Kalothanasia and Death with Dignity: Assisted Dying as a Relational and Moral Practice. A Qualitative Evidence Synthesis of Patients’, Families’, and Healthcare Professionals’ Experiences

Assisted dying (AD), including physician-assisted suicide (PAS) and medical aid in dying (MAiD), is an increasingly prominent and contested end-of-life practice. This review examined whether and how AD is understood as kalothanasia, a “good death” aligned with dignity, autonomy, relational closure, and meaning-making. Guided by PRISMA and ENTREQ, we searched PubMed, Scopus, Web of Science, CINAHL, and PsycINFO. Sixteen studies (2018–2025) met inclusion criteria, predominantly from Canada (n=9; 56.3%), with additional studies from Australia and the USA (n=2 each) and single studies from the Netherlands, Switzerland, and New Zealand. Interviews were the sole data collection method, conducted in-person, virtually/telephone, or via mixed modes; thematic analytic approaches predominated. Six interrelated themes were identified: (1) autonomy and control over dying; (2) dignity and relief of suffering; (3) choreographing a “good death” through planning and presence; (4) ambivalence and moral conflict; (5) assisted suicide as care versus intentional ending of life; and (6) closure, bereavement, and continuing complexity. Overall, assisted suicide was experienced as a moral and relational process rather than a purely medical act, and the attainability of a “good death” was contingent on interpersonal dynamics and organizational context. Findings support integrating death education and structured ethical support to foster realistic expectations, reduce moral distress, and inform clinical practice, service design, and policy.