Table 2

Overview of included empiric articles relating to grief and bereavement of family/friends

Beuthin et al, 202123CanadaQualitative (semistructured interviews)9 bereaved family and friends
(average 15 months; range 4–36 months)
All caucasian, middle to older-aged womenEuthanasiaExplore bereavement experiencesGrief-bereavement is an extended period that includes predeath to the present
MAiD/certainty of death creates ‘parade of lasts’
Brown et al, 2020a(25)CanadaQualitative (semistructured interviews)5 patients, 11 family members, 14 HCP100% Caucasian; 77% female; ages >40EuthanasiaExplore patient, family, HCP experiences with MAIDCare considerations in four domains:
Emotional (unique facets associated with MAID)
Physical (eligibility, location, procedural)
Spiritual (honouring choice, acknowledging loss)
Relational (supporting the circle of support)
Brown et al, 2020b(24)CanadaQualitative (semistructured interviews)5 patients, 11 family members, 14 HCPAll Caucasian; 77% female; ages>40EuthanasiaExplore perspectives on MAiD access and care deliveryCare pathway has ambiguity, causing gaps in knowledge, participation, institutional supports
Quality improvement processes are needed to improve legal barriers and clarify HCP roles
Frolic et al, 202026CanadaQualitative (semi-structured interviews)16 family members
(“months after MAiD”)
56% femaleEuthanasiaUnderstand Hamilton MAiD programme and MAiD legacy impactFour domains of opposing tensions:
Time as gift/burden
Decreased suffering/time
Individual’s legacy/family’s bereavement
Gamondi et al, 201537SwitzerlandQualitative
(semistructured interviews)
11 bereaved family members
(median 24 months; range 12–72 months)
54% femaleAssisted suicideExplore family involvement in decision-making and subsequent bereavementAll described moral dilemmas during decision-making
Barriers causing isolation stem from concerns from stigma and secrecy
Ganzini et al, 200942USQuantitative
(validated scales or questionnaires)
Family members of those who received MAiD (n=95) and those who did not (n=63)
(range 4–36 months)
MAiD group: 100% Caucasian; 69% Female; Mean age 60.9
Comparator: 97% Caucasian; 79% Female; Mean age 60.1
Assisted suicideCompare grief symptoms and mental health of family caregivers between those who received MAiD and notNo differences between groups in measures of prolonged grief (2% vs 0%) or depression symptoms (11% vs 14%), or mental health service use (44% vs 52%)
Quality of life in last 7 days rated higher by family for those who received MAiD (4.2 vs 2.9, p=0.03)
Hales et al, 201927CanadaMixed-methods (focus groups, unstructured conversations, survey)11 bereaved family membersNSEuthanasiaUnderstand perspectives, identify improvementThere should be improvements to the process, clarifications to the scheduling and 10-day period of reflection
Burden associated with patient privacy, clinician objective, lack of bereavement resources following MAiD
Ho et al, 2020CanadaQualitative (semistructured interviews)26 HCPs88% female; 46% nurses, 27% physicians, 19% social workers, 8% spiritual healthEuthanasiaExplore HCPs challenges and resource recommendationsThere are inadequate psychological and professional support for family/friends. Resources are needed to ease family distress regardless of whether patients receive MAiD
Hashemi et al, 20216CanadaMixed-methods (semistructured interviews, validated questionnaires)13 caregivers of home MAiD
(average 18 months; range 10–28 months)
100% Caucasian; 69% female; mean age 60.1EuthanasiaExplore quality of bereavement for home MAIDMAiD was easier to accept, family/friends accepted and ready for death
All participates had positive experience, and none suffered from complicated grief (IES-R mean=9.2 and BGQ mean=2.1)
Holmes et al, 201828CanadaQualitative
(semistructured interviews)
18 family or friends
(before and after MAiD)
NSEuthanasiaExplore bereavement experiencesPlanned death day is odd, although often peaceful, with valued time to say goodbye
Laperle et al, 202134CanadaQualitative (semistructured interviews)Bereaved family members, 8 after euthanasia, 8 after natural death (range 6–48 months)75% female; mean age 49.4EuthanasiaOffer insights into the relational landscape of bereavement experienced in anticipated death
Draft an interpretive model of grief
The bereaved are active agents who co-construct their experience with their social environment
Bereaved family experience four landscapes:
I feel open and visited
I feel far away, along with the deceased
I feel besieged
I feel I am expanding and invested with a message
Laperle et al, 202235CanadaMixed-methods (semistructured interviews, questionnaires)Bereaved, 25 after MAiD, 36 after death with palliative care
