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The Last Doctor: Lessons in Living from the Front Lines of Medical Assistance in Dying
NATIONAL BESTSELLER
*SHORTLISTED FOR THE 2022 WRITERS' TRUST BALSILLIE PRIZE FOR PUBLIC POLICY*
An urgently important exploration of the human stories behind Canada's evolving acceptance of Medical Assistance in Dying (MAiD), from one of its first and most thoughtful practitioners.
Dr. Jean Marmoreo spent her career keeping people alive. But when the Supreme Court of Canada gave the green light to Medical Assistance in Dying (MAiD) in 2016, she became one of a small group of doctors who chose to immediately train themselves in this new field. Over the course of a single year, Marmoreo learns about end-of-life practices in bustling Toronto hospitals, in hospices, and in the facilities of smaller communities. She found that the needed services were often minimal--or non-existent.
The Last Doctor recounts Marmoreo's crash course in MAiD and introduces a range of very different and memorable patients, some aged, some suffering from degenerative conditions or with a terminal disease, some surrounded by supportive love, some quite alone, who ask her help to end their suffering with dignity and on their own terms.
Dr. Marmoreo also shares her own emotional transformation as she climbs a steep learning curve and learns the intimate truths of the vast range of end-of-life situations. What she experiences with MAiD shakes her to her core, makes her think deeply about pain, loneliness, and joy, and brings her closer to life’s most profound questions.
At a time when end-of-life care and its quality are more in the public eye than ever before, The Last Doctor provides an accessibly personal, deeply humane, and authoritative guide through this difficult subject.
*SHORTLISTED FOR THE 2022 WRITERS' TRUST BALSILLIE PRIZE FOR PUBLIC POLICY*
An urgently important exploration of the human stories behind Canada's evolving acceptance of Medical Assistance in Dying (MAiD), from one of its first and most thoughtful practitioners.
Dr. Jean Marmoreo spent her career keeping people alive. But when the Supreme Court of Canada gave the green light to Medical Assistance in Dying (MAiD) in 2016, she became one of a small group of doctors who chose to immediately train themselves in this new field. Over the course of a single year, Marmoreo learns about end-of-life practices in bustling Toronto hospitals, in hospices, and in the facilities of smaller communities. She found that the needed services were often minimal--or non-existent.
The Last Doctor recounts Marmoreo's crash course in MAiD and introduces a range of very different and memorable patients, some aged, some suffering from degenerative conditions or with a terminal disease, some surrounded by supportive love, some quite alone, who ask her help to end their suffering with dignity and on their own terms.
Dr. Marmoreo also shares her own emotional transformation as she climbs a steep learning curve and learns the intimate truths of the vast range of end-of-life situations. What she experiences with MAiD shakes her to her core, makes her think deeply about pain, loneliness, and joy, and brings her closer to life’s most profound questions.
At a time when end-of-life care and its quality are more in the public eye than ever before, The Last Doctor provides an accessibly personal, deeply humane, and authoritative guide through this difficult subject.
304 pages, Paperback
Published April 16, 2024
35 people are currently reading
794 people want to read
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Displaying 1 - 30 of 70 reviews
December 22, 2022
Initially, I really didn’t take to Dr. Jean Marmoreo, perceiving her as over-confident, even brassy, but I came to appreciate her informative book, finding it considerably more nuanced than Stefanie Green’s
This is Assisted Dying,
which came out in March 2022. Both Marmoreo and Green were at the forefront when medically assisted death became legal in Canada in 2016—Green on the west coast of Canada, Marmoreo in the Greater Toronto Area. Since Marmoreo’s book is the more recent, it covers new developments in Medical Assistance in Dying (aka MAiD, an acronym I loathe, as it suggests to me tidying up the unwanted mess of chronically or terminally ill people. I’ll add here that I am no fonder of the euphemistic term Marmoreo consistently uses—“provision”— which only sounds like a way to avoid stating what these doctors actually do: euthanize patients. Marmoreo notes that in the Netherlands, they’re more straightforward: it’s acknowledged there as killing people. I prefer that directness.)
Marmoreo does some of the usual things you see in medical memoirs. She presents a wide range of case studies. She also talks about assessments, criteria, the approval process, the procedure itself, and the thorny matter of assisted death for patients in cognitive decline. What interested me about her story is the perspective she brings to the subject. Marmoreo has been a family doctor for over 40 years. She’s now 80–still very sharp and physically fit—but aware that her own time on earth is drawing to a close. (It’s unclear to me if she still has a medical practice outside of providing medically assisted death). My point here is that she has spent years caring for her patients. She knows them, their struggles, how they’ve coped with challenges in the past—in short, their stories. The fact that she assesses and ends the lives of people she does not know well greatly concerns her, and it’s taken an emotional toll. She had hoped that over time Canadian family physicians, like Dutch GPs, would incorporate assisted death into practices where longterm relationships with patients have been established. Family doctors in the Netherlands can expect to perform an average of five euthanasias over the course of their careers. The Dutch, acknowledging the emotional burden of ending someone’s life, have ensured that doctors have some opportunity to recover after the procedure. They do not go into their offices and clinics the day following an assisted death. Unfortunately, 85% of assisted deaths in Canada are performed by physicians who are essentially strangers to patients. This is the inverse of what happens in the Netherlands, where only 15% of euthanasias are performed by physicians not known by the patient, and 85% by family doctors.
Before Marmoreo began performing assisted deaths, she created and followed a learning program, shadowing palliative care doctors in both urban and rural settings. This has proved to be invaluable when it comes to assessing patients. She describes cases in which she intervened to find supports and resources for patients in order to give them extra quality time, but she openly acknowledges the frustration and distress she has felt when services—community, home care, mental health, and medical—can’t be drawn on because there are none to be had. This is particularly true in rural areas and in the northern parts of Ontario. There’s been an increasing number of articles in the Canadian press about patients who are opting for euthanasia because they cannot get the home care they require. Some people request (and are approved for) an assisted death out of loneliness or concerns about finances.
