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Voluntary Assisted Dying for Grief: Medicalisation, a Proposed Autonomy-Only Approach, and Lessons From Prepubescent

Tessa Jane Holzman^1,2

¹Charles Sturt University, Wagga Wagga, New South Wales, Australia.

|November 28, 2025

Summary

Prolonged grief disorder is the only current pathway to medical assistance in dying (MAID) for severe grief in the Netherlands. This article explores alternatives to medical diagnoses for MAID access, proposing a "watchful grief affirming waiting" model.

Keywords:

autonomy autonomy‐only gender care grief medicalisation voluntary assisted dying

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Area of Science:

Medical Ethics
Grief Studies
Palliative Care

Background:

The diagnostic criteria for prolonged grief disorder (PGD) face criticism for potentially medicalizing normal grief.
In the Netherlands, PGD is currently the sole criterion for accessing medical assistance in dying (MAID) for individuals with extreme or persistent grief.
This reliance on PGD for MAID access is threatened by criticisms of the disorder and concerns about undue medicalization.

Purpose of the Study:

To examine the current Dutch policy on MAID for grief, including the role and criticisms of PGD.
To explore alternative frameworks for establishing eligibility for MAID in cases of grief without relying on medical diagnoses.
To propose a novel model, 'watchful grief affirming waiting,' for assessing MAID requests related to grief.

Main Methods:

Analysis of Dutch MAID policy concerning grief and prolonged grief disorder.
Examination of the medicalization debate surrounding prolonged grief disorder.
Exploration of the autonomy-only approach to MAID and its implications for grief.
Drawing parallels with guidelines from prepubescent gender care for a proposed model.

Main Results:

Prolonged grief disorder presents a complex pathway to MAID in the Netherlands, balancing access with medicalization concerns.
The autonomy-only approach to MAID offers a potential alternative but requires careful consideration within the context of grief.
The proposed 'watchful grief affirming waiting' model offers a framework for assessing MAID requests related to grief without solely relying on a medical diagnosis.

Conclusions:

There is a tension between providing MAID access for severe grief and the risk of medicalizing normal human experiences.
Alternative frameworks, such as the autonomy-only approach, need further investigation for their applicability to grief-related MAID.
The 'watchful grief affirming waiting' model provides a novel, ethically grounded approach to support individuals experiencing profound grief seeking MAID.