(average 11.8 months)
85% female; mean age 16EuthanasiaDescribe the grief experiences of individuals who have lost a loved one through MAid or natural deathNo differences between groups in measures of prolonged grief disorder (Prolonged Grief-13) or psychopathological symptomatology of grief (Revised Grief Experience Inventory)
Neither MAiD or death with palliative care favour prolonged grief; although there may be less social stigma in Quebec, Canada
Oczkowski et al, 202130CanadaQualitative
(semi-structured interviews)
20 HCPs45% femaleEuthanasiaDescribe HCP perspectives, identify successes and suggestionsNeed for centralised portal to cover technical and logistics
Emotional support for patients and families before, during and after through SW, spiritual care
Philippkowskil et al, 2020AustraliaQuantitative (validated scales)164 adults randomised to read one of four vignettes79% femaleAssisted suicideInvestigate the cause of death and age of the deceased on emotional responses to the bereaved, desire for social distance, and grief expectationsThe age of death affected grief experiences
The mode of death did not affect grief experiences (p=0.33)
Pronk et al, 202141NetherlandsQualitative (semistructured interviews)12 family/friends of individuals with mental illness who requested or received MAiD50% femaleEuthanasia (lethal prescription or injestion)Examine experiences of relatives of patients that requested MAiD due to mental illnessWhen patients with mental health request MAiD, family/friends generally feel ambivalence. Family/friends more strongly want to be involved in decision-making and have their views heard by HCPs and the patient.
Schutt, 201131CanadaQualitative
(semistructured interviews)
seven bereaved family members100% Caucasian; 57% femaleEuthanasiaExplore insights from family members’ experience of MAiDProcedural aspect of MAID augmented perception of biomedical process
Should be presented with palliative philosophy
Smolej et al, 202236CanadaQualitative (semistructured interviews)eleven caregivers of individuals who requested or received MAiD91% female; average age 54.5EuthanasiaExplore the experiences and support needs of family caregivers who are or have provided care peri-MAiD
Srinivasan, 201943USAQualitative
22 bereaved family members
(‘bereaved within 3 years’)
100% Caucasian; 68% female; age range 61–80Assisted suicideExplore bereavement experiencesThemes identified with assisted death:
General grief reactions
Anticipatory grief
Sense of control
Level of agreement with assisted death
Grief expression and stigma
Swarte et al, 200340NetherlandsQuantitative
(validated questionnaires)
Bereaved family and friends of terminally ill patients with cancer who received MAiD (n=189) and those who did not (n=316)MAiD group: 54% female; mean age=48
Comparator: 58% female; mean age=49
Euthanasia (lethal prescription or injestion)Assess how euthanasia affects grief of family and friendsBereaved family and friends of those who died by euthanasia had less traumatic grief symptoms (adjusted difference −5.29 (95% CI −8.44 to −2.15)), less current feeling of grief (adjusted difference 2.93 (0.85 to 5.01)); and less post-traumatic stress reactions (adjusted difference −2.79 (-5.33 to -0.25))
Trouton et al, 202029CanadaQuantitative
18 physicians who provided MAIDNSEuthanasiaExplore physician practices for bereavement support to patientsImportance of bereavement support recognised (72.2%), but physicians do not have time or resources to provide support
Bereavement following MAID is unique due to unfamiliarity and potential for stigma
Wagner et al, 2011SwitzerlandQuantitative
(validated questionnaires)
85 relatives or friends
(mean 20 months)
56% female; mean age=60.15Assisted suicideExamine the effects of perceived social acknowledgement on symptoms of post-traumatic stress and complicated griefGeneral disapproval, rather than family disapproval or recognition, were correlated with PTSD (rs=0.50=0.56) and complicated grief scores (rs=0.63–0.71)
Wagner et al, 2012SwitzerlandQuantitative
(validated questionnaires)
85 relatives or friends
(mean 19 months)
56% female; mean age=60.15Assisted suicideExamine the impact of witnessing assisted suicide on mental healthCompared with general Swiss population, survey found slightly higher rates of PTSD (13%) and depression (16%)
Rates of complicated grief were comparable (4.9%)
  • BGQ, Brief Grief Questionnaire; HCP, healthcare professional; IES-R, Impact of Event Scale - Revised; MAiD, medical assistance in dying; NS, not significant; PTSD, post-traumatic stress disorder; SW, social work.