What Factors Explain the Growing Use of Medical Assistance in Dying in Quebec? Protocol of an Interdisciplinary, Mixed and Multi Methods Study (Preprint)

BACKGROUND Medical Assistance in Dying (MAiD) became a legal end-of-life option on December 10th, 2015 in Quebec, and on June 17th, 2016 in the rest of Canada. Since its legalization, there has been a steady increase in the number of MAiD requests and provisions. Across permissive jurisdictions, Quebec now has the highest rate of assisted death. OBJECTIVE The objective of this paper is to present the protocol developed by CIRAMM (in French: Consortium interdisciplinaire de recherche sur l’aide médicale à mourir), an interdisciplinary research consortium, including an International Advisory Committee, set up to better understand the growing use of MAiD in the Canadian province of Quebec. METHODS The design of this protocol is multimethods and convergent mixed-methods, including 1) an international cross-thematical approach with four main research methods (a scoping review, key informant interviews, focus groups with healthcare professionals and a population-based survey) chosen to partially answer research questions across the entire study and to compare with other jurisdictions, and 2) theme-specific methods (including community forums, media coverage analysis, comparative legal analyses, case studies of triads, individual interviews, system mapping) to enrich and complement findings from the cross-thematical approach. RESULTS In July 2024, several research methods not requiring ethics committee approval were initiated. By Summer 2025, interviews with key informants and analyses were completed. Concurrently, other sub-teams are getting ready to seek ethics approval for their protocols and data collection processes. CONCLUSIONS Findings from the international cross-thematical approach and theme-specific methods will provide a comprehensive understanding of the factors influencing the use of MAiD in Quebec. This study has strengths, including the use of a specific theoretical framework, a variety of complementary methods, and an integrated knowledge mobilization strategy. As for its limitations, we foresee challenges with comparison of jurisdictions in terms of language, culture and legal systems, as well as access to data about MAiD cases since reporting systems may differ between jurisdictions.