What It's Like When A Family Member Chooses Assisted Death

TikToks in which grandparents make a cameo are usually lighthearted. But in late May, Victoria Secret’s model and influencer Ali Tate Cutler posted a video with her grandmother about a decidedly different subject: Her grandma’s decision to pursue assisted death . 

“My grandmother has chosen euthanasia for her terminal diagnosis, so this is the last time I can take her out to dinner,” Cutler said in a “get ready with me” video, a popular format on the app . 

In a follow-up video, Cutler asks her grandmother questions about her decision to choose assisted death. (Medical assistance in dying  or MAiD, as its abbreviated was legalized in Canada, where Cutler’s grandmother lives, in 2016.)

“What are your thoughts as you move closer to the date?” Cutler asks.

“It’s like the light at the end of the tunnel,” says her grandma, who has Stage 4 ovarian cancer.

“What are some of the precursors or questions they asked to make sure you were doing it for the right reasons?” Cutler asks.

“Your diagnosis, if it’s fatal, how many more months you have,” Cutler’s grandmother explains. “They give you time to consider, and they keep stressing the fact that you can change your mind.”

When Cutler asks if her grandma is dwelling on the decision as the day approaches, the older woman shakes her head no.

“I’ve always made my own decision for myself in living, and I trust I will in death,” she tells her granddaughter. “I do believe my husband [will] be there saying, ‘It’s about time.’”

Combined, the videos have over 22 million views. The response Cutler received from the videos was expectedly mixed. While some applauded the grandmother-granddaughter pair for demystifying what assisted death looks like, others accused the model of treating the procedure too casually or using her grandmother’s story for clout.

“Why would you publicize this? So wrong,” one highly upvoted comment read on TikTok.

“Life is no longer sacred to a large portion of the population,” one person tweeted about the video.

In an interview with Insider  last month, Cutler said that her grandmother was on board with posting the videos. She also told the outlet her grandma hadn’t picked a date yet for the procedure. (HuffPost reached out to Cutler for comment but hadn’t received her responses at the time of publication.)

“I wanted to show people what I saw in her, which was a woman dying well,” the model explained to Insider. “She wasn’t scared, and she wasn’t dreading it. I wanted to document what it looked like to die with ease and not fear.”

Cutler isn’t the first to share online what assisted dying looks like for the terminally ill. There is an ever increasing number of personal stories , TV documentaries  and news articles  sharing the experiences of patients , families  and loved ones.

“Sharing conversations like the one Cutler posted can help normalize talk about death as a fully anticipated chapter in our lives,” said Dr. Stefanie Green , a MAiD practitioner and author of “This Is Assisted Dying: A Doctor’s Story of Empowering Patients at the End of Life.”

“It can help us find the vocabulary we need to discuss end-of-life options in general and, yes, assisted dying in particular,” she said. “If these posts can spark a discussion within yourself, or shared with loved ones, about what you might believe or want or do in a similar situation, then I believe they are valuable.”

Krystal, a Canadian whose terminally ill aunt chose assisted death, thinks Cutler’s viral videos could help de-stigmatize discussions about dying.

“People use the argument that doctors take a Hippocratic Oath to do no harm as a reason against MAiD; I think they forget that doctors who deny a person’s dignity in dying when they’re dealing with a painful terminal illness actually goes against their oath to do no harm,” she told HuffPost.

Krystal, who lives in Alberta, Canada, and asked to use her first name only to protect her privacy, said her aunt was 55 and in the end stages of polycystic kidney disorder  when she chose assisted death.

Medically assisted death is legally complicated.

MAiD is highly controversial in Canada. Initially, the law stated that a patient’s death had to be “reasonably foreseeable,” but that changed in 2021. As it stands now, the person has to “have a serious and incurable illness, disease or disability” and the request for the procedure has to be approved by at least two physicians.

The law was later amended to allow people who are not terminally ill to choose death, including those with serious mental illness or disabilities an expansion that many disability activists and some medical practitioners take issue with.

“To provide MAiD, we need to be able to predict that a medical condition will not get better, but for mental illnesses, evidence shows that even when someone is very ill, our chances of accurately making that prediction in any person are less than 50/50,” said Dr. K. Sonu Gaind , a chief of psychiatry at Sunnybrook Health Sciences Center in Toronto, Ontario.

“This means that when Canada allows MAiD for mental illness, my colleagues could wrongly tell a person during periods of despair that they will not improve, and at least half the time that person would have gotten better, but they will get MAiD instead,” Gaind told HuffPost. 

