Nurses' support for medical assistance in dying: A systematic review and meta-analysis

BackgroundMedical assistance in dying (MAID) raises complex ethical and professional questions for nurses, whose attitudes may vary across legal, sociocultural, and clinical contexts. Although nurses' experiences and attitudes toward assisted dying have been extensively examined, the prevalence and contextual variation of nurses' support for MAID across the international evidence remain unclear.Research aimTo estimate the prevalence of nurses' support for MAID and examine whether support varies across geographic, legal, clinical, and country-income contexts.Research designA systematic review and meta-analysis of studies reporting quantitative data on nurses' support for MAID or related assisted-dying practices.Search and quality appraisal10 electronic databases were searched from inception to 10 May 2025. Methodological quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Random-effects models were used to pool prevalence estimates, with subgroup analyses and univariable meta-regression used to examine contextual variation.Results26 studies involving 12,529 nurses from 19 countries were included. The pooled prevalence of support for MAID was 42.5% (95% confidence interval 34.6%-50.4%), with very high between-study heterogeneity (I² = 99.6%). Support varied by geographic region (p = .004), with pooled estimates of 51.0% in Europe, North America, and Oceania, 30.1% in Asia, and 23.1% in Africa. Support was also higher where an eligible form of assisted dying was legally authorized than where it was not (58.4% vs 37.6%; p = .038). Neither clinical setting nor country income level was significantly associated with support.ConclusionsNurses' support for MAID varies substantially across the available international evidence and should not be interpreted as a uniform global professional position. Geographic region and legal status were associated with this variation, supporting the need for context-sensitive ethical preparedness, role clarity, and organizational support rather than assumptions of professional consensus.