Project Overview
The Law Commission of Ontario’s Last Stages of Life for First Nation, Métis and Inuit Peoples: Preliminary Recommendations for Law Reform presents findings from extensive engagements with First Nations, Métis, and Inuit communities across Ontario, as well as with health professionals working in those communities.
This work was undertaken as a distinct but complementary component of the LCO’s broader Last Stages of Life project, which examines how law and policy shape the rights, choices, and quality of life of people who are dying and those who support them. The LCO recognized that health care for Indigenous peoples in Canada—and the legal frameworks that govern it—requires urgent reform, particularly in relation to palliative care, end-of-life care, and medical assistance in dying.
The project is guided by the recommendations of the Truth and Reconciliation Commission of Canada, including its call to recognize, revitalize, and integrate self-determined Indigenous legal orders and traditions within Canada’s justice system. The LCO’s approach centres Indigenous self-definition and acknowledges that meaningful law reform is only possible through the revitalization of Indigenous laws, traditions, and governance systems.
The LCO does not speak for or on behalf of Indigenous communities. Guided by an independent Indigenous Engagement Advisory Committee, this report reflects a multi-year engagement process supported by Indigenous Engagement Lead and Legal Counsel, and is intended to be read alongside—but distinct from—the LCO’s Last Stages of Life: Final Report. The LCO is deeply grateful to the 118 participants from more than a dozen Indigenous communities across Ontario, who generously shared their knowledge, experiences, and trust with the LCO.
Acknowledgements and Advisory Committee
The LCO wishes to acknowledge the contributions of Cassandra Baars, Indigenous Engagement Lead, as fundamental to building this project from the ground up and in sustaining its commitment to engage openly and meaningfully with each community we met with.
We also acknowledge the members of the Indigenous Engagement Advisory Committee who gave so generously of their time, expertise, and lived experiences:
- Myeengun Henry, Former Chief, Indigenous Knowledge Keeper from Chippewas of the Thames First Nation
- Alana Hill, Six Nations Health Care
- Kathleen Lickers, Lawyer
- Megan Logan, Chiefs of Ontario
- Katie Gasparelli, Six Nations Health Care (Advisory Group Member 2018-2020)
- Lori Davis Hill, Six Nations Health Care (Advisory Group Member 2020-2022)
- Donna Loft, Chiefs of Ontario (Advisory Group member 2018-2020)
We further acknowledge the contributions of Don McIntyre for his images and storytelling. Don was kind enough to paint the image that appears on the cover of the report, illustrating his story of the Four Hills also included in the paper. Don also generously contributed several other art works used throughout this paper. More of Don’s works can be found at Elevation Gallery in Canmore, Alberta. Thanks as well to those who connected us: Cheryl Baxter of Elevation Gallery, Anna Chief of Lakehead University, and Jula Hughes, Dean, Bora Laskin Faculty of Law, Lakehead University.
The LCO also wishes the acknowledge the contributions of Summer Law Student Scholars:
- Adrian Zita-Bennett, LCO Student Scholar
- Allison Nesbitt, LCO Student Scholar
- Jonathan Simard, LCO Student Scholar
This project would not have been possible without a dedicated project grant from the Law Foundation of Ontario (LFO).
Finally, we acknowledge that this report was written during a time of pandemic. The pandemic has further disrupted Indigenous families and communities and brought illness and pain. But it also reminds us that many Indigenous health ceremonies and traditional practices include mention of pandemics. These look back in time to the effect of colonial pandemics of the past. And they look forward in anticipation of pandemics to come. Traditional knowledge and practices are the source of much resiliency and set a path we hope this report reflects towards greater autonomy over community wellness.
Key Recommendations
The report sets out 36 recommendations, framed as “promising directions for future law reform conversations.” These recommendations are organized around four interrelated areas.
1. Reframing decision-making and consent
- Rethink legal approaches to health care consent, capacity, and substitute decision-making to better reflect Indigenous values, collective decision-making practices, and community responsibilities.
- Examine how existing legal standards can conflict with Indigenous laws and traditions governing care in the last stages of life.
2. Jurisdiction, access, and equity in care
- Address the impact of jurisdictional complexity on equitable access to health care, including the operation of Jordan’s Principle.
- Identify how federal and provincial laws intersect in ways that create barriers to timely and culturally appropriate care for Indigenous peoples.
3. Supporting Indigenous practices, caregivers, and professionals
- Facilitate traditional practices related to dying at home, death in community, and natural burials.
- Improve supports for Indigenous health professionals, family members, and caregivers providing end-of-life care.
- Expand access to Indigenous-led hospices and community-based care models.
4. Accountability and measures of quality
- Rethink how health care performance and outcomes are measured by incorporating Indigenous values, practices, and definitions of wellness.
- Create space for plural legal and intercultural approaches to accountability that support self-determination and reconciliation.
These recommendations are intended to inform future conversations between Indigenous communities, Ontario, and the federal government, and to support legal co-creation grounded in Indigenous law and governance.