Mapping the landscape of medical assistance in dying through exploring barriers and facilitators among providers in Canada

In June 2016, medical assistance in dying (MAiD) became legal in Canada following changes to the Criminal Code.1 This allowed doctors and nurse practitioners (NPs) to administer or assist in MAiD without legal repercussions. Two permissible methods can be employed when administering MAiD in Canada: direct administration of medications by a health care provider to induce death at the person’s request or self-administration of medications prescribed by a health care provider to induce death. Individuals must meet specific conditions to qualify for MAiD, and safeguards have been implemented to ensure its proper use. Since the original legislation, there have been several significant revisions to the eligibility criteria and safeguards, and more changes are expected, including the eligibility of persons suffering solely from a mental illness, which has been postponed until March 2024.1 Significant revisions to the legislation were made following the Superior Court of Québec’s 2019 Truchon decision.1 As of March 2021, the law no longer requires a person’s natural death to be “reasonably foreseeable.” The person must, however, meet the following eligibility criteria: i) be 18 years or older with decision-making capacity; ii) be eligible for publicly funded health care services; iii) make a request for MAiD that is voluntary and free from external pressure; iv) be able to give informed consent after receiving all the necessary information; v) have a severe and incurable illness, disease, or disability (excluding mental illness, until March 17, 2024); vi) be in an advanced state of irreversible decline in capability; and vii) be in enduring, intolerable physical or psychological suffering that cannot be alleviated under conditions the person deems acceptable.1 Along with these changes, the federal government introduced a 2-track approach to safeguards for MAiD based on whether a person’s natural death is reasonably foreseeable (Track 1)2 or not reasonably foreseeable (Track 2). Additionally, the federal government introduced the waiver of final consent, defined as “an arrangement in writing between the person (on Track 1) requesting MAiD and their provider that the provider would administer substances to cause their death after they have lost decision-making capacity.”2(p.24) The rapidly changing MAiD legislation has implications for various practice guidelines and policies3 as well as implications for health care providers and perceptions of their role in MAiD.4,5 In Canada, physicians, NPs, and medical residents play a crucial role in the context of MAiD. These professionals ensure high-quality assessments, as well as decision-making and administration of MAiD. They are essential for providing a process that follows the legal and ethical standards set by the federal government. Having a sufficient number of MAiD providers is also critical to ensure access to MAiD for eligible patients. The most recent data indicate that the number of MAiD providers has increased, with 1837 providers in 2022. Since 2019, the annual average increase in MAiD providers has been 18.2%, reflecting a consistent growth in the number of health care professionals engaging in the provision of MAiD.6 Concurrently, the growth rate of the provision of MAiD has outpaced the increase in practitioners, averaging 32.7% annually over the same period.6 This notable difference in growth rates implies a considerable rise in the average number of MAiD procedures per practitioner each year. These observed statistical trends compelled the authors to explore the factors influencing providers to engage in this relatively new medical practice. Our scoping review protocol7 in this issue of JBI Evidence Synthesis outlines the objectives, methods, and reporting procedures for the review’s question: What are the perceived barriers and facilitators for engaging in the practice of MAiD for physicians, NPs, and medical residents in Canada? Our comprehensive review will offer valuable insights to better understand the motivations and challenges faced by providers capable of providing MAiD within different contexts. Conducting this scoping review will be a foundational step in informing and shaping future research by comprehensively mapping the literature, identifying research gaps, and informing future research questions. Analysis of key themes in the review will guide the development of hypotheses and conceptual frameworks for subsequent research. Including studies from various contexts may enhance understanding of how contextual, cultural, or legislative differences may influence barriers and facilitators for engaging in MAiD. Additionally, the scoping review can inform policy recommendations and best practices, positioning future research as a valuable resource for shaping ethical guidelines and health care practices. By building on existing knowledge, we hope the subsequent research will contribute to the evolving discourse on MAiD.

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