In 2023, Canada will likely be extending medical assistance in dying to the mentally ill. There’s talk, too, of allowing mature minors to request it, and having it performed on infants with serious disabilities. In short, Canada is fast becoming the nation with the most liberal euthanasia laws in the world. Is this a good thing? I tend to think not. If it’s so easy to kill people, why bother developing support services? The Canadian medical system is a mess. It’s no exaggeration to say it’s in crisis. This past summer, a number of emergency departments were shut down on weekends due to staffing issues. There are unacceptable wait times for diagnostic imaging and surgeries. Many family doctors and specialists have found they prefer doing “telemedicine” over actually seeing and examining patients. (Thanks, Covid.) Ending lives could become a cost-effective solution. I’m not being facetious. It’s happening now. Is more of that really where we want to go?
Marmoreo is one tough cookie. Even so, she acknowledges that ending people’s lives involves carrying an emotional burden. It can lead to “moral injury”, a term I first encountered in Francisco Cantú’s The Line Becomes a River, an account of his time as a border patrol officer. I do not deny that euthanasia is sometimes a blessing—in cases where there’s intractable pain and suffering, for example. However—and I’ve mentioned this before—I’ve personally experienced (and been taken aback by) the callousness of veterinarians who routinely euthanize animals. Is that where we want to go? Physicians carrying out this procedure so frequently that they wall off their humanity and become hardened?
While I might intellectually understand why a medical professional feels committed to doing this work, I admit that on an emotional level I don’t fully understand what makes these doctors tick. A practice, such as Stefanie Green’s for example, exclusively dedicated to ending people’s lives concerns me. I worry about the effect on the physicians and on the patients and families they serve.
Marmoreo does some of the usual things you see in medical memoirs. She presents a wide range of case studies. She also talks about assessments, criteria, the approval process, the procedure itself, and the thorny matter of assisted death for patients in cognitive decline. What interested me about her story is the perspective she brings to the subject. Marmoreo has been a family doctor for over 40 years. She’s now 80–still very sharp and physically fit—but aware that her own time on earth is drawing to a close. (It’s unclear to me if she still has a medical practice outside of providing medically assisted death). My point here is that she has spent years caring for her patients. She knows them, their struggles, how they’ve coped with challenges in the past—in short, their stories. The fact that she assesses and ends the lives of people she does not know well greatly concerns her, and it’s taken an emotional toll. She had hoped that over time Canadian family physicians, like Dutch GPs, would incorporate assisted death into practices where longterm relationships with patients have been established. Family doctors in the Netherlands can expect to perform an average of five euthanasias over the course of their careers. The Dutch, acknowledging the emotional burden of ending someone’s life, have ensured that doctors have some opportunity to recover after the procedure. They do not go into their offices and clinics the day following an assisted death. Unfortunately, 85% of assisted deaths in Canada are performed by physicians who are essentially strangers to patients. This is the inverse of what happens in the Netherlands, where only 15% of euthanasias are performed by physicians not known by the patient, and 85% by family doctors.
Before Marmoreo began performing assisted deaths, she created and followed a learning program, shadowing palliative care doctors in both urban and rural settings. This has proved to be invaluable when it comes to assessing patients. She describes cases in which she intervened to find supports and resources for patients in order to give them extra quality time, but she openly acknowledges the frustration and distress she has felt when services—community, home care, mental health, and medical—can’t be drawn on because there are none to be had. This is particularly true in rural areas and in the northern parts of Ontario. There’s been an increasing number of articles in the Canadian press about patients who are opting for euthanasia because they cannot get the home care they require. Some people request (and are approved for) an assisted death out of loneliness or concerns about finances.
In 2023, Canada will likely be extending medical assistance in dying to the mentally ill. There’s talk, too, of allowing mature minors to request it, and having it performed on infants with serious disabilities. In short, Canada is fast becoming the nation with the most liberal euthanasia laws in the world. Is this a good thing? I tend to think not. If it’s so easy to kill people, why bother developing support services? The Canadian medical system is a mess. It’s no exaggeration to say it’s in crisis. This past summer, a number of emergency departments were shut down on weekends due to staffing issues. There are unacceptable wait times for diagnostic imaging and surgeries. Many family doctors and specialists have found they prefer doing “telemedicine” over actually seeing and examining patients. (Thanks, Covid.) Ending lives could become a cost-effective solution. I’m not being facetious. It’s happening now. Is more of that really where we want to go?
Marmoreo is one tough cookie. Even so, she acknowledges that ending people’s lives involves carrying an emotional burden. It can lead to “moral injury”, a term I first encountered in Francisco Cantú’s The Line Becomes a River, an account of his time as a border patrol officer. I do not deny that euthanasia is sometimes a blessing—in cases where there’s intractable pain and suffering, for example. However—and I’ve mentioned this before—I’ve personally experienced (and been taken aback by) the callousness of veterinarians who routinely euthanize animals. Is that where we want to go? Physicians carrying out this procedure so frequently that they wall off their humanity and become hardened?
While I might intellectually understand why a medical professional feels committed to doing this work, I admit that on an emotional level I don’t fully understand what makes these doctors tick. A practice, such as Stefanie Green’s for example, exclusively dedicated to ending people’s lives concerns me. I worry about the effect on the physicians and on the patients and families they serve.
June 19, 2025
This "Last Door: Lessons in Living from the Front Lines of Medical Assistance in Dying" is an exploration into MAiD (Medical Assistance in Dying) being practiced in Canada. It is customary for a physician to sustain patients and life in general; however, in 2016 the Supreme Court in Canada granted permission to MAiD.
“When Joe was sixty-six, he was diagnosed with ALS, known more commonly as Lou Gehrig’s disease. He’s felt numbness in his extremities for a while, and he knew it was something worse than diabetes.”
— Dr. Jean Marmoreo
Dr. Jean Marmoreo then obtained training (along with colleges) for this new field that includes end-of-life (EOL) practices in hospitals, hospices and community facilities in Toronto. EOL services were non-existent to minimal at this time. She shares the stories of her patients and thus immortalizes a myriad of struggles by documenting end of life care and practices. Read.
“When Joe was sixty-six, he was diagnosed with ALS, known more commonly as Lou Gehrig’s disease. He’s felt numbness in his extremities for a while, and he knew it was something worse than diabetes.”
