“I think it’s time,” is what I said to my cousin. His mother, my maternal aunt, had been in and out of delirium for about a year. When she was delirious, she wanted to die. When the delirium cleared she didn’t. But she was lucid during one of my visits with her in the summer of 2024. She very calmly and clearly said to me that she wanted MAID. And so I called my cousin.

My aunt had been suffering from a progressive neurodegenerative disease for a few years and was mostly confined to her bed and wheelchair. She was fully dependent on the staff at the care facility for all her needs. In hindsight, it is clear that she was not willing to accept being dependent on others. She was fiercely independent her entire life. She was principal of a school for troubled teens while offering homestay for international students. Sometimes she had up to 12 students living with her. She also volunteered at the community centre, leading things like photography classes. As a university student in the early 80s I spent every Sunday with my aunt and her ever-changing household of students from around the world. It was wonderful.

In her later years when she could no longer manage a house full of students, she moved to assisted living and was active in the book clubs, outings, and continued to be involved with the community centre. Eventually she could no longer walk independently, nor care for herself, and was forced to move to a facility that provided full care. It was the delirium that was most agonizing for her and for those around her. She could be angry and aggressive, frantic and fearful. She would tell her son and me that she wanted to die. When the delirium cleared she could remember how she behaved but no longer spoke of wanting to die. She spent much of her days in bed. She appreciated visitors but over time had very little capacity for visits. When she started talking once again about dying in the summer of 2024 I wondered if the delirium was returning. When it didn’t I realized there had been a shift. And then she asked about MAID, so I called my cousin. He was having similar conversations with her. We agreed it was time to ask for a MAID assessment.

After that, several things happened that changed her day-to-day life. Her GP agreed with a referral to MAID. The MAID assessment was scheduled. Her medical appointments were cancelled (the GP suspected breast cancer). Her level of care at the facility was changed to comfort care; staff no longer insisted on her getting up to shower, to get dressed. They stopped trying to coax her into a chair, to go to meals. They brought food to her, spent more time talking with her at her bedside. She told them she was going to have MAID.

Once the MAID assessment was done, my aunt chose a day for her death. She wanted to die the following week in the afternoon. Wanting to die stopped being the focus of our daily conversations and we spent more time looking at photos and reminiscing. My aunt and cousin started planning what her final day would look like. She wanted her sons and grandsons at her side. And me. I brought cake and balloons, per her wishes. No one could eat, but the room looked as if a celebration was happening. Perhaps it was.

Throughout the day staff came by to say their goodbyes. They told us afterward that they had never been part of the MAID process, and typically weren’t informed that MAID was being planned for one of their residents. They were grateful to be included.

As we gathered at her bedside we shared photos and stories. The MAID nurse and nurse practitioner went about their business starting IVs, finalizing their assessments. They weren’t rushed and let the family have the time we needed. They explained what would happen and answered any questions.

And then it was time; my aunt was getting tired. With the nurse practitioner sitting at the head of the bed preparing the medications, we said our goodbyes and expressed our love. Then she closed her eyes and was gone.

When I tell friends and family who knew my aunt, often their response is, “she died on her own terms.” I know she wasn’t happy living within the confines of a care facility, having how she spent her day determined and scheduled by others. She spent her whole life managing people,  nurturing people as a teacher, a principal, a homestay mother, a volunteer. She was always surrounded by people who looked to her for guidance. Once that was gone, her work was finished, and she was done.

I am grateful for MAID. And I know she is grateful that she was able to die on her own terms.