How does assisted dying affect the experience of the bereaved in the UK?

Fish, Janette and Preston, Nancy and French, Maddy (2023) How does assisted dying affect the experience of the bereaved in the UK? PhD thesis, Lancaster University.

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Abstract

Abstract Background Assisted suicide is a choice to die voluntarily using self-administered drugs obtained from a clinician in a country with a permissive legal framework. This study is the first to explore the experiences of caregivers bereaved by assisted suicide in the UK. Aim To explore the experiences of caregivers who supported a patient through assisted suicide. Methods A constructivist grounded theory methodology was used to analyse the experiences of British people bereaved through assisted suicide. These experiences are discussed with results of a critical interpretative synthesis review of studies on the experience of people bereaved through suicide, to further develop a grounded theory of the experience of those bereaved by assisted suicide. Findings Thirteen interviews were conducted with 13 caregivers of 9 individuals who died due to an assisted suicide. Participants sought to honour the wishes of the person seeking an assisted suicide. The role included responsibility to plan the death, engage in gatekeeping information about the planned death from those who might not agree and usually accompanying them to their death. Fear of legal sanction and social stigma led to secrecy associated with an experience of isolation and after the death, some engage in campaigning to change the law. A critical interpretive synthesis of the experience of those bereaved by suicide shows similarity with the experience of those bereaved by assisted suicide in that they share the experience of stigma and isolation and have the capacity to campaign to challenge this stigma of suicide. A grounded theory is presented that links the experience of enabling an assisted suicide with subsequent campaigning, allowing the bereaved to challenge the stigma and make meaning of their experience, including the opportunity to justify their role to enable the death. The dual process model (Stroebe & Schut, 2010) supports improved understanding of the needs of those bereaved by assisted suicide, both before the death (including opportunities for anticipatory grief), and as part of bereavement, illustrating the dynamic processes that require both loss orientation and restoration orientation activity. The study presents the first application of the dual process model to anticipatory grief. Conclusion Those bereaved by assisted suicide in the UK believe that this was the best available death for their relative or friend, despite the anxiety and distress they experienced. Since the death they campaign for legalisation of assisted suicide in the UK to challenge the stigma they experience, to be more open and less isolated, and understand their experience. They receive little support before, during and after the death and the dual process model can assist in understanding how best to support those within the UK and elsewhere, with the complex and challenging experience of being bereaved by assisted suicide.