— Dr. Jean Marmoreo
Dr. Jean Marmoreo then obtained training (along with colleges) for this new field that includes end-of-life (EOL) practices in hospitals, hospices and community facilities in Toronto. EOL services were non-existent to minimal at this time. She shares the stories of her patients and thus immortalizes a myriad of struggles by documenting end of life care and practices. Read.
This entire review has been hidden because of spoilers.
November 6, 2022
A thoughtful and thorough analysis of MAiD, its' evolution in practice and in legislation, and stories of people who have requested it. Marmoreo writes with compassion and a clear-headed view of the provision of it. She also writes about burnout on the part of providers, including her own story, and makes a plea that MAiD be part of every family physician's practices. She also identifies where Canadian society is falling down in services to the elderly, the disabled, the mentally ill, and those who are alone. Highly recommended read.
October 17, 2022
*Libro.fm*
“A doctor has to swear to do everything possible to keep a patient alive, but when the patient is suffering and is only a shadow of themselves, isn’t selfish to prolong an unwanted life?”
Wow. This book is essential. It both answers questions to HOW and WHY it’s done. As a Canadian, I think this is an important topic to understand.
I also really really enjoyed the way it was told ; a patient by chapter. The author tells us their story, their personality and then the journey to the final procedure. I was on the verge of tears on many occasions, sometimes because of suffering and loneliness, but mostly because of champagne/music/family parties right before the procedure. This was so inspiring to read, and I’m so happy that my country offers a way of ending a life that is, really, not a life anymore.
With a dad with Alzheimer’s that once told me he would eventually want MAID, I just HAD to read this book. I always agreed with his decision, but reading this just made me feel at peace. The chapter about Dementia and chronic muscle illness respectively reminded me of my dad and my grandfather and those were so hard to get through emotionally, but also freeing in a way. I felt both understood and heard. This was almost narrated as a memoir/short stories so don’t be afraid of it if you don’t usually like non-fiction!!!
8.5/10
“A doctor has to swear to do everything possible to keep a patient alive, but when the patient is suffering and is only a shadow of themselves, isn’t selfish to prolong an unwanted life?”
Wow. This book is essential. It both answers questions to HOW and WHY it’s done. As a Canadian, I think this is an important topic to understand.
I also really really enjoyed the way it was told ; a patient by chapter. The author tells us their story, their personality and then the journey to the final procedure. I was on the verge of tears on many occasions, sometimes because of suffering and loneliness, but mostly because of champagne/music/family parties right before the procedure. This was so inspiring to read, and I’m so happy that my country offers a way of ending a life that is, really, not a life anymore.
With a dad with Alzheimer’s that once told me he would eventually want MAID, I just HAD to read this book. I always agreed with his decision, but reading this just made me feel at peace. The chapter about Dementia and chronic muscle illness respectively reminded me of my dad and my grandfather and those were so hard to get through emotionally, but also freeing in a way. I felt both understood and heard. This was almost narrated as a memoir/short stories so don’t be afraid of it if you don’t usually like non-fiction!!!
8.5/10
October 4, 2022
I received a copy of this book in exchange for an honest review.
An excellent look at Canada and its acceptance of MAiD, medical assistance in dying, from an experienced doctor in the field. Sensitively written and of utmost importance, I recommend this book for anyone wanting to explore this concept and gain full understanding.
An excellent look at Canada and its acceptance of MAiD, medical assistance in dying, from an experienced doctor in the field. Sensitively written and of utmost importance, I recommend this book for anyone wanting to explore this concept and gain full understanding.
October 20, 2022
Pay attention, Canada Reads - this is a timely, relevant, culturally important Canadian book - it is a well-written, well-researched work that is infused with boundless compassion, love and respect for its subjects.
Yes, a book on Medical Assistance in Dying (MAiD) may not be the first thing that comes to mind when regarding literary bestsellers, but you can bet that the majority of Canadians have thoughts on MAiD, both informed and uninformed - there is no better book than Jean Marmoreo’s The Last Doctor that is able to dispel myths, provide correct information, and promote important discussion regarding end of life care -
Highly recommended
Yes, a book on Medical Assistance in Dying (MAiD) may not be the first thing that comes to mind when regarding literary bestsellers, but you can bet that the majority of Canadians have thoughts on MAiD, both informed and uninformed - there is no better book than Jean Marmoreo’s The Last Doctor that is able to dispel myths, provide correct information, and promote important discussion regarding end of life care -
Highly recommended
November 20, 2022
Wow, Dr. Jean Marmereo is an admirable women. I am grateful to have had a taste of her expertise throughout this read. I‘m now inspired to apply her backpack trick, where you collect significant items, poems or ressources that help keep you stay grounded and healthy as a professional in a mentally demanding field. I would recommend this to someone who knows nothing about MAiD as much as to someone who is passionate about it. There is still so much to reflect on regarding MAiD, thus the importance of informing ourselves.
« Now when I ask a patient who is requesting MAiD : “Is there anyway that something could happen that would change your mind?” I ask it knowing the limits imposed by aging, social isolation, poverty, racialization, lack of education, uneven healthcare ressources. I ask it so that together my patient and I can make our last best jugement. Not the right decision, or the only one, but our best. »
« Now when I ask a patient who is requesting MAiD : “Is there anyway that something could happen that would change your mind?” I ask it knowing the limits imposed by aging, social isolation, poverty, racialization, lack of education, uneven healthcare ressources. I ask it so that together my patient and I can make our last best jugement. Not the right decision, or the only one, but our best. »
November 4, 2023
I think the final chapters were the most interesting to me. I liked seeing her grow as a as person and as a MAID provider. Interesting cases presented and I enjoyed the mental exercise of thinking through what I think I would’ve done in those cases. I realize you never really know what you’ll do until you’re in the situation yourself. Ethically it’s so interesting how our personal biases and experiences can impact interpretation of the laws - which are quite vague and open to interpretation from a practical point of view and appreciate that more and more guidelines and standards of practice are being implemented as time goes on and we collectively gain experience in the field.
October 13, 2022
Excellent insight into this new legislation in Canada that will have a huge impact on us all. Maybe now we can start talking about our own deaths, and planning ahead for a dignified exit on our own terms. This was an important read for me, and I recommend it to all who are reading my review.
