In hospital rooms, homes, and places of worship across Canada, conversations about death are increasingly shaped by a question that sits in the middle of medicine, law and faith: what role should spirituality play when someone is considering medical assistance in dying or MAID?
Nearly a decade after MAID was legalized in Canada, the policy has become part of the country’s health-care landscape. Recent federal data show the number of assisted deaths rose steadily in the years following legalization before recent eligibility changes slowed the pace of expansion in 2023.
Even so, the practice continues to raise highly personal questions for patients and families managing the final stages of life.
For many people, those questions surpass medical eligibility or legal criteria.
Topics such as suffering, dignity, and crossing faith teachings come into play, making the issue much more controversial.
In Calgary, conversations about MAID are unfolding across a range of spiritual traditions and groups.
A senior rabbi describes accompanying members of his congregation as they contend with the decision.
A Mount Royal University (MRU) academic draws attention to the broader health disparities Indigenous communities face in Canada.
A Catholic bishop reflects on providing compassion with recommendations for alternative care.
Together, these perspectives illustrate how debates concerning assisted dying are not only legal or medical questions, but spiritual ones as well.
Jewish perspectives: Tradition, law and pastoral care
For Rabbi Russell Jayne, conversations about medical assistance in dying often begin with a difficult balance between religious teaching and the realities families face at the end of life.
Jewish tradition, he said, has long held that life and death ultimately belong to the divine.
“When I have been approached, I always talk about the fact that Judaism as a tradition does not support MAID because the mechanisms of life and death are in the hands of the divine,” Jayne said. “We are not allowed in any way to interfere with those mechanisms.”
At the same time, he said his role as a rabbi does not end with stating the tradition’s position. When someone has already decided to pursue MAID, Jayne sees his own responsibility shifting toward pastoral care for the person and their family.
“For myself, I think that this is a bigger issue than whether or not I formally approve of the process,” Jayne said. “There’s the family, the loved ones, people that they’re leaving behind…they’re in a state of confusion.”
Jayne said he tries to be honest about the teachings of Judaism while also listening to the personal circumstances that led someone to consider assisted dying.
“I need to be honest with them about the tradition and about what the tradition accepts,” he said. “But I also have to be honest with their own particular journey and not belittle them and not belittle the process they have gone through.”
Within Judaism, Jayne emphasized, there is no one response among rabbis about how to handle situations like this. Some clergy choose not to be involved in MAID at all, while others take a pastoral approach similar to his.
“I have colleagues who are much more strict about the process than I am,” he said. “And I respect my colleagues who are anywhere on the spectrum.”
Jayne says those differences reflect the complexity of balancing religious law with pastoral care.
“This is something that is so challenging to deal with,” he said, adding that many rabbis wrestle with the same question: how to honour Jewish teachings while still supporting people facing the end of their lives.
Canada’s legalization of MAID in 2016 has also shifted the conversations he has with congregants.
Jayne says that before the law changed, rabbis could cite both religious teaching and legal restrictions.
Now, he’s lost the ability to reiterate that medically assisted death is against the law.
That shift has reinforced his sense that his role is to clearly explain the tradition while recognizing that individuals may still reach their own decisions.
“You have a tradition that speaks against it, but you have the legal status of the procedure in the land,” he said. “That’s a great tension.”
In some cases, Jayne has been asked to be present when someone undergoes the procedure. When that happens, he said his role is primarily to listen.
From experience, he recalled arriving before the medical team and sitting with the family as they spoke about what they were feeling.
“Most family members would just talk to me and tell me practically anything about how they were feeling,” he said. “Most of them were not so much concerned about what they were feeling at the moment, but again, what exactly do they do once it’s finished?”
Families sometimes ask him to incorporate elements of Jewish ritual or prayer. Other times, they simply want him nearby.
“Some families have asked me to sing songs from the tradition. Some people have asked me to recite psalms. Some people have asked me to do nothing,” he said. “But just knowing that I was there…that was very important to them.”
RABBI RUSSELL JAYNE
After the death, Jayne often helps guide overwhelmed families through the immediate religious practices surrounding burial.
“To have me there as a source of comfort, authority and direction, it has helped them quite a lot,” he said.
A common concern, he added, is whether their loved one will still be buried in a Jewish cemetery—something that carries deep significance in the community.
“We want to make sure that at that moment we are respecting the life of the deceased, giving comfort to the family and making sure that they understand that their loved one will be laid to rest with honour and with dignity,” he said.
