Indigenous perspectives on palliative and end-of-life care
The wrinkles around her eyes curled to highlight the uncontainable joy of her grin as she mimed shooting a moose one more time. An Elder, from a First Nation community outside of Whitehorse, emphasized the importance of returning home from the hospital into the care of her community, knowing that her advanced cancer would progress without ongoing medical treatment. As a palliative care physician living in the Yukon, I have witnessed firsthand the importance of honouring culture, tradition and connection to both community and the land during the end-of-life journey.
Beginning the journey into the spirit world: First Nations, Inuit and Métis approaches to palliative and end-of-life care in Canada provides a thoughtful overview of the factors contributing to palliative care experiences of First Nations, Inuit and Métis in Canada by exploring both historical and contemporary factors, including key legislation. Best and promising practices in palliative care, specific to First Nations, Inuit and Métis Peoples are woven throughout.
As health-care providers, we have a responsibility to emphasize personhood and dignity in the face of illness, to be with people and hear their stories, and to provide not just physical care for the body, but mental, spiritual and emotional care for the mind, heart and spirit. This is especially true when caring for First Nations, Inuit and Métis Peoples, for whom history and experiences are inextricably linked to health and well-being.
Regardless of your experience or role in palliative care, Beginning the journey into the spirit world: First Nations, Inuit and Métis approaches to palliative and end-of-life care in Canada provides insights and teachings that will support you and others in your caregiving journey.
Alexander Kmet, Métis physician specializing in Anaesthesia, GP Oncology and Palliative Care Medicine in Whitehorse, Yukon
Indigenous Peoples are the fastest growing population in Canada. There is much diversity among First Nations, Inuit and Métis Peoples and communities in languages, lifestyles and teachings.
The rights of First Nations, Inuit and Métis Peoples and the commitment to full partnerships and relationships are articulated in Section 35 of the Constitution Act (1982). Furthermore, this section of the Constitution Act reflects a promise on the part of the Government of Canada and associated entities to respect the distinct rights of First Nations, Inuit and Métis Peoples as well as the treaty obligations that create a framework for First Nations, Inuit and Métis Peoples and non-Indigenous People to work and live together.
Increasingly, readers will work alongside people from many different cultures and backgrounds, including First Nations, Inuit and Métis Peoples, their families and communities. Therefore, we need to recognize First Nations, Inuit and Métis perspectives and considerations on palliative and end-of-life care.
To support cultural safety, it is important for allies working with First Nations, Inuit and Métis Peoples to have access to timely, relevant and culturally congruent palliative and end-of-life care strategies, promising practices and resources.
It is also beneficial for readers to enhance their understanding of and their interpersonal communications with First Nations, Inuit and Métis Peoples living with life-limiting illnesses, their families and communities.
In 2007 and 2015, two notable Indigenous declarations and reports were published that informed discussions and corresponding actions in Canada and internationally with regards to Indigenous rights, well-being, engagement and partnerships.
United Nations Declaration on the Rights of Indigenous Peoples
UNDRIP was adopted by the United Nations General Assembly on September 13, 2007 and by Canada in 2016. This declaration establishes a comprehensive international framework of minimum standards for the survival, dignity and well-being of the Indigenous Peoples of the world. It elaborates on existing human rights standards and fundamental freedoms as they apply to the specific situation of Indigenous Peoples.
The following are notable UNDRIP articles that relate to Indigenous approaches to palliative and end-of-life care:
Article 7(1): Indigenous individuals have the rights to life, physical and mental integrity, liberty, and security of person.
Article 21(1): Indigenous peoples have the right, without discrimination, to the improvement of their economic and social conditions, including inter alia, in the areas of education, employment, vocational training and retraining, housing, sanitation, health and social security.
Article 23: Indigenous peoples have the right to determine and develop priorities and strategies for exercising their right to development. In particular, Indigenous peoples have the right to be actively involved in developing and determining health, housing and other economic and social programmes affecting them and, as far as possible, to administer such programmes through their own institutions.
Article 24(2): Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.
For more information, watch How UNDRIP changes Canada’s relationship with Indigenous Peoples –
Truth and Reconciliation Commission of Canada Calls to Action
From 2008 to 2014, the TRC heard stories of abuse (for example, mental, emotional, sexual, physical) from thousands of residential school survivors. The purpose of the TRC was to document the history and impacts of the residential school system in Canada. The TRC provided former residential school survivors with an opportunity to share their experiences during public and private meetings held across Canada. In June 2015, the Commission released a report based on these hearings, resulting in 94 calls to action. The TRC calls to action address the legacy of residential schools and advance the process of Canadian reconciliation.
The following are TRC calls to action that the Truth and Reconciliation Commission of Canada specifically asked the Partnership and our colleagues in health institutions across the country to realize:
TRC call to action #22. We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.
TRC call to action #23. We call upon all levels of government to: i. Increase the number of Aboriginal professionals working in the health-care field. ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities. iii. Provide cultural competency training for all health-care professionals.
TRC call to action #24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.
Reconciliation is not about forgiving and forgetting. Rather, reconciliation is about remembering and changing.
Furthermore, reconciliation is not a final destination: it is a shared journey and process for First Nations, Inuit and Métis Peoples and non-Indigenous Peoples in Canada.
As people living and working in Canada, we all have individual and collective roles in advancing the TRC calls to action.
For more information about the TRC final report, refer to
UNDRIP and the TRC calls to action shine a light on the importance of understanding the historical, social, cultural and political landscape that shape relationships between Indigenous Peoples and institutions such as the health-care system in Canada. Understanding this landscape and these relationships is crucial to achieving social justice. As orders of governments, health-care organizations, and related leadership and education groups implement the TRC calls to action and the UNDRIP articles, helpers need to be aware of their roles when working with First Nations, Inuit and Métis Peoples living with life-limiting illnesses, their families and communities:
- Recognize the effects of historical and intergenerational trauma on Indigenous Peoples—These effects are often associated with the policies of forced assimilation through the residential school system and other forms of colonization in Canada (for example, Indian Act legislation and the reserve system, land appropriation, Indian hospitals, Sixties Scoop);
- Deconstruct one’s understanding of change at the community level—First Nations, Inuit and Métis communities set the pace and define (or redefine) ways of knowing related to identity/identities; resiliency; palliative and end-of-life care. It is important to recognize that a community’s readiness to engage in or lead Indigenous approaches to palliative and end-of-life care will differ within and between First Nations, Inuit and Métis communities;
- Engage communities—Take the time needed to grow relationships and sustain trust among individuals, groups and organizations who provide Indigenous approaches to palliative and end-of-life care and related support to individuals with life-limiting illnesses; and
- Understand processes and protocols for working with and alongside First Nations, Inuit and Métis communities—Understanding these processes and protocols includes acknowledging, recognizing and understanding cultural practices associated with dying and death.