July 31, 2025
When I first began “The Last Doctor” by Dr. Jean Marmoreo, I wasn’t sure how to feel. Her voice struck me as a bit brash, someone who knew all the answers and wasn’t shy about asserting them. But as I kept reading, that façade peeled away, revealing someone deeply reflective, unafraid to explore her own doubts, missteps, and emotional limits. That vulnerability is what makes this book remarkable.
What truly elevates “The Last Doctor” is the way Dr. Marmoreo brings the humanity and suffering of each patient to the forefront. These aren’t just clinical case studies or cautionary tales — they’re intimate portraits of people navigating the end of life with courage, fear, and grace. She doesn’t sanitize their pain or simplify their choices. Instead, she sits with them, listens, and invites us to do the same.
The strength of this book lies not only in its insight into medicine, but in its willingness to linger in discomfort: the gray zones of ethics, the unanswerable questions, the ache of watching someone choose when and how to die. Dr. Marmoreo balances clinical precision with emotional honesty, showing that even the most seasoned doctor can be humbled by a patient’s story. That is so rare in a doctor these days.
As someone entering medicine, this book made me reflect deeply on what lies ahead. This book doesn’t just document Medical Assistance in Dying (MAiD); it illuminates its emotional, ethical, and spiritual complexity. It challenges the traditional definition of care, not as prolonging life at all costs, but as walking with someone toward a death that is unequivocally their own. It opened my eyes to a more compassionate, patient-centered future in medicine, one where presence, dignity, and choice are just as vital as any treatment.
By the end, what stayed with me wasn’t just the medical journey, but the people: the mother, the artist, the husband, the rebel. Through them, and through Dr. Marmoreo’s own evolving voice, “The Last Doctor” becomes less about endings and more about presence, courage, and the radical act of seeing one another fully.
What truly elevates “The Last Doctor” is the way Dr. Marmoreo brings the humanity and suffering of each patient to the forefront. These aren’t just clinical case studies or cautionary tales — they’re intimate portraits of people navigating the end of life with courage, fear, and grace. She doesn’t sanitize their pain or simplify their choices. Instead, she sits with them, listens, and invites us to do the same.
The strength of this book lies not only in its insight into medicine, but in its willingness to linger in discomfort: the gray zones of ethics, the unanswerable questions, the ache of watching someone choose when and how to die. Dr. Marmoreo balances clinical precision with emotional honesty, showing that even the most seasoned doctor can be humbled by a patient’s story. That is so rare in a doctor these days.
As someone entering medicine, this book made me reflect deeply on what lies ahead. This book doesn’t just document Medical Assistance in Dying (MAiD); it illuminates its emotional, ethical, and spiritual complexity. It challenges the traditional definition of care, not as prolonging life at all costs, but as walking with someone toward a death that is unequivocally their own. It opened my eyes to a more compassionate, patient-centered future in medicine, one where presence, dignity, and choice are just as vital as any treatment.
By the end, what stayed with me wasn’t just the medical journey, but the people: the mother, the artist, the husband, the rebel. Through them, and through Dr. Marmoreo’s own evolving voice, “The Last Doctor” becomes less about endings and more about presence, courage, and the radical act of seeing one another fully.
December 17, 2022
I read this intense book slowly because there was so much to think about.
Another GR reviewer (CR) has done an outstanding summary of the concerns, issues, and processes of MAiD. ( The acronym reminds me of Emily Dickenson’s line about “the awful sweeping-up after death.”)
As I add a few thoughts, the Canadian government has announced a delay to implementing the expansion of assisted dying to people suffering from irremediable mental illness. The parliamentary committee studying this struggled with even defining mental illness and irremediable. There are also concerns from the psychiatry profession. So I was relieved that the March 2023 implementation is delayed. I do support MAiD in general as do most Canadians. I agree with the doctor that it should not become a specialty in itself but the challenge is to bring more family doctors on board and to ensure doctors doing euthanasia are cared for. Curative and palliative medicine have their limits. Medical staff involved with MAiD have witnessed a lot of pointless suffering in their work with patients. They are motivated by a sincere desire to put an end to the suffering when the patient clearly asks for help and there is no reasonable hope of it ending without this final merciful intervention.
Another GR reviewer (CR) has done an outstanding summary of the concerns, issues, and processes of MAiD. ( The acronym reminds me of Emily Dickenson’s line about “the awful sweeping-up after death.”)
As I add a few thoughts, the Canadian government has announced a delay to implementing the expansion of assisted dying to people suffering from irremediable mental illness. The parliamentary committee studying this struggled with even defining mental illness and irremediable. There are also concerns from the psychiatry profession. So I was relieved that the March 2023 implementation is delayed. I do support MAiD in general as do most Canadians. I agree with the doctor that it should not become a specialty in itself but the challenge is to bring more family doctors on board and to ensure doctors doing euthanasia are cared for. Curative and palliative medicine have their limits. Medical staff involved with MAiD have witnessed a lot of pointless suffering in their work with patients. They are motivated by a sincere desire to put an end to the suffering when the patient clearly asks for help and there is no reasonable hope of it ending without this final merciful intervention.
November 23, 2022
Wow! Wow! Wow! Another fascinating exploration into the world of Medical Assistance in Dying (MAiD).
I don’t think that I am ‘overly affected or impacted’ because I work for a hospice (where we provide education about, and facilitate, MAiD) but I suppose it is a possibility.
As with This is Assisted Dying by Dr. Stefanie Green… this is very well written… following her on her incredible journey as she breaks new ground developing the playbook for medical assistance in dying.
This will definitely bring you to tears.
I hope that anyone who is not already convinced of the need for MAiD reads this and takes it to heart, giving long hard thought to allowing their dying loved one one final act of control and dignity.
I don’t think that I am ‘overly affected or impacted’ because I work for a hospice (where we provide education about, and facilitate, MAiD) but I suppose it is a possibility.
As with This is Assisted Dying by Dr. Stefanie Green… this is very well written… following her on her incredible journey as she breaks new ground developing the playbook for medical assistance in dying.
This will definitely bring you to tears.
I hope that anyone who is not already convinced of the need for MAiD reads this and takes it to heart, giving long hard thought to allowing their dying loved one one final act of control and dignity.
