David Maginley is a Canadian author, ordained Lutheran minister, and psychospiritual specialist with more than 25 years of experience in cancer, palliative, and intensive care. Based in Halifax, he served as an interfaith spiritual counsellor at the QEII Health Sciences Centre and now maintains a private practice supporting patients and families facing life‑limiting illness. He is the award‑winning author of Early Exits: Spirituality, Mortality, and Meaning in an Age of Medical Assistance in Dying, as well as Beyond Surviving: Cancer and Your Spiritual Journey. A four‑time cancer survivor and near‑death experiencer, David brings clinical, theological, and lived insight to his writing and international speaking on spirituality, grief, and end‑of‑life care. Known for his compassionate, evidence‑informed approach, he blends professional expertise with warmth and a touch of humor. Learn more at davidmaginley.com.
Much of the conversation surrounding medical assistance in dying begins with suffering: how much can be endured, what can be relieved, and when a person should be permitted to say, “Enough.” But beneath those questions may lie another: What are we afraid of losing when we die? In this conversation, David Maginley, author of Early Exits, explores the existential dimensions of dying—and particularly our fears of dependency, diminishment, and losing control. Drawing on decades of spiritual-care work, Maginley considers MAID alongside palliative care, near-death awareness, ego and identity, and the possibility that dying has something important to teach both the person approaching death and those gathered around them. What emerges is not a simple argument for or against MAID, but an invitation to recover a richer understanding of dying—and, perhaps, of what it means to be fully human.
Names mentioned:
Aristotle, Jeffrey Long, Christopher Kerr, Kathryn Mannix, Pam Reynolds, Kathleen Dowling Singh, Elisabeth Kübler-Ross, Robert Twycross.
Organizations mentioned:
International Association for Near-Death Studies, Near-Death Experience Research Foundation, Hospice Buffalo.
Books mentioned:
Beyond Surviving: Cancer and Your Spiritual Journey (by David Maginley)
The Grace in Dying (by Kathleen Dowling Singh)
Radix: David, thank you so much for your time, your experience, and your evident care and compassion. Your book, Early Exits, was especially meaningful as I prepared this issue of Radix, and I was grateful for how exceptionally well referenced it is.
Although Radix is based in California and has a primarily American readership, I’m Canadian, and MAiD has become an especially important conversation here—as well as an increasingly significant one elsewhere. When I came across your work—and the work of several other Canadian voices—I knew I wanted those perspectives included. While we’ll naturally be speaking about the Canadian context, the questions your book raises are universal. The issues surrounding suffering, dying, and what it means to live well are relevant far beyond Canada’s borders.
David Maginley: Absolutely. While Canada has one of the broadest MAiD programs in the world, physician-assisted dying also exists in several American states and a number of other countries. This is a deeply relevant conversation. Even more fundamentally, though, everyone is going to die. My book is about much more than MAiD. It’s about how to die well. What are the psycho-spiritual dynamics at work as we approach death? What are the existential dimensions unfolding within a person during that final stage of life?
I wanted to articulate that inner landscape as clearly as I could. Judging from the response I’ve received, I think the book has done that well. Much of what I’ve learned comes from my teachers, and foremost among them are the patients I’ve cared for over the past twenty-five years, including those I accompanied as they chose MAiD.
Radix: One of the things I appreciated most was the tone of the book. It’s remarkably compassionate while also gently challenging readers to think more deeply. As you say right from the beginning, this isn’t simply a book about MAiD—it’s about living more fully and preparing ourselves for the death that every one of us will eventually face.
DM: Yes, it is. And wouldn’t it be wonderful if someone handed us a roadmap for the inner experience of dying? In many ways, that roadmap exists, but it certainly isn’t a bestseller, nor is it embedded in our culture. We simply don’t talk about death. Instead, we’ve institutionalized it. We place it behind hospital walls and in care homes, and it has largely ceased to be a communal event in the way it remains in many parts of the world. I wrote the book as an investment in our culture’s spiritual intelligence—particularly regarding the most significant journey any of us will ever take.
Radix: You’ve already begun answering this, but perhaps you could tell us a little about yourself and what led you to write Early Exits.
