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

Background: Medical Assistance in Dying (MAiD) was first legalized in Canada in 2016, with legislation expanding from foreseeable to non-foreseeable natural deaths. A sole underlying medical condition of mental illness is expected to be added in 2027. Although legislation and reporting requirements are federally mandated, the implementation and delivery of MAiD are the responsibility of individual provinces and territories. Objectives: The aim of this study is to compare the organization, delivery, and oversight of MAiD programs across provinces and territories in consideration of access, equity, and safeguards. Methods: This study used a mixed methods approach to collect data. A comprehensive and systematic search for published peer reviewed literature on MAiD programs in Canada was conducted along with qualitative interviews with key informants using purposive and snowball sampling. A qualitative descriptive design was used for qualitative data, including content analysis. To facilitate a detailed comparative analysis of MAiD across jurisdictions, separate tables were created for each component or element, organizing the results of the literature review and qualitative analysis by jurisdiction. Patterns within these tables were identified through qualitative interpretation. The findings were then summarized in a narrative format. Results: A total of 113 interviews were conducted, representing all provinces and territories but Nunavut. Findings showed varied practices throughout the MAiD process between jurisdictions. Conclusions: The main findings of this study are that the organization of MAiD programs, oversight, reporting methods to Health Canada, intake, preliminary assessments, assessments, provision, and bereavement support vary. In addition, specific policies related to potentially vulnerable populations are lacking and jurisdictional practices also vary. Centralized, multidisciplinary MAiD programs with strong oversight mechanisms may strengthen issues related to access, equity, and safeguards.