Medical Assistance in Dying — The spiritual dimension and the reality of the care process

Choosing to request medical assistance in dying (MAiD) is a deeply personal decision. For many, this choice involves spiritual or religious beliefs that weigh just as heavily as physical suffering or the emotional burden of illness.

What is medical assistance in dying?

Medical assistance in dying is a legal medical act in Canada. It is carried out by a physician or a nurse practitioner who administers medication intravenously, at the person’s request, to bring about death in a rapid and painless way.

This option is available to individuals aged 18 or older who are capable of making this decision on their own and who are living with a serious and irreversible medical condition that causes intolerable suffering.

MAiD is not an alternative to palliative care, but rather an option that can be considered when suffering can no longer be relieved in a manner the person finds acceptable. Individuals with heart disease or another serious illness can rely on defined eligibility criteria, clear steps to follow, and structured support throughout the process.

Who can make a request?

Discussions about medical assistance in dying often bring strong emotions. Beyond personal and spiritual reflection, there is also a precise legal framework. This framework exists to protect vulnerable individuals and ensure that the decision is truly thoughtful.

Eligibility criteria

To be eligible for MAiD in Canada, certain conditions must be met:

Being an adult: the person must be 18 years of age or older.
Living with a serious and incurable illness or disability: for example, severe heart disease or another irreversible medical condition. The illness must cause continuous and intense physical or psychological suffering that the person finds intolerable.
Ability to consent: the person must be able to understand the nature of their illness, their prognosis, the available treatment options, and the consequences of their decisions, in order to provide free and informed consent.
Intolerable suffering: the person must experience ongoing suffering that cannot be relieved in a way they consider acceptable.
A voluntary and well-considered decision: the choice must be made freely, without pressure, after exploring available care and support options.

👉 Note: At this time, serious and incurable psychiatric illnesses do not provide access to MAiD in Canada.

Once these criteria are understood, the most delicate part remains: the inner reflection. Beyond law and medicine, this choice is rooted in each person’s deepest values, particularly in their spiritual and existential beliefs.

The weight of spiritual values

For many people, faith and a relationship with a higher power give deep meaning to life and to suffering. Certain religious traditions or familiar expressions—such as “offer your pain to God”—encourage accepting suffering as a form of spiritual trial.

This perspective can make the very idea of requesting MAiD difficult, or even unthinkable.

But spirituality is diverse. Most religions place compassion, dignity, and love at the centre of their teachings. Nothing requires a person to endure unnecessary suffering in the name of faith. The reflection therefore becomes deeply personal: how can spirituality be reconciled with the desire to end unbearable and irreversible suffering?

Cultural heritage and religious upbringing

Many people in Canada have grown up in Judeo-Christian traditions or in other belief systems in which suffering carries moral or spiritual meaning. These messages, passed down through family or community, can create inner conflict: loyalty to inherited values on one hand, and the desire to preserve dignity in the face of suffering on the other.

Recognizing this heritage—without feeling bound by it—can help clarify the decision. It is not about abandoning one’s faith, but about re-examining what that faith means in the present moment.

A courageous and thoughtful decision

Choosing MAiD is not a “shortcut” nor an impulsive act comparable to pressing a reset button. It is a decision reached gradually, often after long periods of reflection and conversations with loved ones, medical teams, and sometimes spiritual advisors.

Setting a date or making the formal request can, for some, represent a way to regain control over the end of life—preserving dignity, avoiding distressing experiences considered unnecessary, and at times protecting loved ones from prolonged suffering.

The gaze of others and the fear of judgment

The fear of being judged—by family, community, or society—can weigh heavily. Some relatives struggle to accept the reality of the illness or fear the solitude that such a decision brings to light.

Choosing MAiD does not mean “abandoning” those close to us; for many, it is instead a way of safeguarding them.

Solitude, support, and accompaniment

This process is not undertaken alone. Medical teams, loved ones, and spiritual or pastoral advisors can offer support throughout the reflection.

What matters most is creating a space where the person can speak freely about doubts, fears, and personal convictions.

The steps to follow once the decision is made

Making this decision is a very important moment, one that requires courage and reflection. Once the choice is made, a clear process is in place to support the person and ensure that everything proceeds with respect for their wishes.