October 9, 2023
« An end to intolerable suffering. A dignified, peaceful exit, honouring the patient, their values, and the meaning of their lives ».
I remember meeting the doctor that would be providing MAiD to my father. I could not look him in the eyes; I was trying really hard not to cry, and him explaining to me what would be happening in a few days scared me way too much. It’s one thing to be told your father will die soon, it’s another to know the exact date and time.
But, MAiD is never about the family, it’s about the patient. And for that, I am grateful that the Supreme Court of Canada ruled Carter v. Canada and grateful for doctors like Dr. Marmoreo.
This book is about development, health, dignity in death and much more. Really touching to read stories of memorable patients of Dr. Marmoreo, and eye-opening to read about MAiD from her perspective.
I remember meeting the doctor that would be providing MAiD to my father. I could not look him in the eyes; I was trying really hard not to cry, and him explaining to me what would be happening in a few days scared me way too much. It’s one thing to be told your father will die soon, it’s another to know the exact date and time.
But, MAiD is never about the family, it’s about the patient. And for that, I am grateful that the Supreme Court of Canada ruled Carter v. Canada and grateful for doctors like Dr. Marmoreo.
This book is about development, health, dignity in death and much more. Really touching to read stories of memorable patients of Dr. Marmoreo, and eye-opening to read about MAiD from her perspective.
January 23, 2024
3.5. A great read to highlight how necessary MAiD is in healthcare, the complexities surrounding circumstances that lead people to choose MAiD, but also how we can and should step up in so many other areas so people aren't resorting to MAiD to end their pain / suffering prematurely, to ease financial burdens, or to cure loneliness.
July 14, 2025
Thoughtful analysis on MAiD in Canada. Started the book in full support but left feeling more unsure. Feels like healthcare systems need to offer more thorough care, specially access to palliative care and solutions for social isolation, before this becomes widely available. Appreciated her case studies and commentary on changes to legislation.
November 17, 2025
very good and still relevant in current policy context
February 2, 2023
General Review
Canadians in all areas of life, not just medicine and related healthcare areas, should consider reading this book and/or learning about MAiD. Wouldn't you want to know more about what governs your choices — yours, your family, and your friends?
The individuals mentioned in this book are illustrated beautifully. Sensitivity and honour were given to their decisions and their thoughts. With books like these, I feel that we should focus on the message, not the vehicle sometimes. But I want to emphasize that this was excellently written.
The vulnerability and thoughtfulness of Dr. Jean Marmoreo is admirable and will be appreciated for lifetimes.
My perspective and lingering thoughts
• Important book to read. I feel as though MAiD gives everyone involved the chance to tap into the most intimate parts of an individual's life — their soul. sure, you can be emotionally detached from this work. I understand that being detached is necessary and expected. but that runs the risk of losing out on enhancing the quality of life and dignity of the patient, too, no? having graciousness to listen for what suffering means to them, as well as what their essential needs are, is in an intimate act.
• I'm still very new to this and this book is truly just a snapshot of the depth and nuances involved with MAiD, palliative care, and the quality of life. However, this book tackles so much. It does not overwhelm you with content, but rather with questions to consider and values to establish. To be overwhelmed with such values and morals is why we may want to shy away from the topic of MAiD. But as Canadians and with the evaluation of our laws, this is important to know, even if you do not "involve" yourself in medicine per se. Since we all have life and death in common, MAiD is something we should all be familiar with and shape a stance towards.
• My own perspective after reading this book: An important read for Canadians. You should know how laws govern your health. You never know how MAiD might meet a family member, a neighbour, or a friend. Where Western culture prevails, it is one warped in individualism, hustle, and consequently, isolation. So where this culture is dominant, this isolation reaches everyone, irrespective of proximity to wealth and resources. We say that we should do more, and provide more preventative measures — and yes, we should. But as seen by the impact on elderly Canadians in these recent years of the COVID-19 pandemic, our healthcare systems fail to bring the needed measures to everyone, even in our major cities with the talent and resources. So naturally, doesn't MAiD become an option? As Canadian laws become less restrictive around MAiD, I hope that we approach it with consideration and respect. May we remember to value the quality of life. May we also respect how one's faith and religious beliefs may come into play. As a Christian myself, my faith is fundamental to who I am and what I believe is a dignified life for myself. Oh, how human life is nuanced. I remember this more when I think about death.
Canadians in all areas of life, not just medicine and related healthcare areas, should consider reading this book and/or learning about MAiD. Wouldn't you want to know more about what governs your choices — yours, your family, and your friends?
The individuals mentioned in this book are illustrated beautifully. Sensitivity and honour were given to their decisions and their thoughts. With books like these, I feel that we should focus on the message, not the vehicle sometimes. But I want to emphasize that this was excellently written.
The vulnerability and thoughtfulness of Dr. Jean Marmoreo is admirable and will be appreciated for lifetimes.
My perspective and lingering thoughts
• Important book to read. I feel as though MAiD gives everyone involved the chance to tap into the most intimate parts of an individual's life — their soul. sure, you can be emotionally detached from this work. I understand that being detached is necessary and expected. but that runs the risk of losing out on enhancing the quality of life and dignity of the patient, too, no? having graciousness to listen for what suffering means to them, as well as what their essential needs are, is in an intimate act.
• I'm still very new to this and this book is truly just a snapshot of the depth and nuances involved with MAiD, palliative care, and the quality of life. However, this book tackles so much. It does not overwhelm you with content, but rather with questions to consider and values to establish. To be overwhelmed with such values and morals is why we may want to shy away from the topic of MAiD. But as Canadians and with the evaluation of our laws, this is important to know, even if you do not "involve" yourself in medicine per se. Since we all have life and death in common, MAiD is something we should all be familiar with and shape a stance towards.
