A qualitative study of the barriers to and facilitators of the delivery of medical assistance in dying services in Canada from the perspectives of involved professionals

BACKGROUND: Medical Assistance in Dying (MAiD) and related services are legally available in a number of countries under specific conditions and continue to be the subject of ongoing international debate. In Canada, MAiD has been legally available since 2016, with eligibility expanded in 2021 to include individuals whose natural death is not reasonably foreseeable (Track 2), in addition to those whose death is reasonably foreseeable (Track 1). MAiD is federally regulated, but services are organized and delivered at the provincial and territorial levels, resulting in substantial variation in staffing, funding, oversight, and training. To date, most research has focused on the experiences of individual professional groups, such as physicians, or on single jurisdictions. Less is known about how the service delivery process functions as a whole and how its organizational and operational features shape the experiences of the healthcare professionals (HCPs), administrators, and policymakers involved. This study examines the barriers to and facilitators of MAiD service delivery from the perspectives of professionals across the service delivery process throughout Canada and identifies key system-level and operational factors that may inform MAiD policy and program planning both domestically and internationally. METHODS: Participants were recruited through professional networks, provincial and territorial MAiD working groups, and MAiD-related non-profit organizations. Participants included healthcare professionals (HCPs), program administrators, and policymakers involved in MAiD service delivery. Interviews were held virtually and were recorded and transcribed. Data was analyzed using a qualitative descriptive design with a structured, five-phase inductive thematic analysis approach and constant comparison to identify barriers to and facilitators of MAiD service delivery. RESULTS: A total of 46 semi-structured interviews were conducted between July 2024 and January 2025 with participants from seven provinces and one territory. Ten themes and 25 sub-themes were identified. Barriers included high workloads, limited collaboration with other health services, limited coordination, and inadequate training and financial support. Emerging issues included misinformation about MAiD eligibility criteria, limited bereavement support services for patients' families, and acquiring and transporting MAiD-related medications. Facilitators included centralized coordination systems, standardized documentation and reporting, interprofessional collaboration, and supportive leadership. CONCLUSIONS: These findings offer a process-level view of how MAiD services have been operationalized in Canada a decade after its legalization. They highlight persistent and emerging challenges in MAiD service delivery as well as promising innovations used to address them. As Canada prepares for the March 2027 expansion of MAiD to persons whose sole underlying medical condition is a mental illness, and as other jurisdictions continue to develop assisted dying legislation, these findings map the system-, operational-, and support-level factors needed to sustain and strengthen MAiD service delivery.