DM: Certainly. I’m a Lutheran pastor, and for twenty-five years I served as an interfaith hospital chaplain—what we now call a spiritual care practitioner—at a major hospital in Halifax, Nova Scotia. I worked primarily in cancer care, palliative care, and intensive care. My vocation was to accompany people through the greatest crises of their lives and help them bring the deepest parts of their humanity into those moments. I loved that work. It was profoundly meaningful, and it became one of the greatest sources of spiritual growth in my own life.
I’m also a four-time cancer survivor. I had a particularly aggressive cancer called paraganglioma, and I’m extraordinarily fortunate to be alive. I’ve now been in remission for thirty years, so perhaps I’ve done my homework. If cancer is meant to teach us something, I must have been a rather thick-headed student. Still, I’m deeply grateful for what it taught me. I also had a near-death experience that profoundly shaped my faith, my understanding of humanity, and even my sense of reality itself. It transformed what I would call my ontological architecture. Its influence reaches well beyond any single religious tradition, including my own. Now that I’m retired, I maintain a private practice in Halifax, meeting with people both in person and remotely. I’ve written a couple of books, and I continue to enjoy conversations like this one. So thank you for inviting me onto Radix.
Radix: For readers who may not be familiar with Canada’s system, one of the things that surprised me was how quickly someone can move through the MAiD process. Could you briefly explain what happens when someone applies for MAiD and how the process works?
DM: Let me begin with a little background. MAiD has now existed in Canada for about ten years. It was originally intended for people experiencing intolerable suffering. Most people naturally assumed that meant severe physical suffering or unbearable pain. Of course suffering is multidimensional—there are existential, relational, and psychological dimensions as well—but physical suffering was largely what people envisioned. As the number of requests increased, however, the legislation evolved into two assessment streams.
Track One applies to people whose natural death is reasonably foreseeable. Track Two applies to those whose death is not reasonably foreseeable and who may still have many months—or even years—to live. The assessment process involves two independent assessors who determine whether a person has decision-making capacity, whether any coercion is involved, and whether the legal criteria have been met.
What often concerns me is that, despite the compassion of many assessors, the deeper nature of a person’s suffering isn’t always explored in great depth. The evidence from more than a decade in Canada—and from other jurisdictions around the world—is remarkably consistent: the primary driver behind requests for MAiD is not physical pain but existential distress. Once someone is approved, two clinicians must agree that the legal requirements have been satisfied. A physician or nurse practitioner trained in the procedure then administers the medications. Immediately beforehand, they once again confirm that the person understands what is about to happen, freely consents, and remains competent to make the decision.
Competency has become one of the more difficult issues. Some patients fluctuate in and out of competency, while others lose it before the scheduled procedure, making them ineligible. That led to calls for advance consent—for example, someone diagnosed with Alzheimer’s disease wishing to authorize MAiD before reaching the point where they can no longer provide informed consent. That remains an area of ongoing public debate. The legislation also continues to evolve. The proposed expansion to include mental illness as a sole underlying condition has been postponed several times. The Canadian Psychological Association has argued that psychological conditions generally fluctuate over time, treatments continue to improve, and it is therefore inappropriate to treat them as permanently irremediable in most cases.
So MAiD has had a complicated and often contentious history. Yet public support remains relatively strong. Part of that, I think, depends on how the question is framed. If people are asked, “If you were experiencing intolerable suffering and approaching death, would you want the option of MAiD?” many understandably answer yes. But if they’re asked, “Would you want comprehensive palliative care, effective pain management, twenty-four-hour medical support, and the opportunity to be surrounded by your family?” they also overwhelmingly answer yes. The question itself shapes the response. Ultimately, though, I don’t think this can be reduced to survey questions or assessment checklists. What’s happening within a person at the end of life is far more complex than that. That’s really what the book explores: What does the inner landscape of dying actually look like?
Radix: One of the themes you explore is the existential dimension of suffering, which you’ve already begun to touch on. I recently spoke with a physician here in British Columbia who has worked with patients considering MAiD for a number of years. She observed that many of those seeking it are relatively affluent people who have spent their lives exercising a great deal of control. As they approach old age or serious illness, they still want to retain that sense of control, even over the timing and manner of their death. That seems to connect closely with what you discuss in the book.
DM: It does, and the data supports that observation. Generally speaking, the more educated and affluent a person is, the more likely they are to want to remain in the driver’s seat right to the end. Before exploring the existential dimensions, though, it’s important to acknowledge something fundamental: people simply want to feel safe. Of course they do. They’re dying.
