We received 1210 completed questionnaires. The response rate from each medical school is presented in Table 1.

Table 1 Participation rate by Canadian medical school Full size table

Figure 1 reports the unadjusted proportion of medical students willing to participate in MAID according to various socio-demographic characteristics, with 95% confidence intervals. Willingness to participate in MAID was measured using the question “Will you be personally willing to provide physician assisted dying (PAD), or generally participate in the process of PAD, under a legal framework that permits it?” with response options “No” or “Yes”. Respondent sub-categories with fewer than five respondents, or with proportions of 0% or 100%, were suppressed to protect the anonymity of participants. Overall, 71% of respondents expressed willingness to participate in MAID, but with significant variation across some respondent characteristics.

Fig. 1 Mean willingness to participate in medical assistance in dying by socio-demographic subgroup, with 95% confidence interval Full size image

Respondents in the 21–25 age group, the largest age group among medical students in this study, reported the lowest willingness to participate in MAID. However, differences between the age groups were not statistically significant. Nor did we find statistically significant differences in willingness to provide MAID by sex.

Medical students born outside of Canada showed a significantly lower willingness to participate in MAID (62%) than those born or raised in Canada (73%) (p = 0.002). The effect remained significant when controlling for every type of religion. However, it was attenuated by controls for frequency of religious attendance.

Among medical students born in Canada, those born and/or raised in New Brunswick reported the greatest willingness to provide MAID (92%), followed by Québec (83%), Nova Scotia (81%), Saskatchewan (75%), Manitoba (71%), Ontario (69%), British Columbia (65%), and Alberta (63%). A bivariate logistic regression model showed that both the elevated rate of willingness to participate in MAID in Québec, and the reduced willingness in Alberta, were statistically distinct from the other provinces. (Québec: OR 2.20, 95% CI 1.47–3.32, p < 0.001; Alberta: OR 0.59, 95% CI 0.41–0.85, p = 0.005).

Religion and frequency of religious attendance were strongly correlated with willingness to provide MAID. Medical students who report being non-religious, atheist, or agnostic report the highest willingness to participate in MAID (89%), followed by Jewish (70%), Catholic (70%), Muslim (46%), and Other Christian religion (40%), which included all reported Christian denominations other than Catholic. A bivariate ANOVA (analysis of variance; not shown) confirmed that religious between-group variances are statistically significant at the p < 0.001 level. A deeper investigation revealed an interaction effect between religion and province of birth: Catholic respondents born in Québec reported a higher willingness to provide MAID (84%) compared to Catholic respondents in the rest of Canada (63%), a statistically significant difference (p = 0.026). No other province or religion showed an interaction effect other than that of Québec Catholics.

While type of religion strongly predicted willingness to provide MAID, so too did frequency of religious attendance. Medical students who report never attending religious services were more willing to provide MAID (89%) than those who attend a few times per year or less (81%), about once per month (40%), or about once per week (14%). The effect of religious attendance remained strongly significant (p < 0.001) whether modelled as a linear or categorical predictor.

Table 2 reports the results of a stepwise logistic regression model for the effect of the three most significant variables (province of birth and/or childhood, type of religion, and frequency of religious attendance) on willingness to participate in MAID. In Model 1, we see that the likelihood of participating in MAID among respondents from Québec and Alberta are significantly different from the rest of the provinces. However, the pseudo-R2 value of less than 3% suggests that province of origin is not a major explanatory variable for differences in willingness to participate in MAID.

Table 2 Willingness to participate in MAID by province of origin, religion, and frequency of religious attendance: Logistic regression odds-ratios with (standard errors) Full size table

Model 2 additionally controls for type of religion. Respondents who report being non-religious show an increased willingness, while Christian and Muslim respondents show a reduced willingness to participate in MAID. The effect of being born and/or raised in Québec remained statistically significant despite controlling for type of religion. The single addition of religion as a variable in our multivariate model raises the explanatory power (pseudo-R2) of the model to 18.7%, indicating that a major portion of the variance in willingness to participate in MAID is explained by type of religion.

Finally, Model 3 additionally controls for frequency of religious attendance. Compared to respondents who “never” attend religious services, those who attend “a few times per year” are not statistically distinct. However, respondents who attend religious services “about once per month” or “about once per week” show a strongly reduced willingness to participate in MAID (about 15%, and 3.2%, respectively), controlling for province of origin and type of religion. The reduced willingness among “Other Christians” remains significant despite controls for province of origin and frequency of religious attendance, but the effects of province of origin and all other religious categories are attenuated below the significance threshold. Moreover, the addition of frequency of religious attendance further increases the explanatory power (pseudo-R2) of this model to 31.8%. It appears that frequency of religious attendance, and to a lesser extent type of religion, dominate among the factors that explain willingness to participate in MAID.

Several other sociodemographic variables measured in this survey, such as urban/rural upbringing, parental education, year of study in medical school, and previous academic major before medical school, did not correlate with willingness to provide MAID.