Beginning the journey into the spirit world: First Nations, Inuit and Métis approaches to palliative and end-of-life care in Canada is informed by the following considerations and shared understandings:

  • Braiding (harmonizing). We acknowledge that Indigenous and non-Indigenous systems of care can work together in palliative and end-of-life care;
  • Cultural assessment. This assessment should be an expectation for every encounter with people with life-limiting illnesses and for every health-care provider, not just for Indigenous Peoples but for everyone;
  • Culture as medicine. Culture, Indigenous identities and the reconciliation process are necessary for healing and helping in palliative and end-of-life care. Culture is medicine for someone with life-limiting illness just as antibiotics are medicine for someone with a serious infection;
  • Distinctions-based approach. This approach recognizes the unique rights, interests and contexts for First Nations, Inuit and Métis Peoples across Canada. It is important to acknowledge that there is much diversity among Indigenous Peoples and communities in terms of languages, lifestyles, histories, values, practices and teachings. This includes diversity of settings in which Indigenous Peoples live (for example, urban, rural, remote, northern, on-reserve communities). There is also diversity in individual communities, particularly in terms of use of Indigenous and non-Indigenous spiritual practices. Therefore, if and where possible, a distinctions-based approach was used in preparing this report to recognize the unique rights, interests and contexts for First Nations, Inuit and Métis Peoples;

  • Empowerment and validation. Knowledge and recognition of Indigenous approaches to palliative and end-of-life care is an empowering and validating way for First Nations, Inuit and Métis Peoples with life-limiting illnesses to transition to the spirit world with support from their families and communities:
  • Indigenous approaches to palliative and end-of-life care. Palliative and end-of-life care is fundamentally life affirming. It supports communities as much as they support individuals recognizing that one cannot separate individuals or communities from each other. Palliative and end-of-life care encompasses grief and bereavement supports for individuals and their communities including after death;
  • Person-centred approach. This approach recognizes that the person is placed at the center of palliative and end-of-life care and treated as a person first. The focus is on the person and what they can do, not their life-limiting illness. Support focuses on achieving the care goals of the person with the life-limiting illness and is customized to their needs and unique circumstances;

Helpers using a person-centred approach demonstrate the following three attributes:

(1) genuineness—being real, not hiding behind a false front/persona;

(2) unconditional positive regard—caring for the person with the life-limiting illness by developing an open-minded philosophy and being non-judgmental; and

(3) empathic understanding—being sensitive to the feelings expressed by the person with the life-limiting illness and offering continued support during palliative and end-of-life care.

Nothing about us without us.

This statement signifies that local engagement and consultation with First Nations, Inuit and Métis Peoples and communities is required when developing and implementing palliative and end-of-life care programs.

Learning styles. Recognizing diverse learning styles[1] aids readers to find out more about Indigenous approaches to palliative and end-of-life care. Creative arts are equally important as oral and written forms of knowledge sharing. As such, graphic design images, art, photos and infographics were designed and included in this report and the accompanying knowledge products;

Life stories and lived experiences. Throughout this report, life stories and lived experiences have been shared to engage readers’ hearts and minds on themes such as healing, empowerment, reflection, connections to place and community, strength and resiliency, cultural heritage and identities that relate to Indigenous approaches to palliative and end-of-life care;

While great strides have been made to engage Indigenous Peoples in palliative and end-of-life care research and evaluation, much of the research and evaluation on this topic across Canada has focused on perspectives, ways of knowing and lived experiences of First Nations Peoples, their families and communities.

