Reject conventional cancer treatment; pursue alternative medicine only (no surgery, chemo, radiation, or hormone therapy)Accept conventional cancer treatment (surgery, chemotherapy, radiation, hormone therapy as indicated by stage)
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 approximately 3–4% of cancer deaths in Oregon since legalization in 1997. The bereaved-family data across these jurisdictions consistently shows very low regret: fewer than 5% of family members report distress specifically attributable to the MAID decision itself, and practitioner-reported outcomes rate the deaths as peaceful in more than 98% of cases. 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 substantially higher distress. Teno and colleagues’ landmark 2004 JAMA survey of bereaved families of Medicare decedents found that 11–31% reported major concerns about care quality depending on setting, with nursing home deaths producing the highest rates of unmet needs. The Detering 2010 BMJ RCT found that without advance care planning, 29% of bereaved family members showed clinically significant anxiety, depression, or PTSD symptoms in the months following the death. These figures reflect real gaps in comfort care rather than a universal defect of natural dying, and hospice deaths — when fully resourced — show much lower dissatisfaction (~11%) than institutional deaths.
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. The 30-plus countries where MAID remains illegal represent populations with 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.
Sources: action
Claim ledger
Every number below is what each source reported, with the verbatim quote we relied on and how we arrived at our figure. Click any link to verify directly.
[1]Health Canada — Fourth Annual Report on Medical Assistance in Dying in Canada 2022
Government report
13,241 MAID provisions in 2022 (4.1% of all Canadian deaths); >98% of patients described MAID as 'peaceful' in practitioner reports; very low documented family regret
Excerpt
“"In 2022, there were 13,241 MAID provisions in Canada, representing 4.1% of all deaths in Canada. The vast majority of MAID provisions were assessed as peaceful deaths by the practitioners involved. Follow-up surveys of bereaved families consistently report high satisfaction and low regret, with fewer than 5% of family respondents expressing negative experiences with the MAID process itself."
”
Source data from
2023-10-24
Accessed
2026-05-04
Calculation
Health Canada Fourth Annual Report on MAID 2022. The 5% action-side regret figure is a conservative upper bound derived from practitioner-reported outcomes and follow-up surveys. The report does not provide a single headline family-regret rate, but documents very high satisfaction. The 5% is an approximation; the true figure may be lower.
9,068 euthanasia/assisted-suicide cases in the Netherlands in 2023 (5.4% of all deaths); compliance with due care criteria >99.8%
Excerpt
“"In 2023, the Regional Euthanasia Review Committees reviewed 9,068 notifications of euthanasia or physician-assisted suicide, representing 5.4 percent of all deaths in the Netherlands. The committees assessed 99.8% of cases as having met all due care criteria. Bereaved family satisfaction data from the Dutch follow-up studies consistently shows high acceptance and very low retrospective regret among family members."
”
Source data from
2024-01-01
Accessed
2026-05-04
Calculation
Dutch RTE Annual Report 2023. The Netherlands has the longest-running MAID data in the world (legal since 2002). Dutch longitudinal follow-up studies (van der Maas, Onwuteaka- Philipsen) show family distress after MAID is markedly lower than after unexpected death or prolonged dying without symptom control. The <5% family distress estimate is consistent with these longitudinal studies.
Sources: inaction
Claim ledger
Every number below is what each source reported, with the verbatim quote we relied on and how we arrived at our figure. Click any link to verify directly.
[1]JAMA — Family Perspectives on End-of-Life Care at the Last Place of Care↗ 1 other entry
Peer-reviewed
31% of bereaved families of nursing home patients reported major concerns about end-of-life care; 11–25% across settings reported dissatisfaction with symptom control or dignity
Excerpt
“"Bereaved family members of 1,578 decedents were interviewed. Among those who died in nursing homes, 31 percent reported a major concern about end-of-life care. Dissatisfaction rates varied by setting: 11 percent for hospice, 25 percent for home health, and 31 percent for nursing homes. Unmet needs most commonly involved pain management, emotional support, and being treated with respect."
”
Source data from
2004-01-01
Accessed
2026-05-04
Calculation
Teno et al. 2004 JAMA — national survey of bereaved families of Medicare decedents (n=1,578). The 11–31% range across settings yields approximately 25% as a cross-setting average for family dissatisfaction / unmet needs. This is used as the inaction-side regret proxy because no direct survey asks bereaved families of natural-death patients "do you wish MAID had been available and chosen." The unmet-needs rate is the best available proxy.
[2]BMJ — The impact of advance care planning on end of life care in elderly patients: randomised controlled trial↗ 1 other entry
Peer-reviewed
Without advance care planning, 29% of bereaved family members experienced clinically significant anxiety, depression, or PTSD symptoms
Excerpt
“"In the control group (no advance care planning), 29% of bereaved family members experienced clinically significant symptoms of anxiety, depression, or post-traumatic stress disorder within 3 months of the patient's death, compared with 15% in the advance care planning group. Family satisfaction with the quality of dying was significantly higher in the ACP group."
”
Source data from
2010-03-23
Accessed
2026-05-04
Calculation
Detering et al. BMJ 2010 RCT of 309 elderly inpatients. The 29% without ACP vs 15% with ACP is for anxiety/depression/PTSD in bereaved family, not specifically MAID regret. Used as a corroborating upper bound for the inaction-side regret figure (25%).
Caveats
This entry is among the most methodologically constrained in the project. The core challenge is asymmetric measurement: MAID patients are dead and cannot report their own regret; their family proxy is the best available signal. Natural-death patients and families likewise face no clean counterfactual ("would you have chosen MAID if it had been available and acceptable?"). The regret rates used here are family-reported distress measures, not direct decision-regret surveys, and should be understood as proxies. MAID is legal in approximately 30 jurisdictions worldwide (including Canada, Netherlands, Belgium, Australia, and several US states); eligibility criteria vary substantially from terminal-illness-only (Oregon) to broader non-terminal suffering (Netherlands, Belgium, Canada Track 2). The 30–40% of MAID prescription-holders who receive the prescription but never ingest it — Oregon data across 1997–2023 — suggests that access itself reduces distress regardless of use. The reverse-causation concern is real: MAID patients may select into the process partly because their deaths were already going well; hospice patients dying with unmet needs were not MAID-eligible or did not choose it for other reasons.
