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Correspondence to Dr Sarah Hales, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; [email protected]
Globally, medically assisted death remains a controversial topic with various names and forms that differ based on the laws and customs of the countries where it is debated or discussed. In Canada, where medically assisted death became legal in 2016, medical assistance in dying (MAiD) is a term that refers to both the direct administration of a lethal substance (ie, injection of a drug) or providing/prescribing a lethal substance that the eligible patient administers themselves. In other jurisdictions, these may be referred to as voluntary euthanasia and medically assisted suicide, respectively. Regardless of the nomenclature used, ethical and political debate remain the focus of much discussion, with less emphasis in the lay press or healthcare literature on the personal perspectives and subjective experiences of the parties directly involved.
Worldwide, MAiD is now legal in 10 countries and 8 states in the USA, with many other jurisdictions soon to follow suit. With these rapid legislative and healthcare changes, there is a need to explore the experience and process of this intervention from the perspective of those most closely impacted by it. Much of the research literature to date has focused on patient and healthcare provider perspectives on MAiD, often excluding informal caregivers from the discussion. This is consistent with the patient-centred approach that is engrained as a standard of Western healthcare and the principle of individual autonomy which is often called on to support the ethics of assisted dying. Given that family is integral to the advanced disease experience, it is important to gain insight into how MAiD affects family caregivers in order to provide the best possible care not just to the patient, but to the family as a whole. While caregivers of those with advanced disease are less likely to be the focus of care or research, we know that their distress may in fact be higher than that of patients,1 that they also need to be considered as a focus of end-of-life care,2 3 and that attention to their needs during the dying process may be protective against later bereavement morbidity.4
The aim of this article is therefore...