Canada’s expansion of Medical Assistance in Dying has made it a global focal point — with a staggering “one in 20 deaths in Canada now occurring through Maid”, according to Melanie Yach, partner at Aird and Berlis LLP in Toronto.

That reflects a 15.8 per cent increase over the previous year, amounting to about 20,000 requests, with the province of Quebec posting the nation’s highest rate.

“Canada has the greatest increase in medically assisted deaths of any country anywhere in the world. The number of medically assisted deaths as a percentage of the population is as high in Canada as it is in the Netherlands [one of the first countries to introduce such legislation],” Ms Yach said, speaking yesterday at the Society for Trust and Estate Practitioners Bermuda Conference 2025, held at the Bermuda Underwater Exploration Institute.

The legislation is evolving rapidly, with upcoming changes set to expand Maid to individuals whose only medical condition is mental illness, and active debate about allowing “mature minors” — children as young as 12 — to access assisted dying with parental consent, and those between 16 and 18 potentially eligible without it.

For trust companies and global practitioners, the implications are real. “Almost every one of my clients is asking about … executing a power of attorney that allows them to undergo a medically assisted death,” shared Ms Yach.

This trajectory is echoed by the dizzying pace of legislative change in Canada and globally. Ms Yach said that “about 20,000 people in Canada requested Maid last year and about 78 per cent of those actually underwent a medically assisted death. But sadly, about 15 per cent died before they could undergo Maid.”

Quebec stands out with 36.5 per cent of Maid deaths, despite only representing about 22 per cent of the Canadian population.

Turning to Britain, Ruth Hughes KC of 5 Stone Buildings in London, emphasised the importance of safeguards. She noted: “I have done a lot of predatory marriage cases and the kind of lack of concern there seems to be in this Bill process for protecting people who might lack capacity or might be being coerced ... from being assisted to die by the state for someone else’s financial gain … I find very troubling.”

Ms Hughes warned about the difficulty of fully protecting vulnerable people, even as new boards and review processes were introduced with upcoming legislation.

As Maid spreads to other jurisdictions, she said, practitioners must be ready to address evolving estate planning, ethical and risk management challenges.