Table 2.

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

Beuthin et al, 202123	Canada	Qualitative (semistructured interviews)	9 bereaved family and friends (average 15 months; range 4–36 months)	All caucasian, middle to older-aged women	Euthanasia	Explore bereavement experiences	Grief-bereavement is an extended period that includes predeath to the present MAiD/certainty of death creates ‘parade of lasts’
Brown et al, 2020a(25)	Canada	Qualitative (semistructured interviews)	5 patients, 11 family members, 14 HCP	100% Caucasian; 77% female; ages >40	Euthanasia	Explore patient, family, HCP experiences with MAID	Care 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)	Canada	Qualitative (semistructured interviews)	5 patients, 11 family members, 14 HCP	All Caucasian; 77% female; ages>40	Euthanasia	Explore perspectives on MAiD access and care delivery	Care 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, 202026	Canada	Qualitative (semi-structured interviews)	16 family members (“months after MAiD”)	56% female	Euthanasia	Understand Hamilton MAiD programme and MAiD legacy impact	Four domains of opposing tensions: Autonomy/ambivalence Time as gift/burden Decreased suffering/time Individual’s legacy/family’s bereavement
Gamondi et al, 201537	Switzerland	Qualitative (semistructured interviews)	11 bereaved family members (median 24 months; range 12–72 months)	54% female	Assisted suicide	Explore family involvement in decision-making and subsequent bereavement	All described moral dilemmas during decision-making Barriers causing isolation stem from concerns from stigma and secrecy
Ganzini et al, 200942	US	Quantitative (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 suicide	Compare grief symptoms and mental health of family caregivers between those who received MAiD and not	No 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, 201927	Canada	Mixed-methods (focus groups, unstructured conversations, survey)	11 bereaved family members	NS	Euthanasia	Understand perspectives, identify improvement	There 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, 2020	Canada	Qualitative (semistructured interviews)	26 HCPs	88% female; 46% nurses, 27% physicians, 19% social workers, 8% spiritual health	Euthanasia	Explore HCPs challenges and resource recommendations	There 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, 20216	Canada	Mixed-methods (semistructured interviews, validated questionnaires)	13 caregivers of home MAiD (average 18 months; range 10–28 months)	100% Caucasian; 69% female; mean age 60.1	Euthanasia	Explore quality of bereavement for home MAID	MAiD 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, 201828	Canada	Qualitative (semistructured interviews)	18 family or friends (before and after MAiD)	NS	Euthanasia	Explore bereavement experiences	Planned death day is odd, although often peaceful, with valued time to say goodbye
Laperle et al, 202134	Canada	Qualitative (semistructured interviews)	Bereaved family members, 8 after euthanasia, 8 after natural death (range 6–48 months)	75% female; mean age 49.4	Euthanasia	Offer 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, 202235	Canada	Mixed-methods (semistructured interviews, questionnaires)	Bereaved, 25 after MAiD, 36 after death with palliative care (average 11.8 months)	85% female; mean age 16	Euthanasia	Describe the grief experiences of individuals who have lost a loved one through MAid or natural death	No 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, 202130	Canada	Qualitative (semi-structured interviews)	20 HCPs	45% female	Euthanasia	Describe HCP perspectives, identify successes and suggestions	Need 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, 2020	Australia	Quantitative (validated scales)	164 adults randomised to read one of four vignettes	79% female	Assisted suicide	Investigate the cause of death and age of the deceased on emotional responses to the bereaved, desire for social distance, and grief expectations	The age of death affected grief experiences The mode of death did not affect grief experiences (p=0.33)
Pronk et al, 202141	Netherlands	Qualitative (semistructured interviews)	12 family/friends of individuals with mental illness who requested or received MAiD	50% female	Euthanasia (lethal prescription or injestion)	Examine experiences of relatives of patients that requested MAiD due to mental illness	When 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, 201131	Canada	Qualitative (semistructured interviews)	seven bereaved family members	100% Caucasian; 57% female	Euthanasia	Explore insights from family members’ experience of MAiD	Procedural aspect of MAID augmented perception of biomedical process Should be presented with palliative philosophy
Smolej et al, 202236	Canada	Qualitative (semistructured interviews)	eleven caregivers of individuals who requested or received MAiD	91% female; average age 54.5	Euthanasia	Explore the experiences and support needs of family caregivers who are or have provided care peri-MAiD
Srinivasan, 201943	USA	Qualitative (interviews)	22 bereaved family members (‘bereaved within 3 years’)	100% Caucasian; 68% female; age range 61–80	Assisted suicide	Explore bereavement experiences	Themes 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, 200340	Netherlands	Quantitative (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 friends	Bereaved 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, 202029	Canada	Quantitative (survey)	18 physicians who provided MAID	NS	Euthanasia	Explore physician practices for bereavement support to patients	Importance 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, 2011	Switzerland	Quantitative (validated questionnaires)	85 relatives or friends (mean 20 months)	56% female; mean age=60.15	Assisted suicide	Examine the effects of perceived social acknowledgement on symptoms of post-traumatic stress and complicated grief	General 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, 2012	Switzerland	Quantitative (validated questionnaires)	85 relatives or friends (mean 19 months)	56% female; mean age=60.15	Assisted suicide	Examine the impact of witnessing assisted suicide on mental health	Compared 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.