Medical Aide in Dying (MAiD): Ethical Dilemmas and Sacred Support
Written by: Erin Merelli | Death Doula | Educator | Ceremonialist | Public Speaker
Medical Aide in Dying (MAiD) is one of the most complex, controversial, and in my opinion, sacred aspects of death work. As a death doula, supporting individuals and families through this process demands sensitivity, clarity, and deep compassion. While MAiD offers a path of autonomy and dignity for those facing unbearable suffering, it also brings emotional, ethical, and spiritual questions that require careful navigation.
Navigating Ethical Complexities
One of the most profound challenges of MAiD is addressing the ethical dilemmas it raises. Every family and individual brings their own beliefs, values, and emotions to this process. For some, the decision aligns with deeply held convictions about autonomy and the right to end suffering. For others, it can conflict with cultural or religious teachings, creating internal and familial tensions.
As a death doula, my role is not to judge or guide someone toward a specific choice but to create a space where all perspectives can be voiced. I often help families navigate these difficult conversations by:
Encouraging open dialogue about fears, hopes, and beliefs.
Sharing stories of other families who have made this choice.
Offering resources or connecting them with spiritual advisors or counselors.
Validating the range of emotions, from relief to guilt, that often accompany this decision.
Holding Space for the Emotional Journey
The emotional weight of MAiD is profound, not only for the person choosing it but also for their loved ones. Many experience a mix of gratitude for the option and grief over its necessity.
I remember sitting with a client—we’ll call her Maria—who had chosen MAiD after a long battle with a debilitating illness. Her family, while supportive, struggled with feelings of loss and guilt. Maria expressed a deep need to reassure her children that her decision was not a rejection of life but an embrace of peace. Together, we created a letter-writing ritual, where Maria wrote goodbye messages to each family member, and they, in turn, wrote notes to her. This process allowed for mutual understanding and emotional closure.
Spiritual Dimensions of MAiD
Many people wrestle with spiritual questions when considering MAiD: “Is this decision aligned with my faith?” “What does this mean for my soul?” “How do I find peace?” As a doula, I help clients explore these questions without imposing answers.
For some, this involves incorporating religious or cultural rituals into their final moments. For others, it’s about creating new, personalized ceremonies that honor their journey. I’ve supported clients in:
Organizing a “living funeral” so that love can be shared before it is too late
Lighting candles and reciting meaningful prayers.
Sharing moments of silence or meditation with loved ones.
Choosing music or poetry that reflects their values and legacy.
Practical and Emotional Guidance for Families
Families supporting a loved one through MAiD often need as much care as the individual themselves. I offer guidance by:
Preparing them for what to expect during the procedure.
Encouraging open expressions of love and gratitude.
Helping them plan meaningful moments leading up to and following the MAiD process, such as sharing meals, telling stories, or creating keepsakes.
Transforming the Experience Through Story
Every MAiD experience is unique, but the humanity of the process is always at its core. One family I worked with chose to surround their father with his favorite music and photos from their childhood. As the procedure began, they held hands and spoke aloud the qualities they admired most in him. This act of collective gratitude turned a moment of profound loss into one of sacred connection.