• My own perspective after reading this book: An important read for Canadians. You should know how laws govern your health. You never know how MAiD might meet a family member, a neighbour, or a friend. Where Western culture prevails, it is one warped in individualism, hustle, and consequently, isolation. So where this culture is dominant, this isolation reaches everyone, irrespective of proximity to wealth and resources. We say that we should do more, and provide more preventative measures — and yes, we should. But as seen by the impact on elderly Canadians in these recent years of the COVID-19 pandemic, our healthcare systems fail to bring the needed measures to everyone, even in our major cities with the talent and resources. So naturally, doesn't MAiD become an option? As Canadian laws become less restrictive around MAiD, I hope that we approach it with consideration and respect. May we remember to value the quality of life. May we also respect how one's faith and religious beliefs may come into play. As a Christian myself, my faith is fundamental to who I am and what I believe is a dignified life for myself. Oh, how human life is nuanced. I remember this more when I think about death.
December 31, 2025
I read this because MAID practicioners have a large amount of discretionary power and I was curious about what doctors have to say about how they make these determinations. Marmoreo seems focused on patient autonomy and some of the cases she approves do seem borderline. She comes across as someone who cares about the dignity of her patients, but I wonder how she would improve MAID based on what she's seen. That's actually the q I have. This book is re: her experiences as a MAID practicioner prior to Track 2 MAID (non-terminal, serious/degenerative) so it's not going to answer questions re: what expansions in access are necessary from here on out, which is what I'm actually interested in.
I fail to understand why a cancer patient in their 30s with a 65% chance of a total cure is granted MAID (a case discussed in The Atlantic, not in this book) because they refuse treatment and have stated they would refuse even if the cure was 100%, and cancer is terminal if unreated, and I'm the same age bracket, have a degenerative disease with no cure, only management, and I am expected to adapt to progressive disability until it reaches a threshold others think would make my life have no value, which is far below a standard that I believe would allow me dignity. If you believe MAID is about enshrining patient autonomy into law, the differences between how Track 1 MAID (terminal illness) and Track 2 MAID (non-terminal illness) are treated do not make sense. Why are Track 1 candidates allowed to simply opt despite good treatment options, and Track 2 candidates need to be in an "advanced state of irreversible decline", meaning granting access is delayed till a third party thinks your life is truly not worth living. Disability advocates tend to focus on coercion when writing about Track 2 MAID - I think instead they should wonder, why are disabled people not trusted to decide when they've had enough? Why aren't they allowed to make determinations about their life based on future considerations when already down an irreversible path of decline? I think the issue is that whatever the SCC intended about patient rights and equality, MAID as written is not concerned with those issues, but how to determine when life is disposable. Track 1 MAID (terminal): you would die without our assistance, so we can help you because it doesn't go against us valuing life - you are only provisionally alive as it is; Track 2 MAID: we can help you once we determine you're worthless alive, but not before. Those are the issues I want to see people write about. This book however, is OK as a historical document re: early MAID days but not what I was looking for.
I fail to understand why a cancer patient in their 30s with a 65% chance of a total cure is granted MAID (a case discussed in The Atlantic, not in this book) because they refuse treatment and have stated they would refuse even if the cure was 100%, and cancer is terminal if unreated, and I'm the same age bracket, have a degenerative disease with no cure, only management, and I am expected to adapt to progressive disability until it reaches a threshold others think would make my life have no value, which is far below a standard that I believe would allow me dignity. If you believe MAID is about enshrining patient autonomy into law, the differences between how Track 1 MAID (terminal illness) and Track 2 MAID (non-terminal illness) are treated do not make sense. Why are Track 1 candidates allowed to simply opt despite good treatment options, and Track 2 candidates need to be in an "advanced state of irreversible decline", meaning granting access is delayed till a third party thinks your life is truly not worth living. Disability advocates tend to focus on coercion when writing about Track 2 MAID - I think instead they should wonder, why are disabled people not trusted to decide when they've had enough? Why aren't they allowed to make determinations about their life based on future considerations when already down an irreversible path of decline? I think the issue is that whatever the SCC intended about patient rights and equality, MAID as written is not concerned with those issues, but how to determine when life is disposable. Track 1 MAID (terminal): you would die without our assistance, so we can help you because it doesn't go against us valuing life - you are only provisionally alive as it is; Track 2 MAID: we can help you once we determine you're worthless alive, but not before. Those are the issues I want to see people write about. This book however, is OK as a historical document re: early MAID days but not what I was looking for.
January 21, 2023
to be honest this book didn’t sit well with me. I kept feeling that many of the medically-assisted-deaths the author “provided for" were mainly people in distress calling out for help. If they had access to better care, more resources, pain management, psychological help and even spiritual guidance, many still had years of good life left, albeit compromised. For example, one of the male deaths had chronicle pain from a neurodegenerative disease, but he still was fit and healthy. He oscillated between getting better pain management (which had a long waitlist) and requesting MAiD, and when he was eventually denied a fast admission to specialty pain management he opted for death. Then there was the case of cognitive decline — it’s an oxymoron. Patients have to give consent while they are still cognitively able to, which meant they were still healthy and sound-of-mind, prematurely opting for death. Once they are in cognitive limbo they can no longer give consent — so many people pre-empt it by getting the procedure while they still could. (Although, this requirement was later relaxed, so consent is NO LONGER required at moment of death. But then doctors would administer the drugs to a vegetative state patient who may have changed their mind.) I was also confused and frustrated by the newly introduced "Track Two” — effectively patients who do not have a “reasonable and foreseeable death” but simply have lost the will to live. The example of the woman who requested MaiD both because of her blood pressure and her expiring lease / uncertain finances deeply troubled me. If she had better long term care arrangement, would she have chosen to die on August 31st to avoid a Sept 1 new lease?
I know this is bioethical murky water, and the doctors no doubt carry the burden. But it didn’t feel right to me that “medical assistance” was arbitered by a set of ever changing human rules that were so flexible in interpretation. I have two more books on this topic to go through — “This is Assisted Death” and “In Love”, after which I will have a more thorough view. But this book felt like compassion without reasoning, and it’s difficult to stomach at times.
I know this is bioethical murky water, and the doctors no doubt carry the burden. But it didn’t feel right to me that “medical assistance” was arbitered by a set of ever changing human rules that were so flexible in interpretation. I have two more books on this topic to go through — “This is Assisted Death” and “In Love”, after which I will have a more thorough view. But this book felt like compassion without reasoning, and it’s difficult to stomach at times.