One of the reasons MAiD can be so psychologically powerful is that, once a person has been approved, it sits in the background as an available option. Simply knowing it’s there often reduces existential distress because it restores a sense of control. But what lies beneath that desire for control? People fear becoming dependent. They fear the physical decline, the loss of function, the prospect of lying unconscious in a bed while their family watches the final stages of dying. Many recoil at the thought of what is sometimes called the “death rattle” and ask, “Why would I put my family through that?” I’ve heard many patients say, “You wouldn’t do this to a dog. Why would you do it to me?” It’s a sincere question, and one worth taking seriously.
What I try to explore is whether much of that distress arises from resisting one of the most natural processes in the world. Yes, dying can be difficult. Yes, disease is painful, and we should manage that suffering as compassionately as possible. But many people find it unbearable because they can no longer function as the person they’ve always understood themselves to be. The idea of others washing them, feeding them, turning them in bed, and caring for them feels incompatible with their sense of dignity. I understand that reaction completely. But I also believe it comes from identifying ourselves almost entirely with what I would call the ego—the personal identity we’ve spent a lifetime constructing. That identity is real, but it isn’t the whole story.
The ego is built from our thoughts, feelings, bodily experiences, relationships, memories, attachments, hopes, dreams, regrets, and personal history. All of that becomes the story we call me. Yet every one of those elements is temporary. Thoughts arise and disappear within seconds. Feelings change. Our bodies change. Relationships evolve. Experiences come and go. So beneath all of those changing realities, what remains? Death gradually strips away everything temporary. It peels back the layers until, I would argue, we encounter something far more fundamental—the deepest aspect of who we are, something that has always been present. I can only describe it as mystery, wonder, a unique expression of consciousness. Beneath all the temporary aspects of identity is a simple awareness that has been with you from your first day until your last. People often hear that and ask, “So what?” What I’m describing is soul work. It’s the unchanging, mysterious self that many of us spend our lives avoiding.
The ego itself develops very early in life. At birth, we emerge from the womb—a reality in which there is no separate personal identity—and suddenly find ourselves distinct from the world around us. That’s the first separation. Next, we begin distinguishing between ourselves and the objects in our environment. Then we realize that we are minds inhabiting bodies, creating another layer of separation. Finally, all the experiences and emotions we cannot integrate into our conscious identity are stored away in what we call the subconscious, waiting to be revisited throughout life. Those buried experiences don’t disappear. They continue shaping us.
You can see it in a small child whose entire world collapses because a favorite blanket disappears or because they aren’t allowed to have a piece of candy. Their identity has become attached to something outside themselves. As we grow older, the objects of attachment simply become more sophisticated. We attach ourselves to careers, relationships, status, health, family roles, accomplishments, and our sense of competence. Throughout life we repeatedly experience attachment followed by loss. We change jobs. We move. Relationships end. Friends come and go. We retire. Our bodies weaken. Each of these experiences quietly asks the same question: Who are you, really? Are you your profession? Your role in your family? Your physical abilities? Deep down, we know we’re more than those things, yet we often cling to them as though they define us. That’s where suffering intensifies.
I like to say that the ego is healthy when it serves as the vehicle through which consciousness experiences life. It becomes unhealthy when it mistakes those experiences for its identity. Or, as the Buddha famously observed, “Life is suffering.” Then comes a terminal diagnosis. At that point, the process of ego deconstruction accelerates dramatically. If we resist it, we experience profound existential distress. However, if, instead, we surrender to the process—supported by skilled healthcare professionals, loved ones, and wise medical care—we often discover something very different: grace, clarity, connection, and even peace. Most people resist because surrender feels like losing. But surrender isn’t giving up. It’s giving yourself to one of life’s deepest and most universal processes—the same mystery that brought you into the world and, ultimately, carries you beyond it. That, I believe, is the heart of existential distress and one of the primary forces driving requests for MAiD.
Today there is another option. Before someone reaches the turbulence they fear, a trained clinician can administer medications that gently induce sleep and then stop the heart. I don’t mean that disrespectfully. I understand why that option is attractive. I’ve accompanied hundreds of people as they died. The process is rarely easy, but it is remarkably predictable. It contains brokenness and beauty, fear and wonder, often all at the same time. So I encourage people to ask for a roadmap. Ask your healthcare team: What will this illness actually look like? What difficulties lie ahead? How can those symptoms be managed? Most of that turbulence can be managed, and no one should have to face it alone.
