Beginning the journey into the spirit world

Shared understandings

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 healthcare 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 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.

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.

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.1,2

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+-,3 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.

Terminology

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. The complete document, Beginning the journey into the spirit world: First Nations, Inuit and Métis approaches to palliative and end-of-life care in Canada, provides 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.

1 Young TK. Review of research on Aboriginal populations in Canada: relevance to their health needs. BMJ (Clinical research ed.). 2003;327(7412):419–422.
2 Furgal CM, Garvin TD, Jardine CG. Trends in the study of Aboriginal health risks in Canada. International journal of circumpolar health. 2010;69(4):322–332.
3 2SLGBTQQIA+ refers to two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual and other sexually and gender diverse people.