Lessons from MAID

Posted 2026-04-08

Eight years on, I still miss my brother almost every day. I haven’t read much about medical assistance in dying (MAID) since he took advantage of it, but I still think there are lessons there for ending projects. As with the first post in this series, though, I worry about how much of this people will actually do before it’s needed, particularly when they’re already under stress.

Advance Directives

An advance directive (sometimes called a living will) is a document someone writes while they are still healthy and competent, specifying what care they do and don’t want if they become unable to speak for themselves. The direct parallel for a software or research project is something prepared during normal operations that specifies the conditions under which the project should be wound down, who has the authority to make that call, what assets must be preserved and how, and what obligations must be honoured. Towey2026 extends this idea beyond purely medical instructions to cover personal, emotional, and relational matters, which maps well onto the non-technical dimensions of project closure. The most important thing is to recognize that this document needs to be written before it is needed: once a project is under stress, cognitive load and interpersonal conflict make clear-headed decision-making much harder, and governance discussions that should have happened earlier are forced into the worst possible moment.

Total Pain and the Hidden Costs of Closure

Dame Cicely Saunders, who founded the modern hospice movement, introduced the concept of total pain in the 1960s to describe how a dying patient’s suffering is never purely physical: it has physical, psychological, social, and spiritual dimensions that interact and amplify one another Saunders1963. Project closure similarly involves more than logistics: team members experience professional identity loss, grief over unfinished work, anxiety about career prospects, and sometimes guilt or anger that can fracture long-standing relationships. Treating project closure as a purely administrative exercise leaves people worse off and makes it harder for the broader community to learn from the experience.

Goals-of-Care Conversations

Gawande2014 argues that clinicians systematically fail patients by focusing on what medicine can do rather than asking what the patient actually wants. He advocates a structured approach to hard conversations: establish a shared understanding of the current situation, make the other person’s values and priorities explicit, and then negotiate a plan that fits those goals rather than being driven solely by what is technically possible. Similarly, when a project is ending, its leaders must talk with funders, institutional sponsors, and the team about what matters most: not just what data can be preserved, but what is the least bad outcome for each stakeholder, and what trade-offs each party is willing to make.

Dignity Therapy and Legacy Documents

Chochinov2005 and Chochinov2012 advocate dignity therapy as a brief, structured intervention for people near the end of life. The central technique is a guided life-review interview in which the person reflects on what has mattered most, what they are proud of, and what they most want future generations to know and remember. The session is recorded, transcribed, and edited into a permanent legacy document that extends the patient’s influence beyond their death. A similar structured exit interview or retrospective at the end of a project is more than a conventional “lessons learned” report because it is personal, narrative, and explicitly oriented toward what should survive rather than what went wrong.

Continuing Bonds

The continuing bonds theory of bereavement Klass1996 challenged the idea that healthy mourning requires letting go of the deceased and severing the relationship. Instead, it argues that bereaved people who maintain an ongoing internal relationship with the dead through story-telling, physical objects, or integration of the deceased’s values into their own identity are not pathological: they are exhibiting a normal and healthy form of grief. The lesson for project closure is that closing a project is not the same as erasing it, and that participants don’t need to move on in a way that severs their connection to the work. Design decisions, published papers, open-source code, and the skills people developed all continue to exist and to matter. Framing closure around what continues, rather than only around what ends, reduces distress and gives project leaders a vocabulary for talking about archiving, citation, and attribution not as bureaucratic compliance but as genuine acts of preservation.

Bibliography

Chochinov2005: Harvey Max Chochinov, Thomas Hack, Thomas Hassard, Linda J. Kristjanson, Susan McClement, and Mike Harlos “Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life.” Journal of Clinical Oncology, 23(24), 2005, 10.1200/JCO.2005.08.391.
Chochinov2012: Harvey Max Chochinov: Dignity Therapy: Final Words for Final Days. Oxford University Press, 2012, 978-0195176216.
Clark1999: David Clark: “Total pain, disciplinary power and the body in the work of Cicely Saunders, 1958-1967.” Social Science and Medicine, 49(6), 1999, 10.1016/S0277-9536(99)00098-2.
Gawande2014: Atul Gawande: Being Mortal: Medicine and What Matters in the End. Metropolitan Books / Henry Holt, 2014, 978-0805095159.
Klass1996: Dennis Klass, Phyllis R. Silverman, and Steven Nickman (eds.): Continuing Bonds: New Understandings of Grief. Taylor and Francis / Routledge, 1996, 978-1560323396.
Saunders1963: Cicely Saunders: “The treatment of intractable pain in terminal cancer.” Proceedings of the Royal Society of Medicine, 56(3), pp. 195-197, 1963.
Towey2026: Jim Towey: Five Wishes. Aging with Dignity, https://www.fivewishes.org/, viewed 2026-04-08.