Métis and Inuit voices, experiences and promising practices in palliative and end-of-life care continue to be underrepresented in health research across Canada.[2], [3]

  • Relationship building and allyship. Readers are invited to take an inclusive and holistic approach to palliative and end-of-life care. This approach involves the respectful consideration of gender and 2SLGBTQQIA+-,[1] trauma- and resilience-informed approaches when braiding or harmonizing Indigenous ways of knowing and biomedical strategies in the broader continuum of care for people living with life-limiting illnesses, their families and communities; and
  • Language influences cultural and social attitudes. As communication is important, we invite readers to embrace terminology that braids Indigenous ways of knowing and biomedical terms, thus honouring the spirit and intent of Etuaptmumk/two-eyed seeing (refer to Section 10.2). Also, key terms are provided in Section 7.4 (Terminology) and Section 13 (Key terms) which provide a common understanding of notable terms used throughout this report. Wording related to Indigenous approaches to palliative and end-of-life care were consistent and congruent at the time of publication.

Disclaimers

Indigenous approaches to palliative and end-of-life care are supported by appropriate teaching and learning experiences. Therefore, while this report is intended to enrich your learning, the Partnership makes no warranty or representation that reading this report and the accompanying resources on the Partnership’s website deems you culturally competent or identifies you as a recognized expert, healer, traditional teacher or Elder.

From an ethical perspective, experiential teachings and supervision with recognized Elders, Knowledge Carriers and/or healers is needed to continue one’s safer[2] and respectful use of Indigenous healing, helping and spiritual practices in palliative and end-of-life care.

Beginning the journey into the spirit world: First Nations, Inuit and Métis approaches to palliative and end-of-life care in Canada is not intended to be “one size fits all,” nor is it an exhaustive list of all First Nations, Inuit and Métis palliative and end-of-life care initiatives used across Canada. Rather, this report provides examples of First Nations, Inuit and Métis palliative and end-of-life care strategies, approaches and promising practices.

The Partnership recognizes that there is a need for palliative and end-of-life care strategies, programs and resources that acknowledge the unique cultural, jurisdictional topics and issues for First Nations, Inuit and Métis Peoples and communities in Canada.

Stories in this report were shared with permission from the storytellers and were documented as accurately as possible.

The views, opinions, conclusions and recommendations expressed in this report are intended to share themes, lessons learned and promising practices that are representative of a variety of Indigenous perspectives across Canada.

Ethical standards and practices associated with medical assistance in dying remain in the early stages of discussion in the health-care field across Canada. Therefore, further exploration of this topic and its application in cross-cultural settings is needed. Complex planning and guidance from Elders, Healers and Knowledge Carriers in Indigenous communities across Canada are essential.

In this report, promising practices and resources (including websites) are current as of the date of publication. Furthermore, there is recognition that promising practices in one community or organization may not be applicable for all communities and/or organizations. Rather, promising practices are based on community or organizational strengths and are grounded in Indigenous ways of knowing and experiences—so they will vary from one community or organization to the next.

The Partnership accepts no responsibility of liability for any loss or damage that any person may sustain as a result of the information in, or anything done or omitted pursuant, to this report and accompanying resources (presentation deck and infographics).

The views expressed herein do not necessarily represent the views of Health Canada.

Excerpts from Beginning the journey into the spirit world: First Nations, Inuit and Métis approaches to palliative and end-of-life care in Canada may be reprinted for use in educational settings without prior approval; however, the citation on the cover page must be used when referencing this report. The reproduction of text, photos, infographics and/or illustration for publication or other uses requires written permission from the Partnership.

To request permission, contact the Partnership at info@partnershipagainstcancer.ca

Content warning:

This report contains content which may be sensitive, triggering or difficult to deal with emotionally.

If you experience any of these responses, we encourage you to contact a mental health specialist/counsellor, your local Elder or Knowledge Carrier or other support person.

You can also consult

Talk Suicide Canada:
https://talksuicide.ca

Residential School Survivors and Family Crisis Line: 1-800-721-0066;
https://www.irsss.ca/faqs/how-do-i-reach-the-24-hour-crisis-line

It is not our intention to cause any harm or discomfort to readers.
Rather, the Partnership’s intent is to provide an inclusive and holistic overview of the challenges and resiliencies in accessing timely and culturally congruent palliative and end-of-life care for First Nations, Inuit and Métis Peoples, their families and communities across Canada.
By understanding these realities, collective work can be carried out towards palliative and end-of-life care.