Early Exits: Spirituality, Mortality and Meaning in an Age of Medical Assistance in Dying

With 25 years in end-of-life care and firsthand experience with death, dying, and MAiD, David Maginley explores the unaddressed issues at the heart of our effort to control the final human experience.

What drives most requests for Medical Assistance in Dying (MAiD)? Surprisingly, it’s not physical pain but existential distress-the fear of suffering, the loss of dignity, and the struggle to find meaning and purpose as life draws to a close. Yet these very struggles are functional in a process few recognize: the deconstruction of the personal self (the ego), which prepares us for our final and most significant state of being-transcendence. In Early Exits, David Maginley offers a radical reinterpretation of MAiD as an attempt to preserve the ego in the face of this transformation. This is a reflection of our culture’s spiritual poverty and reveals MAiD as a medical procedure being used to treat what is, fundamentally, a spiritual condition.

Early Exits goes beyond discussions of autonomy, ethics, and dignity to explore the fundamental human experience of dying. Each chapter begins with a real-world case example and ends with practical tools to help readers live-and die-more fully informed. Drawing on decades of research into end-of-life phenomena and over 25 years of experience providing spiritual care to cancer and palliative patients, Maginley illuminates the inner dimensions of dying and how to address the distress that drives MAiD requests. With compelling research, personal stories, and profound spiritual insights, Early Exits reframes dying as a transformative process that leads us beyond grief and despair to a state of grace and growth.

Central topics explored:

• Why existential suffering-not physical pain-is at the heart of requests for assisted death, and how to best address it.
• How the deconstruction of identity accelerates spiritual growth and calibrates us for transcendence.
• The importance of addressing both physical and psycho-spiritual needs in palliative care.
• How MAiD compromises the mystical, expansive states of consciousness experienced by most dying people, regardless of culture or belief.

Maginley’s insights are shaped not only by decades of experience supporting those facing mortality but also by his own journey as a four-time cancer survivor. Whether you are navigating a terminal diagnosis, supporting a loved one, or providing care as a professional in hospice or palliative settings, this book offers hope and clarity. Early Exits is an essential resource for understanding-and transforming-the most profound and ultimate event in life. It offers a way forward to a better society, a better tomorrow, and a better end to our days.