January 11, 2026
An excellent book outlining the history of MAiD from the start in Canada. Dr. Jean Marmoreo was one of the first doctors to embrace the concept of being able to die with dignity and be a provider of MAiD. Using case histories she was able to present the reasons why someone who was suffering (and had been suffering for years) would want to choose MAiD. She was also able to dig down to determine if there were other factors at play where their suffering could be alleviated with the implementation of other resources and did what she could before providing a MAiD death. Written in 2022 there have been changes even since then particularly with MI-SUMC - Medical Assistance in Dying for Mental Illness as a Sole Underlying Medical Condition which was originally legislated to take effect in 2023 and has now been extended to 2027. Also AR - Advanced Requests for MAiD, a complex topic concerning those with conditions like dementia who might lose capacity before they can request it, requiring specific legal frameworks and safeguards. These advance requests allow a person to consent to MAiD in the future, potentially through a waiver of final consent, if they become unable to consent when their natural death is not reasonably foreseeable.
A great overview for all - whether you are a proponent of MAiD or have doubts about it to realize how complex the issue is and that there are many health professionals out there who are being thoughtful and compassionate on the subject. Thanks to the Province of Quebec in leading the way with initial legislation. Thanks to all of the Providers of MAiD - it's not an easy task and yet for all those people I know who have had a loved one undertake MAiD they have said what a wonderful and kind experience it was.
A great overview for all - whether you are a proponent of MAiD or have doubts about it to realize how complex the issue is and that there are many health professionals out there who are being thoughtful and compassionate on the subject. Thanks to the Province of Quebec in leading the way with initial legislation. Thanks to all of the Providers of MAiD - it's not an easy task and yet for all those people I know who have had a loved one undertake MAiD they have said what a wonderful and kind experience it was.
August 8, 2023
A thoughtful, well written memoir of one of the first doctors to embrace MAiD in Canada. We are lucky to have such a dedicated, compassionate, thoughtful practitioner who spent 2 years voluntarily training herself to prepare for MAiD when it became legal. She outlines her journey from idealism, to concerns where multiple systems are lacking (isolated seniors and inconsistent access to palliative care). I especially valued chapter 12 'Lessons Learned'. One overriding lesson is that it isn't always about the END of life, but about celebrating and honouring a life lived. And also, how having the option, often allows patients to live out their natural lives with peace, sometimes in palliative care or at home, knowing they don't have to end up in a scenario where they did not have the choice.
One thing that surprised me, and indeed surprised her, is that most Canadian physicians have not embraced training for this, instead allowing 'specialists' to take it on. In other countries (the Netherlands for example), family doctor's perform it, and might do 4 or 5 in their career. No one could imagine the burden of our involuntary 'specialists' juggling 4 or 5 cases at a time, as well as their family practices! And indeed, Dr. Marmoreo is now in her 80's and highlights the need for more doctors to take it on, as well as better palliative care support in Canada.
No matter where you stand on the issue of MAiD, this is an important read, to learn about how MAiD helps those who desperately crave autonomy and dignity over their pain and suffering.
One thing that surprised me, and indeed surprised her, is that most Canadian physicians have not embraced training for this, instead allowing 'specialists' to take it on. In other countries (the Netherlands for example), family doctor's perform it, and might do 4 or 5 in their career. No one could imagine the burden of our involuntary 'specialists' juggling 4 or 5 cases at a time, as well as their family practices! And indeed, Dr. Marmoreo is now in her 80's and highlights the need for more doctors to take it on, as well as better palliative care support in Canada.
No matter where you stand on the issue of MAiD, this is an important read, to learn about how MAiD helps those who desperately crave autonomy and dignity over their pain and suffering.
March 23, 2023
This is another emotional read, as was "This is Assisted Dying". Dr. Marmoreo is older than Dr. Green, and chronicles her experiences offering MAiD services in Ontario. Dr. Marmoreo prepared to offer MAiD services by immersing herself in palliative care settingsv for a year and a half. She believes both palliative care and MAiD have important roles in end of life care, offering "patients the best of care with the broadest of options".
Patient stories are the best part of the book, however the statistics are interesting too. Across countries offering link between MAiD on a similar assisted dying option, between 2 and 4% of the general population will ask for it; most patients fighting for life to the end. The link between suicide attempts and MAiD, with over 60% of her MAiD patients in the first 5 years having tried suicide before MAiD was legal, was both shocking and somehow not surprising. The hope of accessing MAid, for some, is a better option than worrying about botching a suicide attempt.
Dr. Maroreo's Lessons Learned:
1. People want the option of assisted death, with easier access;
2. We can do a lot better in the care of our elders and our ill;
3. Just because we can do MAiD doesn't mean we should; sometimes the choices are difficult or borderline;
4. MAiD can be beautiful.
5. MAiD and palliative care should not be opposites, but should take a team approach to their work.
Patient stories are the best part of the book, however the statistics are interesting too. Across countries offering link between MAiD on a similar assisted dying option, between 2 and 4% of the general population will ask for it; most patients fighting for life to the end. The link between suicide attempts and MAiD, with over 60% of her MAiD patients in the first 5 years having tried suicide before MAiD was legal, was both shocking and somehow not surprising. The hope of accessing MAid, for some, is a better option than worrying about botching a suicide attempt.
Dr. Maroreo's Lessons Learned:
1. People want the option of assisted death, with easier access;
2. We can do a lot better in the care of our elders and our ill;
3. Just because we can do MAiD doesn't mean we should; sometimes the choices are difficult or borderline;
4. MAiD can be beautiful.
5. MAiD and palliative care should not be opposites, but should take a team approach to their work.
October 14, 2022
I’m from the US so I actually didn’t know much about the law/legal parts of MAiD, which was my main interest in this book, I’d seen a recent video by We’re In Hell (youtube) interviewing Dr. Jean Marmoreo and really liked what she had to say. Anyway, I just lost my grandma exactly a month ago, who had advanced dementia and who I was a caretaker for, so I wanted perspectives from other people in end-of-life work.
This book goes into the legal and technical of MAiD in a way that isn’t too hard to understand, there seems to be considerable effort to make this easy to read/see all “sides” but you may need to take breaks every chapter or two because the stories/subject here can be pretty intense. Definitely check it out, but maybe do so outside in the breeze somewhere comfortable and give yourself time if needed.