In Canada, medical assistance in dying (MAiD) is governed by federal legislation. However, each province and territory may define certain aspects of how it is applied.

In general, two pathways exist:

one for individuals whose natural death is considered reasonably foreseeable, and
another for individuals whose life expectancy is longer.

These pathways involve different requirements, particularly regarding timelines and medical evaluations.

1. Request for information

Every process begins with seeking information. A health professional—whether a physician, a nurse practitioner, or another member of the care team—has the responsibility to provide accurate information or to refer the person to an appropriate resource if needed.

The official request

The request must be made in writing, using a form required by law. It must be signed in the presence of a health professional and an independent witness who confirms that the decision is voluntary and free of pressure. The document is then added to the person’s medical record.

3. First medical assessment

A qualified professional (physician or nurse practitioner) reviews the request to ensure that all legal criteria are met: a serious and incurable illness, intolerable suffering, the ability to understand and consent, and a free and well-considered decision.

This assessment also determines which pathway applies, which in turn affects the required timelines.

The two situations defined under Canadian law

Reasonably foreseeable natural death
This applies to individuals nearing the end of life, whose natural death is expected in the short or medium term (for example, advanced cancer or end-stage heart failure).
- Timelines: There is no mandatory waiting period between approval and the administration of MAiD. The date is set by mutual agreement.
- Final consent: In certain situations, the law allows a person to authorize MAiD using a written form, even if they lose the ability to consent before the scheduled date.

Natural death not reasonably foreseeable : This applies to individuals living with a serious and incurable illness, but whose life expectancy remains longer (for example, a progressive neurological disease or major disability).
- Timelines: A minimum of 90 days must pass between the start of the assessment and the administration of MAiD.
- Additional evaluations: During this period, consultations with other professionals (psychologists, social workers, spiritual care providers, etc.) may be arranged to ensure that all reasonable options for relief have been explored.

4. Second medical opinion

A second, independent evaluation by another qualified professional is always required. Its purpose is to confirm that the criteria are met and that the decision is well-informed.

5. Planning the care

Once a request has been approved and all conditions are met, the practical planning begins. A date is agreed upon, taking into account the legal framework, the person’s preferences, and the availability of the care team. Preparing the medication may require some time, often between 24 and 72 hours depending on the setting.

The procedure may take place in a healthcare facility or, when possible and desired, at home. Because the medications are given through a vein, the care team may sometimes recommend placing a more stable intravenous access ahead of time to avoid difficulties on the day itself. The goal of this preparation is to respect the person’s wishes and to create a calm and comforting environment.

It is important to remember that the person remains free to change their mind at any moment, including right before the procedure. Spiritual, psychosocial, or pastoral support may be offered at this stage to help the person and their loved ones.

6. The moment of medical assistance in dying

On the chosen day, the health professional arrives at the selected location, whether at home or in a healthcare facility. Their arrival is marked by calm and respect, acknowledging the unique and meaningful nature of this moment.

Before proceeding, the professional takes time to ensure that the person is ready, understands what will happen next, and confirms their decision.

This moment, often considered over a long period of time, can be deeply personal. Some individuals choose to be surrounded by loved ones, to listen to soothing music, or to include a ritual that aligns with their values or spirituality.

The professional can answer last questions, reassure relatives, and remind everyone that the decision can be withdrawn right up until the end.

When everything is confirmed, the team works to create a serene atmosphere. The medications are administered gently, in a respectful setting, with the intention of ensuring a peaceful, dignified, and pain-free end of life.

7. Confirmation of death and next steps

Death is confirmed on site by the professional who carried out the procedure. If MAiD takes place at home, the required documents are sent to the chosen funeral home, which will coordinate with the family to take charge of the body at the appropriate time.

Bereavement support and resources may be offered to loved ones afterward, helping them navigate the period that follows.

An intimate choice, essential accompaniment

Medical assistance in dying remains both an intimate and complex decision, situated at the crossroads of suffering, dignity, and personal values.

Whether or not it is chosen, it highlights the importance of compassionate support, respect for individual wishes, and open dialogue between the person, their loved ones, and the care team.