“Reconciling”- conceptualising the grieving process of family members involved in assisted dying: a grounded formal theory

The death of a loved one invariably triggers a complex constellation of profound emotional, psychological, and physical grief reactions. While theoretical frameworks for understanding the grieving process are well-established, the advent of assisted dying presents a novel and under-examined context for grief and bereavement. Thus, this study sought to generate a theory explaining the grieving process of family members involved in assisted dying.

A grounded formal theory approach was employed. Extensive systematic searches were undertaken across various four databases for eligible qualitative studies. Constant comparison was employed to iteratively refine emerging codes and categories.

Fifteen (15) qualitative studies were retained. Reconciling, emerged as central to conceptualising the grieving process associated with assisted dying reflecting four interconnected categories: navigating ambivalence, anticipating, transitioning, and navigating the aftermath. This process is characterised as a complex, iterative, and often non-linear proactive journey of meaning-making, through which families strive to integrate the profound dichotomies. Reconciling, as a mid-range theory, extends existing grief models by demonstrating that bereavement in assisted dying involves a proactive, ethically charged negotiation of autonomy, suffering, and relational responsibility; dimensions not accounted for in stage-based or oscillation models.

The grieving process in assisted dying is best understood as Reconciling, a dynamic, iterative negotiation of autonomy, suffering, love, and loss. Families move through ambivalence, anticipation, transition, and aftermath in ways that blend emotional complexity with profound meaning-making. This theory offers a transferable framework to understand and support families navigating this ethically charged form of bereavement.