Research shows that mental illness can improve with the right treatment, whether that’s through therapy, medication or a combination of both. Many people with a mental health condition, including those with serious mental health disorders, can go on to live healthy and fulfilling lives.

In response to the criticism, the Canadian government announced plans in February to delay MAiD eligibility for people whose sole medical condition is mental illness. 

In the U.S., physician-assisted death is legal in 10 states Maine, New Jersey, Vermont, New Mexico, Montana, Colorado, Oregon, Washington, California and Hawaii and in Washington, D.C. The most recent Gallup poll on assisted dying, conducted in 2018, showed a broad majority of Americans, 72%, believed that doctors should be legally allowed, at a patient’s and a family’s request, to end a terminally ill patient’s life.

In the states where it’s legal, there’s a strict vetting process in which a candidate’s physician must have determined that death is expected in less than six months, said Dr. Jessica Zitter, an intensive care and palliative care specialist and author of “Extreme Measures: Finding a Better Path to the End of Life.”

“We also require that the person requesting the medications be of sound mind and demonstrate that they understand that they will be hastening their death, and that they are not being coerced by others to do this,” she said.

As for the process itself, Zitter said patients receive a medication (or, as it’s sometimes called, an aid-in-dying drug) from their doctors that they must prepare and then ingest on their own, usually in their homes. It’s not doctor administered, as in the case of Cutler’s grandmother in Canada. 

“The ethics of physicians actually administering drugs to a patient as opposed to the patient acting on their own feels pretty different to me,” Zitter said. 

While Zitter stresses that it’s important to acknowledge the differences in options in Canada versus the U.S., she does think there’s value in discussing end-of-life treatment on places like TikTok, given our cultural discomfort with death.

“Even just discussing people’s preferences around procedures like intubation and CPR in hospitals is something that few want to engage in,” she said. “Many get those life-prolonging treatments by default without a robust discussion about what their quality of life will look like.”

“I can guarantee you that most of the many hundreds of thousands of people dying on machines in long-term acute care facilities in this country wouldn’t have imagined that that was how their lives would end,” she said. “But when we as a society refuse to engage in those conversations, that’s what happens.”

What it’s like to have a relative choose assisted death.

Those we spoke to who had a terminally ill relative who chose assisted death said that accepting the decision was not easy but that watching them die a painful death would have been worse.

In 2016, journalist Kelly Davis wrote about her experience helping her sister, Betsy , use an aid-in-dying drug in California. In 2013, Betsy had been diagnosed with amyotrophic lateral sclerosis (ALS), a debilitating motor neuron disease that causes a person to slowly lose the ability to move their limbs, speak and swallow.

“My sister didn’t want to be entombed in her body and had reached a point where she was having significant trouble eating — she would experience pretty terrifying choking spells,” Davis, who lives in San Diego, told HuffPost. 

At 41, Betsy made the decision to end her life under California’s End of Life Option Act  (EOLA), which had taken effect about a month and a half before she died.

Davis admits that when she first heard Betsy’s plan, she wasn’t on board.

“Initially I didn’t want her to end her life,” she said. “I clung to the belief we could find a cure or some way to prolong her life,” she said. (ALS still has no cure or an effective treatment to reverse its progression.)

But when Davis saw how at ease Betsy was with her decision how peaceful and happy it made her she came around. So did the rest of her family, though some of Davis’ father’s friends, who are Catholic, were not supportive because of the church’s stance against EOLA .

In any case, Betsy’s death didn’t happen immediately. There were long processes to follow: Betsy had to get an opinion from a doctor stating that she had six months or less to live, and she needed two doctors to sign off on her request for end-of-life medications and find a pharmacy to fulfill the prescription. Then there were some personal matters to attend to. 

“Before she took the medication, she really wanted to throw a celebration — she referred to it as her ‘rebirth,’ and organized a large gathering for family and friends the weekend she ended her life,” Davis said. “My feeling was, I wanted what was best for her, and this was a better option than a slow death.”

Kirsty, a 33-year-old woman who lives in Winnipeg, Canada, told HuffPost that her grandfather Richard was 85 and had Stage 4 lung cancer when he applied and was approved for MAiD in 2017. (For her privacy, Kirsty asked to use her first name only.)

“My grandpa had been fighting his decline with sheer stubbornness and force of will, giving up as little as he could, but the pneumonia weakened him, and the cancer took over,” she said.

