Seven Days of Light: A MAiD Ritual in Practice

With love and reverence for Deirdre, and gratitude to Dr. Sarah Kerr

The need for support for individuals and families (without qualifiers) who choose a medically assisted death is swiftly increasing. In my practice, over half of the people who reach out for Doula support are seeking more education, understanding, and preparation - for both the head and the heart - around Medical Assistance in Dying (MAiD). For this reason, I am grateful to Dr. Kerr for generously sharing a MAiD ritual, one that she refers to as an advent calendar ritual. I have invited several clients to explore variations of this countdown ritual and it has been profound to witness the support of this action with intention. The story of Deirdre, in particular, touched my heart in unforgettable ways.

A while back I was contacted by a man seeking Doula support for his mother who was living in anticipation of a MAiD provision. She lived a short drive away and I agreed to visit her the following day to better understand her needs around her end of life decision. I met with Deirdre the following day in her back garden, we sipped tea, noted the birds at the feeder, and we spoke about where she was on her end-of-life journey and how she hoped to be supported moving forward. Her heart and mind were open and she welcomed companionship.

She expressed that she was quite anxious about her upcoming MAiD provision. She lived alone, her dedicated adult children came by often to spend time with her, but it was challenging to discuss the complexities of MAiD with the people she loved the most. Deirdre was holding so many big feelings and she was grateful at the prospect of having a neutral companion to share her hopes, fears, and goals with in the week leading up to her provision.

I offered to support Deirdre with a MAiD countdown ritual and she was receptive and excited about the support. I learned of this idea from the wise, vibrant, and generous Dr. Sarah Kerr founder of Sacred Deathcare. Dr. Kerr truly is a Canadian treasure - she has been in practice since 2012 and she is overflowing with soul-based wisdom. She is a sacred deathcare practitioner and a teacher, whose passion is contagious. Her focus is on contemporary ritual healing and she is fuelled by helping her clients and students find the healing gifts that can accompany death and loss.

Dr. Kerr acknowledges that something intense happens when the date for a MAiD provision is made. She says that “things in the field coalesce and snap into reality in a way that they haven’t and they don’t until that happens.” She believes that the client needs a way to catch up to this new reality so they can be prepared for the day in a soul way, recognizing that physical time and soul time don’t always align. Ritual is physical, it uses our bodies, and allows us to get real in a different way. Here is the recipe for Dr. Kerr’s MAiD countdown ritual:

- Before proceeding, ask your person if they are interested in participating with this ritual. Consent is key.

- Allow your person to choose a dedicated place for this ritual. This may be a fireplace mantle, a dresser, or a shelf.

- Place candles or tea lights on the altar to represent the number of days remaining before the provision.

- Invite your person to light a candle each morning and state the number of days remaining before the MAiD provision - “There are 10 days remaining.” Saying the number of days out loud makes it a reality.

- Ask your person to set and share an intention for how they want to spend that day. Take a moment to be with that intention, then ask your person to blow out the candle.

- In the evening, go back to dedicated space with your person to light the candle dedicated to that day again.

- Invite your person to express gratitude for the day, take a moment to be with their praise, and guide them to blow out the candle. Remove the candle from the altar to mark the day as complete.

- Clearly acknowledge how many days left. (“There are now 9 days remaining”).

- Repeat daily until the day of the provision.

This ritual can be done solo, with a family member or friend, with another end of life companion, such as a Doula, or with a group of people.

Dr. Kerr believes that counting down the candles, living with intention, and naming the number of days remaining is a deep energetic gesture that allows the internal or soul timing to keep up with external timing of an approaching date for a MAID provision. “When you see 10 candles, 9, 8, 7, it gets real in a different way.” She says that this ritual supports people to “arrive there, body and soul together so that on no level you are surprised. About what is happening so that you get there complete and in one piece.”

I offered to return to Deirdre’s home each day leading up to her MAiD provision date to support her with this countdown ritual and to hold space for the feelings and thoughts that would arise - offering her the opportunity to live out her dying role. She accepted the offer and suggested that we use the fireplace mantle as an altar. My intention was to allow her to share memories, regrets, wisdoms, as well as to celebrate the life that was present each day, guiding her to gratitude and love. With her permission I offered to send her adult children a daily email summarizing the candle ritual so they too could arrive at that day feeling a little more prepared.