Dying is the hardest thing any of us will ever do. But in Canada we now also have the option of an early exit. A person can choose the date, the place, the music, and who will be present. They can die while still comfortable and in control. It’s not difficult to understand why that option has become so compelling. For many people, it offers precisely what they most long for in the face of death: the promise of safety and control.
Radix: One of the ideas that first drew me to your work is this claim that dying itself has an important role in human becoming. That feels almost foreign to our culture. We celebrate living, but dying is treated as something that happens only at the very end, often hidden away. Our elderly become increasingly invisible, and with that we lose much of the wisdom older generations have to offer. Yet you argue that death itself has a formative role in making us more fully human.
DM: Yes. I would go even further. I believe that in dying we experience the final, ultimate, and accelerated movement toward becoming fully human. Now we’re venturing into mystical territory. Research consistently suggests that a very large percentage of dying people—often eighty or ninety percent in some studies—enter what are called transpersonal or transcendent states of consciousness.
Abraham Maslow is well known for his hierarchy of needs, but later in his career he added another stage beyond self-actualization: transcendence. I would argue that this reaches its fullest expression as we die. What does that look like? It usually isn’t a constant mystical experience. Rather, people have brief moments that come and go. They describe expanding beyond the limits of the body, encountering deceased loved ones, experiencing overwhelming peace, perceiving an extraordinary light, or being filled with profound joy and clarity. The experience isn’t something we manufacture. It comes upon us as the ego loosens its grip, allowing us to perceive a reality that, I believe, has always surrounded us. This phenomenon is often called nearing-death awareness.
Dr. Christopher Kerr at Buffalo Hospice conducted one of the largest studies on the subject and found these experiences to be remarkably common. They often begin with unusually vivid dreams unlike ordinary dreaming—dreams in which people encounter deceased family members, find themselves in places of extraordinary beauty, or experience conversations that remain permanently etched in memory. One of the remarkable effects is that these experiences frequently dissolve the fear of dying. You can’t force them to happen, but you can create conditions that make surrender easier. Good symptom management matters. Staying ahead of pain matters. Meditation and contemplation often deepen naturally as death approaches.
I’ve witnessed these experiences many times. I was especially moved to see both of my own parents experience them as they died. They’re almost impossible to describe adequately. What’s equally striking is how profoundly they affect the family members gathered around the bedside. They’re the ones who witness these moments and then struggle to integrate what they’ve seen. Physicians often aren’t present long enough to observe them. Nurses sometimes are, particularly those working extended shifts. But family members are there, and afterward they ask themselves, Did that really happen? How do I make sense of what I just witnessed?
Radix: That is so interesting.
DM: It is! Now, most people already believe, at least in principle, that loved ones may greet them after death or that angels exist. The challenge isn’t believing such things in the abstract. It’s encountering something that seems to confirm those beliefs in such an immediate and personal way. For many people, it produces what I call an ontological upheaval. Their understanding of reality itself changes. What’s remarkable is that these reports appear across cultures, educational backgrounds, ages, and levels of cognitive ability. The pattern is astonishingly consistent.
One concern I have about MAiD is that people often die before reaching this stage—not because anyone intends harm, but because neither the medical system nor our culture has developed a language for these existential dimensions of dying. In my view, this final stage is one of the deepest expressions of what it means to be human. When we begin talking about death this way, the conversation changes. It isn’t simply about sadness or grief anymore. It becomes a conversation about mystery, wonder, curiosity, and the deepest questions of human existence. Near-death experiences point in the same direction.
Here is something important to the conversation: roughly one in ten people who come close to death report such an experience, and the numbers are even higher among those who suffer cardiac arrest. Recent surveys conducted through the International Association for Near-Death Studies suggest these experiences may be considerably more common than earlier estimates indicated. What’s especially compelling is how consistent the accounts are across cultures and throughout history. Reports extend back thousands of years, long before Christianity. The earliest one was actually Sumerian.
Typically, people describe leaving their bodies, sometimes observing medical staff working on them from above. About a third report these out-of-body perceptions. One well-known example is Pam Reynolds. She underwent an extraordinarily complex operation for a brainstem aneurysm during which her body was cooled, her heart stopped, and blood drained from her head while surgeons repaired the aneurysm. During that period, she later described observing the operating room from above, accurately recounting surgical instruments and conversations that, under normal circumstances, she could not have perceived. She then described entering an overwhelming realm of light where she encountered deceased relatives and was told it was not yet her time. Like many people who report near-death experiences, she didn’t want to return. Her uncle eventually escorted her back, telling her she still had work to do—she needed to return to her children.
