Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy


Health and Rehabilitation Sciences


Nouvet, Elysée

2nd Supervisor

Kirkwood, Kenneth



MAiD became legally accessible to Canadians with a grievous and irremediable illness in June of 2016. As I write in 2023, MAiD has been expanded to include patients who do not have a foreseeable death, with anticipated inclusion of those with mental illness as a sole underlying medical condition (MI-SUMC) in 2024. As MAiD now accounts for over 3% of all deaths annually in Canada, there is a growing impetus to explore ways by which MAiD practice can be improved and care can be extended to the family members following the death of a patient.

A hospital in southwestern Ontario created a curriculum for a MAiD specific bereavement group, to support this unique community of loss and further the Canadian initiative for excellence in palliative care (2019) – which extends to the entire network of those involved in supporting a dying patient. It was imperative that this be evaluated to determine if the promises made to this inaugural bereavement group were upheld, and how MAiD practice can be improved to meet this important initiative. In this process, three groups of findings emerged pertaining to:

  1. Assessing and determining the impact and efficacy of the MAiD bereavement group using a mixed methods approach
  2. The synergistic impact of COVID-19 public health measures on those bereaved by MAiD during the pandemic
  3. The relationship between healthcare providers and MAiD-involved families, and the impacts of this relationship into their bereavement through a relational ethics framework

Findings suggest that a bereavement group can support families and help generate communities with shared experiences. Additionally, through secondary analysis, findings suggest that COVID-19 adversely impacted this group through additional isolation, most particularly for those who were already experiencing social isolation and stigma due to the nature of their significant person’s death which was further supported by their involvement in a bereavement group. Finally, the relationship between the health care provider and the MAiD family can have a positive or negative impact on their bereavement narrative, depending on their level of engagement, support of the family before and after the death, and facilitation of access for the patient to MAiD.

Summary for Lay Audience

MAiD (Medical Assistance in Dying) has been accessible to Canadians since 2016. As the practice undergoes ongoing changes and as an increasing number of Canadians access MAiD, it is important that we understand the needs of family members’ needs during and after this process. This research demonstrates that a bereavement group helps create community for those bereaved by MAiD who may experience challenges disclosing this type of death of a loved one. This research also indicates that COVID-19 regulations impacted group members’ ability to create community, discuss their loss, and begin to create new identities after the death of a significant person. Finally, this research suggests that the way a healthcare provider approaches MAiD in discussions with patients and family members can have a lasting impact on family members’ bereavement, including how they talk about the experience of losing their loved one. This research provides recommendations to health care providers in an effort to guide and support their practice around MAiD and MAiD-involved families.