Factors Associated With Evolution of the Use of Medical Assistance in Dying: Protocol for a Scoping Review

As of June 2025, medical assistance in dying (MAiD) is allowed in over 25 jurisdictions across 12 countries, with varying rates of requests and provision. Hypotheses have been suggested to explain these variations, but they are rarely backed up by empirical evidence. As more jurisdictions consider legalizing MAiD, it is important to better understand what factors may explain the evolution of the use of MAiD worldwide with a systematic approach.

This scoping review aims to map the available evidence regarding the factors associated with the evolution of the use of MAiD in jurisdictions where it is allowed.

The scoping review will follow the Joanna Briggs Institute methodology and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Ten electronic databases (including MEDLINE, Embase, CINAHL Complete, and APA PsycInfo) and additional gray literature sources will be searched from inception to the present. This scoping review will consider multiple types of publications (eg, primary studies, research syntheses, and government reports) and will report factors associated with the use of MAiD for people who have requested or died by MAiD in jurisdictions that have allowed it for at least 5 years. Publications in English, French, Spanish, German, or Dutch will be included. Screening for assessment against the inclusion criteria and data extraction will be carried out independently by pairs of reviewers. Findings will be presented in a narrative format and mapped into tables and graphs to address the review aims.

The database search for scientific publications was completed in March 2025. A total of 8570 publications were identified after removing duplicates. As of October 2025, title and abstract screening is complete, with 216 articles retained for the next stage. The full-text review is underway and scheduled to be completed by December 2025, and results are expected to be submitted for publication in 2026.

MAiD is gaining legal and policy attention worldwide, with wide variation in rates of request and provision over time across jurisdictions. This scoping review will contribute to mapping and synthesizing evidence on the factors that may explain these variations.