One detail that has always struck me is how ordinary the conversations often sound. Yes, people describe extraordinary beauty, but the encounters themselves are marked by warmth, familiarity, humor, and immense compassion.
My own near-death experience was deeply transformative. On the surface it sounds almost simple. I found myself on a grassy hill, beside a tree, speaking with an angel who told me I had to return. Yet what I experienced there cannot be adequately expressed in words. It reshaped my understanding of reality itself and convinced me that what we encounter there is not foreign to us but, in some profound sense, our deepest nature.
Death, which we so often regard only as an ending, is not something I ultimately fear. The dying process itself is remarkably predictable. The question is: Can we approach it with both sadness and curiosity? Can we be kind toward our own fear? Can we avoid waiting until the very end to say the four things that matter most: Thank you. I love you. Forgive me. Vaya con Dios [go with God]. I’ll see you on the other side.
Now, MAiD offers something undeniably compelling. I’ve been present for beautiful MAiD procedures, and I understand why many people find them deeply comforting. On one level, they can appear profoundly compassionate. But I become concerned when the conversation shifts from compassion to entitlement. My thought is that we do not have a right to die in a particular way. When death is brought about through medications that intentionally stop the heart, we are asking another person to end our life—to kill us. Those are serious ethical questions. I deliberately use the word kill, fully aware of its emotional weight. There are many different forms of killing, some legal and some illegal, but we shouldn’t hide behind euphemisms. Even ” MAiD” itself functions as a euphemism. The deeper issue, I believe, is that we’ve lost sight of what dying actually is. Dying is, in many respects, a predictable process.
I often encourage people to read the work of palliative care physician Kathryn Mannix. She speaks beautifully about how manageable dying can be when people receive skilled care, ask good questions, and aren’t afraid to use appropriate medications. The process is difficult, but it need not be mysterious or abandoned to fear.
Radix: One of the themes you return to repeatedly is that much of the suffering people fear can actually be managed through medication. You also discuss palliative sedation, which I suspect many people know very little about. It seems to me there’s an important distinction between being gently sedated through the natural dying process and intentionally ending life. Could you say a little about that?
DM: Certainly. One of the surprising things I’ve encountered is how reluctant people can be to use pain medication. They’ll tell me, “I don’t want to become addicted.” My response is usually a little humorous: You’re dying. You’re not going to become addicted. The goal is to stay ahead of the pain. You build a strong enough level of medication that occasional spikes don’t break through. That means taking medication consistently, reporting your pain honestly, adjusting doses appropriately, and having breakthrough medication available if it’s needed.
As death approaches, increasing sleepiness is part of the natural process anyway. Some people worry they’ll miss something important if they’re medicated. But I’d much rather see someone comfortable than enduring excruciating pain simply to remain fully alert. When pain can no longer be adequately managed while someone is conscious, we sometimes consider palliative sedation. That, too, frightens people because their imagination begins filling in the gaps. They wonder, Will I be trapped inside my body? Will I hear distant voices but be unable to respond? Will it feel like sinking into some dark abyss? When someone describes those fears, I usually say, “It sounds as though your imagination is causing you a great deal of suffering. Perhaps the next conversation should be with your physician.”
Most of us have already experienced something quite similar through general anesthesia for surgery. Palliative sedation is not some mysterious or terrifying unknown. Others ask, “If I’m going to be unconscious anyway, why wouldn’t I simply choose MAiD?”
Radix: Right!
DM: I think there’s an important difference. Even while lying unconscious, comfortably cared for, you continue teaching your family what it means to be human. You give them the opportunity to practice compassion at its deepest level—to care for your body, to sit beside you, to resist the temptation to turn away from suffering. In your dependency, you offer them a profound gift. Their humanity is deepened by caring for you. Can you allow them that gift? Can you allow them to live through those days of uncertainty without demanding immediate answers?