“Within a couple of days, he had lost a lot of body mass and was much weaker; barely able to stay awake, talking was exhausting, and he was fed up with the hospital food,” she explained. 

It was clear to him that he would not leave the hospital alive, so he asked to pursue MAiD.

“He had lost his independence which was a huge blow to his pride and sense of self, he was in constant pain, constantly tired and just wanted to move on,” she said. “He met with physicians and mental health specialists to assess his mental state and ensure nobody in his family was forcing him to make this decision.”

The decision devastated the family. Obviously, nobody wanted to lose him. Kristy said her mother was especially hit hard, and for Kristy herself, “it was a surreal thing to know it would be happening and when.”

Her grandpa was approved and given a date of 10 days later for when the drug would be administered. The delay was a requirement of MAiD , to ensure the person requesting it was absolutely sure they wanted to go through with the decision. Kirsty’s grandpa was told he could withdraw the request at any time during that 10-day period. (The 10-day waiting period requirement has since been removed .)

On Dec. 19, 2017, the entire family gathered at the hospital to say their final goodbyes to Kristy’s grandpa. There wasn’t a dry eye in the room, Kristy said.

“Shortly before 11 a.m., the MAiD team came in,” she said. “They apologized to us, but as part of the process they had to ask everyone to step out of the room so they could conduct their final interview with my grandpa, also a necessary step in the process. This interview was to confirm that my grandpa still desired this, that he wasn’t being coerced into it and still met all the requirements for MAiD.”

Once the interview was done, they let everyone back in.

“We all gave him our final goodbyes, with everyone in the room getting a bit of a laugh when he protested about my mom’s perpetually cold hands after she laid a hand on him while giving him a kiss goodbye,” Kristy said.

The family sat with their grandfather while the medical team administered the medication. First they gave him a medication that would put him to sleep, then another to stop his heart. After a few minutes, he breathed his last breath, and the nurse on the team told the family he was gone shortly after.

“I’ll never forget the kindness and compassion of the team that were there that day,” Kristy said. “They understood our grief and how emotionally vulnerable we all were. They were open and honest about what would happen but also were sharing our grief with us. It wasn’t easy on them, I’m sure.”

Kristy understands how thorny MAiD laws have gotten since her grandfather chose the procedure in 2017 and why others may have apprehension about assisted dying in general.

“Nobody wants to see those they love die. Nobody wants to deal with it, and I’m sure, too, there are some that feel their religion would not allow it either, and that’s OK,” she said.

“Ultimately, though, shouldn’t we have the option to choose for ourselves and not be forcing other people to make the same decisions we do?”

Grief may feel different when someone chooses assisted death. Here’s how to cope.

Grief is always unique and specific to each individual, but the process of mourning someone who chooses assisted death can feel a little different, according to Jill Craven,  a therapist in British Columbia, Canada, who specializes in grief and loss.

Some family members may take their loved one’s decision to die personally, feeling like they’re not “enough” of a reason for their loved one to stick around for as long as possible, Craven explained to HuffPost.

“This can bring up old resentments and relationship tensions, again complicating the grieving process and creating further secondary losses,” she said.

Anticipatory grief can occur, too.

“It’s common for loved ones to comment on how ‘surreal’ it is to know the date, time and method of their loved one’s death,” Craven said. 

“Anticipatory grief can also come with a push-pull experience,” she added. “You want to remain as connected as possible with your loved one, but at the same time, you may begin to disconnect from the person you’re losing before the loss happens.”

All in all, conflicting feelings are very normal in this situation. Certainly, religious values and beliefs might factor in as well.

“The best way to deal with the cognitive dissonance, uncomfortable feelings and potential relationship tensions is to seek support from a registered and experienced mental health professional who specializes in grief and loss,” Craven said. “If you are unable to do this, then the first step is acknowledging that it’s OK and normal to have conflicting beliefs and feelings.”

Though it’s true that watching your loved one die in peace can be traumatizing for some people, Craven believes the alternative is generally more traumatizing.

“Watching someone pass in physical and emotional anguish, with complete cognitive decline and witnessing those last medical efforts on the body can burn painful images into the memory of those we love,” she said. 

When handled delicately, assisted death can help mitigate some of the devastation people feel when losing a loved one, the therapist said. 

“Ideally, the timetable allows everyone time to process this transition,” she said. “Knowing that a loved one has chosen to die on their own and hopefully seeing them at ease and at peace about their decision can make acceptance a lot easier.”