We sat together a while longer and she asked about the medications used for MAiD and what to expect. I reassured her that MAiD is a very peaceful process, it is just like going to sleep. She seemed relieved to hear that it was not likely that she would fall off the chair or choke. She shared that for her, MAID has been a very complicated choice. I left her home with the promise to return the following afternoon.

Later that day I sent an email to her adult children summarizing our visit. I offered her family some resources, a link to the Bridge C14, a Canadian organization A Network of Peer-to-Peer Connections and Community Supports Through All Stages of Medical Assistance in Dying (https://www.bridgec14.org), MAiD Family Support Society (https://maidfamilysupport.ca) and a book titled This is Assisted Dying, written by Canadian physician Dr. Stefanie Green, the Founding President of the Canadian Association of MAiD Assessors and Providers (CAMAP).

7 days

The next day as I arrived at Deirdre’s home she met me at the door with a light-hearted smile, welcomed me inside, and offered me a tea. After a short visit we started the ritual. We lined up 7 glass tea light holders on her fireplace mantle and dropped a candle in each one. It was early fall and the dahlias were still in full bloom. As I left my house I passed a bunch of enormous brightly coloured flowers and I decided to snip off a bloom and offer it to Deirdre as a reminder of beauty.

I encouraged her to make the most of her moments - to find beauty where she can. I reminded her that her children love her so much, and that they support her wishes. I acknowledged that saying good bye is not easy and that the her upcoming MAiD provision date is intense and felt by everybody that cares about her. We lit the candle for that day, she set an intention for the day, we had a moment of silence, and then I guided her to blow it out. I put the candle in my bag and said “there are now 6 days remaining.” I placed the bright orange dahlia on the mantle next to the 6 remaining tea lights.

6 days

The next day I returned with a sprig of Rosemary from my front garden. Rosemary symbolizes remembrance and memory. Before lighting the tea light we sat and talked about the natural desire to look back and remember a lifetime of memories that arises in people facing death. We sat in silence sipping our tea and after a while she began to share. She told me all about her family, pointing out people in the framed photos in her living room. She talked about her love of tennis, the summers at the family cabin, and hosting themed dinner parties. She lit up as she recalled her career as a teacher and told stories of a few of her most memorable students. She went on and on with contagious enthusiasm. After a while she decided it was time to light the candle for the day. We approached the mantle and performed the daily ritual. “There are now 5 days remaining,” I announced. Deirdre shook her head. “The waiting is hard,” she replied. I met her eyes and placed a hand on her shoulder. As she saw me to the door, she stopped and thanked me for coming. We shared a hug, and I set off down her walkway to my car.

5 days

When I visited Deirdre the following day I brought a rock to symbolize the heaviness of regret. We had a conversation about how none of us get out of life without regrets. These heavy emotions of sadness, disappointment, or remorse about an action, decision, or circumstance from the past haunt us all. Regrets often nag at us consuming us with the wish that something could be undone or that we had chosen a different path. Regret can surface around perceived mistakes, missed opportunities, and life circumstances that did not meet our expectations.

We wondered together about how to lighten these heavy emotions so we don’t have to lug them around. We talked about how exploring regrets and to sharing these big emotions with others seemed to lighten the burden. As the conversation continued, Deirdre shared some of her life regrets. I sat and listened, feeling with her as she picked up these heavy memories, felt the weight, and put them down. We stood and performed the candle ritual, leaving 4 remaining tea lights on the altar. In the doorway she offered a cheery bye, my sense was she was traveling a little lighter.

4 days

Four days before her scheduled provision I brought Deirdre a mushroom. I noticed so many mushrooms on my morning walk in the forest that day. Various shapes, sizes, and colours bursting out of the ground after a weekend of steady rain. I was inspired by the mushrooms and mycelial networks - the underground web that connects plants and trees, providing nutrients and communication. I chose to bring a mushroom to remind Deirdre about how many people care for her - how many people are holding her during this challenging time.

