Descriptions and Experiences with Medical Assistance in Dying Models Across Canada: A Mixed Methods Study.

Area of Science:

• Public Health
• Health Policy
• Bioethics

Background:

• Medical Assistance in Dying (MAiD) legalized in Canada in 2016, with evolving legislation for natural deaths.
• Expansion to include sole mental illness as an underlying condition anticipated in 2027.
• MAiD implementation is provincially/territorially managed despite federal mandates.

Purpose of the Study:

• To compare MAiD program organization, delivery, and oversight across Canadian provinces and territories.
• To analyze variations in MAiD access, equity, and safeguards.
• To identify best practices for MAiD service delivery.

Main Methods:

• Mixed-methods approach combining systematic literature review and qualitative interviews.
• 113 key informant interviews conducted across all provinces and territories (excluding Nunavut).
• Qualitative descriptive design with content analysis and jurisdictional comparative tables.

Main Results:

• Significant variations observed in MAiD processes across Canadian jurisdictions.
• Inconsistent practices in intake, assessments, provision, and bereavement support.
• Lack of specific policies for vulnerable populations noted, alongside varied jurisdictional approaches.

Conclusions:

• MAiD program organization, oversight, reporting, and support services differ significantly by province/territory.
• Jurisdictional disparities in policies for vulnerable populations require attention.
• Centralized, multidisciplinary MAiD programs with strong oversight are recommended to enhance access, equity, and safeguards.