For Jayne, being present during a MAID procedure can carry emotional weight, but he said he believes it is important that families do not feel abandoned by their faith at a time of grief.
“I cannot abide—no matter what I may personally feel—I cannot abide the thought that someone would think that at that moment of such hurt and loss and trauma that their religious tradition would abandon them,” he said.
At the end of life, Jayne believes, the focus is less on theological debates and more on making sure the person who has died and the family left behind are treated with dignity.
“Every human life is so precious,” he said. “We want to make sure that ultimately a person’s life is celebrated and that they are laid to rest with honour and dignity.”
Indigenous perspectives and systemic health inequities
Anishinaabe academic and MRU professor, Karen Pheasant-Neganigwane, says discussions about death and end-of-life care often start with the broader health disparities Indigenous people in Canada experience, with assisted dying being inseparable from the structural factors influencing Indigenous health.
Speaking about her own family’s experience caring for an ageing parent, she described how chronic illness is a common reality for many Indigenous families.
“My mom is needing 24-seven medical care, so that is why she’s in a nursing home,” she said. “The doctor has told me everything is slowly shutting down on her.”
Pheasant-Neganigwane explains that these experiences often reflect deeper systemic issues that are seldom addressed in public health discussions.
“One of the questions I ask students is, ‘What’s the number one killer of Indigenous people?’” she said. “The standard response is alcoholism or maybe suicide, or maybe these days drugs. But no—the number one killer is diabetes.”
She added that heart disease is also prevalent, linking these illnesses to the long-term effects of colonization and changes in food systems.
Research on Indigenous health outcomes supports this broader context.
A 2026 study in the Journal of Palliative Medicine found that Indigenous communities in Canada continue to face significant disparities in health care access and outcomes due to colonialism and systemic inequities.
The study highlights that colonial policies, systemic racism, and social determinants of health continue to shape Indigenous experiences in the health-care system, affecting trust and access to services, including end-of-life care.
These legacies include documented histories of coercive sterilizations, racially segregated “Indian hospitals,” and medical experimentation on Indigenous people.
Such practices have contributed to ongoing mistrust of health institutions.
Pheasant-Neganigwane pointed to similar historical trauma in her own family’s memories of residential schools.
“My mom…she can’t eat cream of wheat because it reminds her of maggots,” she said. “They would just take the maggots off and eat the other parts of the food.”
Pheasant-Neganigwane stresses that such experiences continue to influence how many Indigenous families view health, ageing, and care.
According to Health Canada, with patient consent, practitioners must collect information on race, Indigenous identity, or disability to identify systemic or individual inequities in the delivery of MAID.
But the recent review notes that Indigenous perspectives remain largely absent from research and policy discussions on MAID, despite its increasing role in Canadian health care.
This gap raises concerns about whether end-of-life care systems adequately address Indigenous cultural needs and support community-based decision-making.
Researchers found that family involvement, traditional practices, and community presence are often central to Indigenous approaches to end-of-life care.
For example, one study cited in the review found that about 90 per cent of Indigenous families surveyed emphasized the importance of family and community participation in end-of-life decisions.
Pheasant-Neganigwane says that these values are reflected in memories of earlier generations.
“Back in the day, we would be leading a full, healthy life and being at home,” she said, recalling when family and community members often surrounded Elders.
KAREN PHEASANT-NEGANIGWANE
Today, adds Pheasant-Neganigwane, many families must navigate ageing and illness within institutional health-care systems. For Pheasant-Neganigwane, those shifts illustrate why conversations about assisted dying must also grapple with broader questions of health equity and social justice.
“When we’re talking about death,” she said, “we have to look at the health crisis going on.”
Catholic perspectives on assisted dying
In the Roman Catholic Church, assisted dying has been a subject of sustained theological debate and ethical reflection.
While the Catholic tradition emphasizes a message of compassion and care, the sanctity of human life and historical opposition to the practice lead many to see MAID as “morally unacceptable.”
In Calgary, the Roman Catholic Diocese oversees 10 Catholic healthcare centres spanning Southern Alberta, none of which will perform MAID.
Diocese of Calgary Bishop William McGrattan said conversations about MAID are becoming more common across the Roman Catholic Diocese of Calgary, reflecting a broader shift in Canada’s health-care and legal landscape.
“In a number of fronts…it has come up in their family and their parish situation,” McGrattan said, describing how parishioners, pastoral care workers and hospital chaplains have all raised questions about MAID in recent years.
Those conversations, he says, often begin with people trying to understand how Catholic teaching applies to complex end-of-life decisions.