Before I left for my visit with Deirdre, I found a message from her son in my inbox. How serendipitous! The email was filled with heartfelt messages from Deirdre’s network! He sent it along to me to share with Deirdre during our visit. Old friends, family members, and neighbours had offered messages - love notes filled with treasured memories and well wishes. I tucked my computer in my bag and hopped in my car.

I passed Deirdre the mushroom as I entered her home. She gave me a little smile and raised her eyebrows. She went into the kitchen and returned with two cups of tea. We sat in the living room and had a conversation about the significance of mycelial networks the unifying force of nature, life-giving networks. I pulled my laptop from my purse and began reading the notes to Deirdre as she listened closely. Some of the messages made her laugh - recalling good times, and others made her quiet and reflective. She asked me to read a couple of the notes twice. It was deeply moving to witness. When it was time to go, we said our goodbyes and I headed down the walkway. I glanced back over my shoulder to see her dancing in the doorway.

3 days

I went to see Deirdre just before noon three days before her MAiD date. I asked her to hold her hands out in front of her and I placed a few drops of sweet orange essential oil in her palm and asked her to rub her hands together. Then I guided her to cup her hands over her nose and mouth and inhale. She was enlivened by the bright smell of citrus and flashed a wide smile. I placed a small orange on the mantle and we talked about the heaviness of grief that accumulates from all the change that is a natural part of the end-of-life journey. The orange oil was offered to brighten the darkness that she may be experiencing and help to invigorate her when she is feeling low. We lit the candle in honour of brightness and she blew it out. I tucked the candle in my bag and glanced at the growing altar of meaning - there was a dahlia, a sprig of rosemary, a rock, a mushroom, an orange, and two tea lights remaining.

2 days

The next day I arrived at Deirdre’s home and passed her an owl's feather at the door. Over tea I shared that on the end-of-life journey it is best to travel light. We talked about how sharing regrets and grief with trusted others is one way to travel lighter. She gazed out her living room window as we sat in silence for a while. She talked a lot about her home town. She spoke about her childhood and sang a little song that her father used to sing to her. She shared about motherhood, being a wife, and a friend. We lit the candle and I stated that there was one day remaining.

1 day

When I arrived at Deirdre’s home on the day of her MAiD provision I was greeted by her three adult children. The living room was thick with emotion. We exchanged hugs and care. I acknowledged the enormity of the day and shared my wish that they take the time to tune into their hearts and say whatever is asking to be said - be it forgiveness, gratitude, and / or love. I was there to complete the countdown ritual so Deirdre and I walked up to the mantlepiece. We stood there for a while, then Deirdre picked up the one remaining tea light and I struck a match. We lit the last candle. She silently set her intention for the day and blew out the flame. I put the candle in my bag and placed a maple leaf with hints of red, burnt orange and yellow on the mantle. We talked about impermanence and change, about the nature of life, about cycles and seasons. She opened her arms and we had a long embrace.

After an emotional goodbye, I walked out the door, and down the walkway, I turned to look over my shoulder to see Deirdre in the doorway surrounded by her three children waving goodbye.

Later that evening I received an email from Deirdre’s son. He said that when the physician who came to administer the MAiD provision asked her if she was ready, she answered calmly and unequivocally, 'yes'. She passed away peacefully in her living room, with her three children at her side. He shared that his mom would have been quite pleased that, as I had assured her, she did not choke. He felt that she would also be pleased with everybody's efforts to ensure that she did not fall off the chair, a fear she had shared with all. He expressed heartfelt gratitude for the support and guidance I offered Deirdre to prepare her and their family in the days leading up to the big day.

Her daughter reached out too - grateful for the support offered to the family as they all navigated the very difficult end of life decision she was facing. She felt that the connection created in the week leading up to the provision allowed her to speak more freely about her wishes and fears. She said even though it was an intensely emotional journey she was at peace with her decision in the end. This allowed her children to be at peace believing that she finally felt ready. She shared that just before the provision she spoke to her kids about the wonderful life she had lived. Her daughter said it seemed almost like a weight had lifted and she could simply enjoy her final moments with her family.

This ritual supported Deirdre by inviting connection, meaning, pleasure, and presence right up until the final moments. Offering the same for companions - family, friends, doulas - to arrive there, souls and body aligned.