Our culture has become accustomed to instant solutions. We want everything resolved quickly and neatly. But life has never worked that way. Why would we expect death to? At the same time, I don’t want anything I’ve said to sound glib. This is the hardest thing any human being will ever do. I’ve walked beside hundreds of people as they’ve died, including both of my parents. I’ve seen people die well, and I’ve seen people die poorly. When my own time comes, I hope I’ll have the wisdom to die well. I’ll find out when I get there. But I’m not afraid of what’s on the other side. In many ways, I’m homesick for it. Once you’ve glimpsed it, that never completely leaves you. As I wrote in my first book, you move through the world like an odd duck—never quite feeling entirely at home here. Still, as long as you’ve got a pulse, you’ve got a purpose.
Radix: [Laughter] That’s a wonderful line.
DM: Yeah! It is. So, take your time. Live well. Love deeply. Build a life in which you not only love others but know yourself to be deeply loved. Sure, you’ll make mistakes. We all do. But even those become teachers. When you finally reach the end of your life, I hope you can look back with gratitude—not only for the joys but even for the poor choices that helped shape you. After all, it has been quite a ride. And, if you can, get into a little good mischief along the way.
Radix: I also appreciated how comfortably your book draws from different religious traditions. Whatever someone’s background, they can hear the humanity in what you’re saying. That leads to a practical question. If dying well begins long before we’re actually dying, what practices have helped you become more fully human and prepare for that final journey?
DM: Whatever I practice, I should admit that I’m inconsistent. For me, it begins with small moments of wakefulness. Aristotle said, “We are what we repeatedly do.” I decided that every time I look at my wife, I would quietly tell myself, You are wonderful. I love you. What a gift you are. The remarkable thing is that I find myself loving her more every day. The same is true of the rest of life. Wake up to the air, the ocean, the trees. Slow down. Pause. Become present. The quality of presence you bring to yourself determines the quality of your experience of life.
Am I fully present all the time? Not remotely. Even after my near-death experience, I still stumble through life. I still say foolish things. I still wrestle with my inner critic. I’m still learning. One of the things my angelic guide said as I returned from my near-death experience was, “You have more work to do. You can’t stay. But we’ll be with you.” I’ve carried those words ever since. Sometimes, walking through the hospital, I’d quietly say, “All right, let’s do something together today. I could use a little help.” Then I’d simply get on with my day.
Ultimately, I believe the purpose of spirituality is not merely to believe in God or secure a place in heaven. It’s to know yourself as you truly are beneath everything temporary. Near-death experiences, nearing-death awareness, and many of the experiences we’ve been discussing all point toward that deeper reality. Death itself eventually awakens us to it. What concerns me is that MAiD can unintentionally frame death as a technical problem to solve, grief as something to avoid, and suffering as nothing more than an inconvenience. Certainly, being in control feels good. But this isn’t primarily about feeling good. It’s about becoming wise. It’s about discovering that grief can be both broken and beautiful. It’s about entering the mystery of what it means to be human.
This is a question of existential health, not simply medical efficiency. If someone has access to MAiD, I would hope they also have access to compassionate physicians, good pain management, and meaningful palliative care. Unfortunately, that isn’t always the case. Only about thirty percent of Canadians currently have access to high-quality palliative care. We need to do much better. The conversation also extends beyond medicine.
Too many requests for MAiD arise from poverty, loneliness, social isolation, and inadequate support. Those realities should be a call for communities to care more deeply for one another. Instead, we live in an age of epidemic loneliness, widening economic inequality, and an overburdened healthcare system. At the same time, we have very little understanding of the existential dimensions of dying. That’s why Early Exits ended up being more than five hundred pages long. I wanted to explore every one of those dimensions. The book opens each chapter with the story of a real patient and closes with an exercise, inviting readers to begin this inner work while they’re healthy and safe. And if someone is already nearing the end of life and doesn’t have time to read five hundred pages, I’ve included a two-page summary at the back that captures the heart of the entire book.
Radix: The exercises in the book are also excellent. When I was reading your book, I admit I did think, I don’t have time for this; I’ll just move on. Then I had to remind myself: You’re reading the book, and you’re going to be speaking with David. Pluck up your courage and actually do the exercises. So I did several of them, and they’re genuinely thought-provoking.
DM: You did some of them?
Radix: I did. They’re very good. I really appreciate that you took the time to include them.
