Handout: So Now What? Grief and bereavement following MAiD

NOTE FOR PROFESSIONALS:

This resource was developed during my MSW placement at Hazel Burns Hospice in Toronto. It’s built on an extensive review of the available academic literature and consultations with practitioners, grief support workers and family members.

Designed as a handout, you are welcome to adapt the content for your organization’s materials and programs, with attribution. It may also serve as a guide for professionals to develop ways of helping people understand what to expect when grieving a MAiD death.

It was workshopped at the annual HPCO Conference on April 28, 2019.

It’s also available as a PDF at Hazel Burns Hospice, here.

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Grief and bereavement following Medical Assistance in Dying (MAiD) can be very similar to grief and bereavement following a natural death -- but how you feel will depend a lot on how you arrived at this moment, and will be unique to you.

Your grief will depend on your relationship to the person who died -- the death of a close friend or family member may feel different than that of a more distant relation. The nature of your connection will shape the way you feel as well -- was it an easy relationship, or were there challenges and things that need to be forgiven?

How long was your person ill? How much of your time went into caregiving? How well supported did you feel during the illness and MAiD journey and how well supported do you feel now? These are all questions that can shape how you grieve no matter how your loved one died.

It’s important to know there is no “right” way to feel after the death of someone you care about. Grief is a rollercoaster of feeling that will affect not just your emotions, but may affect how you feel in your body too -- from how you sleep, to how you respond to stress, to your energy level in general. Many people say that grieving takes up more energy than they ever expected. Give yourself time to recharge for as long as you need.

The good news is that MAiD has been around for long enough in various countries that we know, on average, grief should be no worse after a MAiD death than a non-MAiD death. However, your experience will vary greatly depending on the kind of support you received during the lead-up to, and following, the event.

Antony Gormley, Another Place. Crosby Beach, Liverpool, UK.

People say one of the positive aspects of a MAiD death…

… is that they had time to talk through important issues with the loved one’s circle of friends and family, to tell stories, resolve conflicts, celebrate and appreciate their person prior to the death. These activities are part of what is called “anticipatory grief,” and they may actually help prepare you for your grief after the death.

People also say that knowing their person is free of suffering can make the death feel like a relief. There is no need to feel guilty if your overwhelming reaction to the death is relief.

There are a few considerations for how your grief will unfold that are specific to MAiD. A big one is how you, and the people and professionals around you, felt about the choice to use medical assistance in dying. If everyone was generally supportive of it, it’s easier to feel comfortable with that decision.

But if you or the people around you were ambivalent or conflicted about it, you may experience some feelings that surprise you, such as anger and disappointment with your loved one. This is normal, and it’s good to be able to express these feelings through writing, art, and conversation. Few choices at end of life are easy, and this one can conflict with your religious or moral beliefs.

Similarly, how open friends and family were about MAiD may play a part in how you feel. When the process has been open and transparent, it’s easier to grieve publicly than if it was something that needed to be kept under wraps.

Because MAiD is a relatively new legal right, and people are still coming to terms with it, there is always the chance you will hear negative comments. Use your discretion to determine how you speak with people about the circumstances of the death. There’s a time to talk about it, and a time when it’s most important to protect your feelings and memories of how your loved one died.

How the procedure unfolded may also affect your grief -- did it go as planned, was it peaceful? Or did it take longer than expected and require extra medical attention? Sometimes our grief becomes focused on the medical journey, and that can get in the way of grieving the loss of the person who died.

There’s no substitute for talking with others when you’re mourning.

Think about those in your circle who knew your person well; share stories and positive memories as well as the sad moments.

Consider joining a bereavement or grief support group -- a general one if you feel confident in speaking about your person’s MAiD death, or one specific to MAiD families if you don’t.

Bridge C-14, the Ottawa-based organization that supports families experiencing a MAiD death, offers online support forums that provide you with connections to others with potentially similar concerns. Dying with Dignity Canada offers phone-based counselling support. Local psychotherapists and counsellors with experience in grief work will be helpful. Check with your local hospice palliative care providers to find a support that’s right for you.

Carolyn Gibson Smith, MSW (C2019), & Jo-Ann Leake, MSW, RSW