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Medical assistance in dying (MAiD) has been legal throughout Canada since 2016. Legislation has evolved to expand eligibility criteria to non-foreseeable natural deaths. A sole underlying medical condition of a mental illness will be included in March of 2027. Provinces and territories are responsible for the development and ongoing improvements to MAiD service and delivery. We aimed to understand the experiences of families and friends of recipients of MAiD and elicit recommendations to improve the quality of MAiD service and delivery and possibly inform future legislation. A qualitative descriptive design was utilized to best capture the personal experiences of family and friends of MAiD recipients in Canada. Social media posts and information sharing through end-of-life organizations invited individuals who self-referred for MAiD and family members to participate. Virtual interviews were completed using a semi-structured interview guide. Participants were specifically asked to provide recommendations for changes or improvements to MAiD service and delivery based on their experiences. Data was transcribed and a five-phase qualitative approach to coding and thematic analysis was employed. Thirty-four family and friends from five provinces in Canada participated in the study. They shared their experiences of supporting 35 individuals who received MAiD. Three main themes were identified including the decision to have MAiD, emotional complexity and challenges with the MAiD process. Ten sub-themes identified were symptom burden, loss of autonomy and control, fear of future suffering, system barriers to care, accessibility, respectful and compassionate care, continuity of care, comprehensiveness and accuracy of assessments, guidance and information sharing and emotional support. Participant recommendations for improvements to MAiD service and delivery in Canada are included in this paper. Participant experiences offer insight into ensuring early intervention that is holistic in nature is provided by a highly skilled healthcare team to individuals who request MAiD. This includes involving and supporting family members; addressing unmet care needs; and offering emotional support, information and guidance throughout the MAiD process.