DM: One exercise is simply to lie down in a graveyard and reflect on your mortality. Another is to complete an advance care plan. In Canada, you can visit Advance Care Planning Canada and download workbooks and other resources to help you consider difficult questions and begin those conversations with your family. People say they want to remain in control. Well, one meaningful way to exercise control is to make your medical wishes known before you lose the ability to speak for yourself. An advance care plan allows your loved ones to understand those wishes and speak on your behalf when the time comes. There are many exercises throughout the book, and I’m glad you did some of them.
Radix: Yeah, thank you for writing them—and for including so many stories. Readers may need a box of tissues nearby, because some of them are deeply moving. Stories are powerful. They draw us into realities that abstract explanations alone often cannot.
DM: Exactly. Stories give the material traction. Ultimately, each of us needs to learn how to unpack our own story. Who am I? What difference did I make? Can I be gracious toward the unfinished parts of my life—the unfinished love stories and the poor choices? Can I be kind to myself? Can I release it all with gratitude? For a person of faith, perhaps the final act is to hand the whole tangled mess to God and say, “You work with this. I did what I did. I don’t fully understand what you were doing through me or with me, but I have to trust the love.” In the end, let love be your spiritual practice. Don’t become overly preoccupied with the content of your beliefs. Attend to the quality of your love. You can’t do much better than that. And allow your family to love you all the way to the end—even beyond what they imagined themselves capable of giving.
That brings me back to the question I often hear: “You wouldn’t do this to a dog. Why would you do it to me?” My response is that animals and human beings possess different structures of identity. Human identity is deeply embedded in narrative, memory, attachment, and cultural meaning. Animals certainly have personality—sometimes a great deal of it—but I don’t believe they possess an ego in the same narrative sense. I wrote about this on my website after we had to euthanize our own dog. Human identity is narrative; animal identity is natural. People die into stories. Animals die into nature. Animals are often far more present than we are. Their identity is structured differently. Dying, as I understand it, dismantles the human ego in the reverse order in which it was formed, gradually returning us to something more natural and fundamental.
Radix: David, thank you very much for your voice, your thoughtfulness, and the spirit in which you communicate. That spirit comes through not only in conversation but also on the page. Words can change minds—or at least make us more receptive to realities beyond ourselves. Listening to you, reading the book, and hearing your other interviews has made the realities you describe feel much more imaginable. I don’t think I would personally choose MAiD, but your vision of life, death, and human becoming has made me see the value of the dying process much more clearly.
DM: You know, it’s astonishing to consider that the hope proclaimed every Sunday, and expressed through spiritual traditions throughout the world, may be far more real than we generally allow ourselves to imagine. But I’m not trying to convert anyone. I’m trying to deepen the conversation. Ultimately, the question isn’t simply, Is there a God? A deeper question may be, What is consciousness? Many brilliant nonreligious thinkers are exploring that question in profound ways. Readers who want to investigate further can look at the International Association for Near-Death Studies, the Near-Death Experience Research Foundation created by Dr. Jeffrey Long, and Dr. Christopher Kerr’s research at Hospice Buffalo on end-of-life dreams and visions. I would also recommend the work of palliative care physician Kathryn Mannix.
For anyone who wants to explore the inner process of dying in greater depth, my own book may be useful, but an even more detailed resource is Kathleen Dowling Singh’s The Grace in Dying. She was a psychotherapist who worked in hospice care, and I regard her as a fitting successor to Elisabeth Kübler-Ross. The book is nothing less than a contemporary cartography of the inner dying process—what happens within us, how we resist it, and how the process unfolds. Importantly, it was written before medical assistance in dying became part of the conversation. For the most detailed roadmap I know, The Grace in Dying is the book.
Thank you, Matthew, for this conversation. I’m sorry my answers have been so long.
Radix: Not at all. It has been wonderful. It’s a substantial topic! Thank you again for your time, and I hope Early Exits continues to reach readers not only in Canada but elsewhere. It’s an extraordinarily important subject. It has been well received, I assume?
DM: Thank you. Yes! The book has been very well received, and I’m deeply grateful. Dr. Robert Twycross, one of the major figures in British palliative care, wrote the foreword. He also worked internationally to advance palliative care, so I’ve been humbled by his support and by the response the book has received. It took six years to write, and I published it the week after I retired from the hospital. I’m simply glad it’s out in the world.
Radix: You should also consider recording an audiobook. It would certainly be long, but you have a wonderful voice. You recorded your first book, didn’t you?
DM: I did, and I enjoyed it. You’re right—the audiobook is on my list.