharp. See anticipatory grief
• Anger, fear, or a sense of being rushed, or the wish to talk the person out of it
• Guilt, whether about not doing more, about feeling relief, or about not being able to change their mind
• Moral or religious conflict, if your beliefs differ from theirs or from your community’s. See what different traditions teach
• Worry about what others will think, including how to explain it

Any of these is understandable. Feeling more than one, including opposite ones, is common in grief.

What does the research on grief show?

The research is limited, and it points in more than one direction, so be wary of anyone who says it’s settled either way.

• Oregon (2009). In a study of 95 family members of people who requested aid in dying, compared with 63 family members of people who died of cancer or ALS, researchers found no differences in depression, grief, or use of mental health services. Family members of people who requested aid in dying felt more prepared and accepting of the death. This was on average about 14 months after the death, and a National Academies workshop volume summarizing the Oregon research reports the same finding
• Switzerland. A study of 85 relatives or friends who were present at an assisted suicide found a higher prevalence of post-traumatic stress and depression than in the general population, with 13% meeting criteria for full PTSD, although the prevalence of complicated grief was comparable. It involved people who were present, in a country with a different system
• Overall. A 2023 systematic review concluded the findings are equivocal, with few studies comparing family members of people who used MAID with those who lost someone in other ways. A discussion of the evidence in a Canadian paper notes that preparing for the death and a sense of control seemed to ease grieving, while disagreeing with the loved one’s decision and real or perceived stigma may complicate it. Those observations come from a small qualitative study in Oregon of 22 people

In short: for many families the experience is manageable, and for some it’s very hard. Support, preparation, and a chance to say what you need to say seem to matter.

Do I have to be there?

No. Being present is a personal decision. In New York, for example, the Department of Health says the law doesn’t require patients to tell their family, though it’s recommended that they discuss it with people close to them, and the law provides that no one is subject to liability for being present when a patient takes the medication or for not acting to prevent it or to resuscitate. Some people want to be present, some want to be nearby, and some can’t be. Whichever you choose, tell the person and the care team what you need. See the last time you say goodbye and what to say to someone who is dying.

What if I disagree, or my family is split?

Families often disagree, and it can be painful. Some things that may help:

• Say what you feel, once, honestly, and then listen. Many people find they can disagree and still stay close
• Remember who decides. In the laws we reviewed, the person must make the request themselves, and family members, agents, and surrogates can’t make it for them. You can voice concerns; you can’t make or block the decision
• If you are worried the person is being pressured, talk with their care team. Laws include safeguards; in New York, for example, witnesses can’t be relatives or heirs, and anyone who coerces a patient can be prosecuted. If you believe a crime is involved, tell the authorities
• Look for common ground, such as making sure they’re comfortable, that the time is used well, and that no one’s left out
• Consider a counselor, chaplain, or social worker. Hospice and palliative care teams often have them. For differences across faith, see interfaith family disagreement and mediation

What is true legally?

Laws vary, but in the ones we reviewed, these deaths are treated differently from suicide. New York’s law says that a patient who requests the medication isn’t considered suicidal and that self-administering it isn’t suicide for any purpose. Oregon’s statute says similar. In both, the death certificate lists the terminal illness as the cause of death; see life insurance and death certificates. People may still feel stigma or hear the word “suicide” from others, which can be hurtful; you don’t owe anyone an explanation.

How do I tell people, and what should the obituary say?

You can say as much or as little as you like: “after a long illness,” “died peacefully at home,” or something more specific. Some families prefer to be open about the choice, others private. There’s no required wording. See writing an obituary.

What support is there?

• Hospice and palliative care teams usually provide bereavement support to families, and in Ganzini’s study, some families used hospice bereavement services
• Grief counselors and support groups. If you disagreed with the choice or feel guilt, a counselor can help you hold both your love and your feelings. See complicated grief to know when to seek more help
• Faith leaders or chaplains, if you find them supportive
• Friends, who may not know what to say. See what not to say to someone grieving

If you’re struggling and feel you can’t go on, please call or text 988, the Suicide & Crisis Lifeline, or call 911 in an emergency.

Research on this topic is limited and evolving. This is general information, not medical or mental health advice; a bereavement counselor or your care team can help with your situation.