In the jurisdictions where it is legal, medical aid in dying is chosen by a small but growing minority of terminally ill patients — 5.4% of deaths in the Netherlands in 2023, 4.1% in Canada in 2022, and a small fraction of a percent of all deaths in Oregon (38.6 per 10,000 total deaths over the law’s first 18 years), though cancer patients make up the large majority of Oregon’s MAID users — 77% of the 991 patients who used the Death With Dignity Act between 1998 and 2015. These provision counts come from government monitoring reports, which do not survey bereaved families. The family-distress evidence comes instead from bereavement studies: Swarte and colleagues’ BMJ 2003 cross-sectional comparison (189 relatives bereaved by euthanasia vs 316 by natural death of gynaecological-cancer patients) found less traumatic grief and fewer post-traumatic stress reactions in the euthanasia group, and a Swiss study of relatives who witnessed assisted suicide found roughly 5% met criteria for complicated grief (and 13% for full PTSD). One figure stands out from the Oregon Death With Dignity Act data: roughly 30–40% of patients who receive the legally required prescription for lethal medication never use it. For many, simply having the option is sufficient.
The comparison group — families of patients who died without MAID, in hospice or hospital settings — shows substantial unmet need. Teno and colleagues’ landmark 2004 JAMA survey of bereaved families of decedents (n=1,578) found that about a quarter said the patient did not get adequate help with pain (24.2%) and a similar share had concerns with physician communication (23.9%), while half reported insufficient emotional support (50.2%); nursing-home patients were least likely to be “always” treated with respect (68.2%, versus 96.2% in home hospice). The Detering 2010 BMJ RCT found that among families of patients who died, control-group relatives (no advance care planning) had clinically significant depression in 30% of cases, anxiety in 19%, and high PTSD risk in 15% — whereas the advance-care-planning group registered none of these. These figures reflect real, fixable gaps in comfort care rather than a universal defect of natural dying; well-resourced hospice deaths scored far better than institutional ones.
The methodological problem that makes this entry uniquely uncertain is the impossibility of asking MAID patients whether they regret the decision. All regret measurement is family-proxied, and all cross-group comparison conflates eligibility, access, and choice. MAID patients are a selected group: motivated enough to navigate legal and clinical requirements, often dying of cancer with predictable trajectories, and in jurisdictions with functioning access infrastructure. MAID remains illegal in the great majority of the world’s roughly 195 countries; those populations have no choice, and their inclusion would likely shift every figure. What the available data supports most clearly is this: in jurisdictions where both paths are genuinely available and supported, the major asymmetry is not in the dying itself but in the quality of the dying — and unmet needs in natural-death settings remain common enough to constitute a public health gap, not a rare failure.