Tough stuff aside though, I’ve left this book feeling really positive about my own involvement in end-of-life care and hopeful for the future of MAiD and other similar dignity/choice-forward programs becoming accessible to everyone as a basic human right.
This book goes into the legal and technical of MAiD in a way that isn’t too hard to understand, there seems to be considerable effort to make this easy to read/see all “sides” but you may need to take breaks every chapter or two because the stories/subject here can be pretty intense. Definitely check it out, but maybe do so outside in the breeze somewhere comfortable and give yourself time if needed.
Tough stuff aside though, I’ve left this book feeling really positive about my own involvement in end-of-life care and hopeful for the future of MAiD and other similar dignity/choice-forward programs becoming accessible to everyone as a basic human right.
March 1, 2025
I disagree with MAiD as a practice, but this book does give an honest and generally unbiased explanation of why Canada and many others are so excited for it. It proves the worth of the procedure, while also showing the mental toll it has on practitioners and family.
I started reading this book with slightly negative feelings about MAiD, I finished this book with slightly negative feelings about MAiD but more conflicted feelings. The stories told in this book are tragic, many people greatly benefited from MAiD, and, as I will probably develop dementia as I age. I too, will want MAiD.
I think that is the point of the book, you develop a slight disgust for MAiD, but, you all realize the humanity that MAiD has.
Furthermore, Marmoreo does an excellent job showing how bad MAiD can be to everyone involved in the process. She does not sugarcoat the procedure, I think it greatly helps everyone develop a deeper understanding of the process.
I started reading this book with slightly negative feelings about MAiD, I finished this book with slightly negative feelings about MAiD but more conflicted feelings. The stories told in this book are tragic, many people greatly benefited from MAiD, and, as I will probably develop dementia as I age. I too, will want MAiD.
I think that is the point of the book, you develop a slight disgust for MAiD, but, you all realize the humanity that MAiD has.
Furthermore, Marmoreo does an excellent job showing how bad MAiD can be to everyone involved in the process. She does not sugarcoat the procedure, I think it greatly helps everyone develop a deeper understanding of the process.
April 24, 2025
This was harrowing to read as well as a bit unsettling. Jean clearly loves her patients and is concerned for their quality of life- personally, talking about 'provisions' so fickly seemed to veil the actual thing she's doing: ethical, legally sanctioned murder.
But this book also made me question my own judgements and presuppositions about MAID. By virtue of being progressive, I'm pro-choice. So I should be pro-MAID. And for track 1 (reasonable that they will die), I am in favor.
But I struggle with MAID for mental illness. On one hand, I think you shouldn't have to suffer through a cruel existence. I also want to be a good leftist and advocate for good institutional or systemic changes. So many people with mental illness considering MAID wouldn't choose it if systems didn't fail them. But that doesn't change the current trajectory for their lives. So it's... complicated.
But this book also made me question my own judgements and presuppositions about MAID. By virtue of being progressive, I'm pro-choice. So I should be pro-MAID. And for track 1 (reasonable that they will die), I am in favor.
But I struggle with MAID for mental illness. On one hand, I think you shouldn't have to suffer through a cruel existence. I also want to be a good leftist and advocate for good institutional or systemic changes. So many people with mental illness considering MAID wouldn't choose it if systems didn't fail them. But that doesn't change the current trajectory for their lives. So it's... complicated.
May 22, 2023
A very honest and reflexive narrative about the experiences of a health care practitioner (doctor) in the early stages of MAiD (medical assistance in dying) in Toronto. In each chapter, Jean writes about the stories of particular patients, lessons she has learned, reflections she had made and ethical considerations that she needed to make through her work. She also analyzes her own ontological and epistemology in her practices, with questions pertaining to "Is this for me? Or is it for the good of the patient?" A particularly stunning and moving story is that of Tom, who perhaps was suffering more from loneliness than his disease. This book highlights the complex interplays of the human condition and is recommended to be read by any individual who works with vulnerable groups.
June 2, 2023
A book with a lot of heart, as the author details the end of life of many of her patients in a compassionate and caring way. I unfortunately don’t think the medical system turns out many doctors like this. Kudos to Dr. Marmoreo.
There is a lot of eye opening information here that many healthy individuals outside healthcare probably don’t know. It’s worth knowing.
I read this book slowly, imagining my end of life, and hoping for someone who will take into account my needs in a way that the current system (medical or social services) can no longer provide.
I hope for better for so many of us.
There is a lot of eye opening information here that many healthy individuals outside healthcare probably don’t know. It’s worth knowing.
I read this book slowly, imagining my end of life, and hoping for someone who will take into account my needs in a way that the current system (medical or social services) can no longer provide.
I hope for better for so many of us.
August 31, 2025
Listened to the audiobook! Beautifully written experiences and stories of people at the end of their life. Particularly interesting read for anyone who works in Healthcare- especially cool that it’s Canadian and a lot of the stories take place in familiar places in the GTA! Really highlights the importance of patient-entered care and how our health system cannot meet the needs of our population- especially with regard to community services… a little repetitive at times that’s why I gave it the 3 stars and I think only people who either work in healthcare or have some sort of experience with this topic would enjoy it. But I’m glad I read it!!
October 30, 2024
Personal stories from a Canadian doctor on the front lines of providing MAID (Medical Assistance in dying). In the past year, while actively volunteering at a long term care home and working with residents who are dying, I’ve known several people who have gone through MAID with their loved ones. This account from a healthcare practitioner serves to demystify the process, even while the laws around it are constantly changing, and to provide numerous case studies in the doctor’s journey providing this type of service.
February 2, 2023
a very important book
This book gives the reader a good understanding of Medical Assistance in Dying from the point of view of an experienced practitioner, who has spent years helping dying people choose their own time of death.
It gives the point of view of a number of patients in very different situations and makes the reader understand that each patient has to be evaluated thoroughly with compassion.
It is a book that all Canadians should read
This book gives the reader a good understanding of Medical Assistance in Dying from the point of view of an experienced practitioner, who has spent years helping dying people choose their own time of death.
It gives the point of view of a number of patients in very different situations and makes the reader understand that each patient has to be evaluated thoroughly with compassion.
It is a book that all Canadians should read
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