When individuals or families approach him or other priests, McGrattan said the first step is to understand their circumstances. From there, he begins the discussion within Catholic teaching, which emphasizes the essential value of life.
“We often say that human life is a gift,” McGrattan said. “God as creator gives us this gift…and we have this responsibility to ensure that gift is respected.”
McGrattan believes that the responsibility Catholics bear extends from conception to the end of life.
“It’s at the end [of life] to allow for natural death to take place, so that we don’t hasten death, that we don’t make that choice of freedom to show disrespect to the gift of life that is created and given to us by God. So it’s in that context that we try and show them,” he said.
At the same time, McGrattan said those teachings are shared within a broader pastoral context that acknowledges suffering and the need for care.
“There are ways in which the community and families can support them,” he said, pointing to the role of pastoral care workers and the importance of accompaniment.
He also emphasized palliative care as a key alternative to assisted dying, describing it as a way to support people at the end of life without prolonging suffering.
“There are these specialized units where individuals and nurses allow people to experience natural death, but without pain. There is this comfort, and there is this understanding that they will not suffer unduly,” McGrattan said.
McGrattan also expressed concern about how eligibility for MAID has evolved over time, arguing that safeguards have weakened since the law was first introduced.
“The federal government has basically eroded those buffers to the point now that they’re talking about those who have mental illness, some in social and living situations, who find it unbearable, can make a request,” he said.
In Alberta, says McGrattan, there have been efforts to address those concerns at the provincial level.
On March 18, the Alberta government introduced Bill 18, the Safeguards for Last Resort Termination of Life Act. If passed, doctors and nurses could not administer MAID to patients with mental health as their sole condition for application.
In his conversations with parishioners, McGrattan says certain concerns recur, particularly fear of burdening others and uncertainty about end-of-life care.
“People often in advanced age find that they might be a burden,” he said. “Or people feel that they might be alone or that they might be abandoned at the end of their life,” he said.
He also pointed to what he described as misconceptions about pain management at the end of life.
“I think it’s really about educating people that there are alternatives which respect human life and that people can seek and have access to in such situations,” McGrattan said.
BISHOP WILLIAM MCGRATTAN
While Catholic clergy may accompany individuals through illness and end-of-life insight, McGrattan said they do not attend the administration of MAID itself.
In the faith, being present at the procedure is not the norm for Catholic clergy and would be seen as participating in the act.
“That would be considered to be an accomplice, and showing that they are somewhat supporting that by being very present,” McGrattan said.
Even so, he emphasized that pastoral care remains central up to that point, with clergy offering support, conversation, and guidance.
“It sounds like we’re not being compassionate or considerate, but we want to walk with the person. We offer various conversations, counselling, and try to assist them to maybe see in the discernment and decision that there are alternatives,” he said.
More broadly, McGrattan said the growing acceptance of MAID raises wider questions about how society views those who may be at risk.
“I think sometimes we begin to wonder, you know, as society is making such choices, is there really a respect for human life? And then we can go through the whole gamut of our human experience, including people who are homeless, in need of food or shelter, or in need of medical care,” he said. “So I think the question is, how is society treating its most vulnerable?”
He linked those concerns to what he described as a broader cultural shift, referencing a phrase used by Pope Francis.
“He said, ‘We live in a society that is a throwaway culture,’ and this whole idea that even as we throw away things that we have, we shouldn’t necessarily have that same attitude and approach to human life,” McGrattan said.
At the same time, he said discussions about MAID should include a range of perspectives, including those shaped by faith.
“What we would like to have is the ability to bring our faith, our convictions, and to be part of this discussion,” he said.
For McGrattan, those perspectives are part of a broader dialogue about how society understands dignity, care and responsibility at the end of life.
Faith, care and the realities shaping end-of-life decisions
Across different traditions and experiences, conversations about MAID reveal that questions of death rarely exist in isolation from the broader contexts that shape people’s lives.
For some spiritual leaders, that means helping families navigate moments of grief while holding space for religious teachings that may not always align with personal decisions.
For others, it means asking how systemic inequities shape the conditions under which those end-of-life decisions are made.
While MAID remains a legal option within Canada’s health-care system, the perspectives surrounding it continue to reflect deeply personal beliefs about dignity, suffering and responsibility at the end of life.
The Calgary Journal reached out to other faith leaders, but did not receive a response.
This article is part of a long-form project by MRU journalism students that examines Western Canada’s healthcare system ahead of the 2027 inclusion of mental illness as a sole criterion for obtaining MAID. To view the whole project, click here.
