How do you talk to your kids about the use of medically-assisted death?

When Trisha Holland's father applied for a medically-assisted death, she had to decide what — and how much — to share with her three children.

Her father, Ronald Watt, had been diagnosed with cancer and chose medical assistance in dying (MAID) after learning his illness was terminal.

At the time, Holland's sons were 10, 13 and 15. 

She told them, "Grandpa Watt doesn't want to be sick anymore and he will choose the day that he passes."

Holland was present for her father's death, and while her children weren't, they came to her afterward with more questions.

"Because then I had answers," she said. "And then I could answer them honestly."

Honest conversations

Debra Wiszniak, a retired social worker with extensive experience in palliative care and MAID counselling, said there is no guidebook for navigating death, dying and grief.

She said age-appropriate discussions like Holland had with her kids are a vital starting point.

Wiszniak helped develop the psychosocial component of Saskatchewan's provincial MAID program. She said research suggests talking with children about illness, dying and death can support healthier coping strategies and bereavement outcomes.

"You're going to make mistakes, and that's OK," Wiszniak said. "The sooner you start to have these conversations with children, the easier it is to carry on that conversation."

She said most children will experience a significant death before they graduate high school.

"Normalizing [death] helps children engage in open and honest dialogue in a nurturing environment. This is a way for children to see that death is a part of life and that hard things can happen and you can get through it together."

Wiszniak said that while children typically start to understand the permanence of death around age eight, each child is different.

"Parents know their children best, their maturity and personality, and if they might be dealing with anxiety or other stressors," she said, advising parents to follow their child's lead. 

"They'll let you know how much they can take in and cope with."

She said a good place to start is asking questions like, "Have you heard about MAID?" and, "What do you know about it?"

Sharing requirements of MAID

Sharing the criteria for MAID in simple terms can help children better understand the process.

Wiszniak suggests telling them:

• MAID is only available to adults 18 and older with a serious life-limiting illness that will cause their death.
• No one can be pressured into choosing MAID, and the person has the right to change their mind at any time.

Children should know it's OK to ask questions. For younger kids who may not fully grasp the finality of death, repeated questions like, "Where is the person now?" are normal.

"Kids will catch us off guard," Wiszniak said. "We can just say, 'That's a really good question. Can I think about it and get back to you?' We are more prepared then."

Throughout her career, Wiszniak has seen children get involved in MAID deaths in direct and indirect ways.

"I had kids who recorded a beautiful song they used to sing with grandma. The kids weren't there, but another family member played the song to grandma before she had her MAID death."

If children won't be present, parents can ask if there's something they'd like to contribute. They might make art, decorate a pillow, or lend a stuffed animal for comfort.

When children do attend, it's important to prepare them thoroughly. Wiszniak said adults should explain:

• What will happen during the procedure, including how medications are administered.
• How the person's body will change after death.
• Who will be in the room for support.
• That it's OK to feel sad, cry, or change their mind about attending.

"I've had children who thought they wanted to be part of it, but in the end, they chose not to," Wiszniak said.

Explaining it through love

A year after her father's death, Holland's mother, Barbara Watt, was diagnosed with terminal cancer and also chose MAID.

As with her father's MAID death, Holland and her siblings were present. None of the grandchildren attended, but they each had time to say goodbye beforehand.

This time, Holland found it easier to explain what would happen in the room. She told her kids that it would be very sad, but she felt lucky her mom wouldn't be alone.

"We all get to be together, and we get to hold hands and we all get to love each other," she told them. "I explained it through love."

More resources for talking to children about MAID can be found at kidsgrief.ca and on the Saskatchewan Health Authority's website.