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Engagement Overview and Status

The Law Commission of Ontario’s Last Stages of Life Project (LSL) considers how the law shapes the rights, choices, and quality of life for persons who are dying and those who support them. The “last stages of life” is an adopted term that gives the project scope to consider a life course that may include palliative care, end-of-life care, and medical assistance in dying.

This project has two distinct but complimentary components. The first is our work looking at law reform throughout Ontario. The second is an engagement with Indigenous communities in Ontario, and those Indigenous communities who use services in Ontario.

The first component was completed in October 2021 with the release of the LCO’s Last Stages of Life: Final Report. It offers 56 law and policy reform recommendations across five major areas. These would:

  • activate the earlier involvement of people in discussing and planning for their last stages of life;
  • better support the professionals and paraprofessionals who provide care and advice in the last stages of life;
  • specifically support the families, friends and community members who act as caregivers;
  • increase access to equitable care for vulnerable communities of unmet needs; and
  • help resolve disputes by making rights-based information and services available earlier and faster.

In parallel to this work, LCO commenced a distinct engagement process with First Nations, Métis, and Inuit communities in Ontario beginning in 2019. The LCO undertook these engagements in acknowledgement that health care for Indigenous peoples in Canada is in dire need of law reform. The findings of these engagements will be published in the Spring 2022 as The Last Stages of Life for First Nation, Métis and Inuit Peoples: Preliminary Recommendations for Law Reform.

Like other LCO projects, our purpose is to research issues and make law reform recommendations in Ontario that:

  • Make the law more efficient, accessible and meaningful to Ontarians
  • Promote scholarly research and debate about the law
  • Address areas when the law creates barriers to full and equal participation for all, particularly for historically disadvantaged groups.

Outreach, engagement, and consultation is fundamental to the work of the LCO. The LCO undertakes to ensure representative participation from the many diverse voices and various groups across Ontario.

Consistent with this commitment, the LCO sought advice and received a recommendation that supported the establishment of a distinct process and materials to engage with Inuit, Métis, and First Nation members in Ontario. The purpose of the engagement process is to identify and hear about Indigenous laws and experiences in the last stages of life. We believe this effort will highlight promising directions for future engagement in discussing the legal frameworks shaping health care between Indigenous communities and the provincial and federal government.

The LCO commenced the first phase of indigenous engagement with visits to, and conversations with, over a dozen communities and groups between January and June 2019. This was supported by an Indigenous Engagement Lead and overseen by an external Indigenous Engagement Advisory Group.

The LCO is currently working with the Indigenous Engagement Advisory Group to formulate a draft report. Once this draft is ready, we will share it first with all the communities and groups we met with to review it and continue the conversation. This will lead up to release of a Final Report in Spring 2022.

We also invite other interested individuals and communities to join in this conversation. Should you have any questions contact Ryan Fritsch, Project Lead, at rfritsch@lco-cdo.org.

Public Engagement Documents

This distinct Indigenous engagement process extends general LSL consultations conducted from June 2017 to September 2018. These consultations materials are available on the Last Stages of Life Project page.

The materials include specific discussion materials about the ways in which historical and contemporary colonial law shapes the experience of Indigenous people in the last stages of life. It also recognizes how the concept of the “last stages of life” is itself a problematic framework and may not align with Indigenous spiritual and world views.

The LCO understands the term Indigenous to include First Nation, Métis and Inuit, and includes status and non-status. The use of the term Indigenous is adopted from the UN Declaration on the Rights of Indigenous Peoples in which Indigenous is not defined. The Indigenous representatives of the United Nations Working Group 1996 stated, “We categorically reject any attempts that Governments define Indigenous Peoples” and instead endorsed the concept of “indigenous” which acknowledges the right of Indigenous peoples to name themselves.

Last Stages of Life Project Timeline

  • 2014 – Registered Nurses Association of Ontario requested Law Commission of Ontario (LCO) study Medical Assistance in Dying
  • 2014 – LCO Board approved
  • 2014/15 – LCO engaged in preliminary consultations of 100 individuals and organization
    • incorporated previous LCO reports on Legal Capacity, Decision Making and Guardianship; Framework of law as it Affects Older Adults and Persons with Disabilities
  • 2015 – establishment of Advisory Group for the Last Stages of Life project
  • 2015 – Call for research papers
  • 2016 – LCO commissioned 7 independent research papers
  • 2017 – Publication of a Last Stages of Life ‘Discussion Paper’, ‘Consultation Issues Map’, ‘Issues Backgrounder’ and ‘Executive Summary’’
  • 2017 – Call for written submissions
  • 2017-2018 – LCO conducted 70 Consultations across Ontario with 720 participants
  • 2017 – Preliminary scan of First Nation, Métis and Inuit led research and projects
  • 2018 – Indigenous Roundtable
  • 2018 – Establishment of the Indigenous Engagement Advisory Group, retaining Indigenous Engagement Lead for the project
  • 2019 – January – June conducted engagement sessions in communities and groups
  • 2019 – 2020 – continued engagement around a draft report
  • 2020 – 2021 – ongoing review of an initial draft report with the Indigenous Advisory Group

Indigenous Engagement Advisory Group

The purpose of the Indigenous Engagement Advisory Group (IEAG) is to provide the LCO with advice and direction from First Nation, Métis and Inuit Elders, youth, community, medical professionals, academic researchers, government and professional association members on how LCO might conduct Indigenous Consultation on Palliative Care, End-of-Life Care and Medical Assistance in Dying. The establishment of the IEAG took place over several steps in 2018:

  • March 2018 – Roundtable “Developing Indigenous Consultations”
    • IEAG requested LCO do a Scan of Indigenous-led end-of-life care programs and research
    • LCO compiled preliminary analysis of 13 LCO Consultation issues identified for LSL and What LCO heard from the Indigenous Engagement Advisory Group
  • April 2018 – Developed into a standing Indigenous Engagement Advisory Group (IEAG) to provide advice and guidance to LCO on Indigenous Engagement and matters related to the LSL
    • IEAG recommended the retaining an Indigenous lawyer to lead Indigenous Engagement
  • November 2018 – LCO retained an Indigenous Engagement lead to assist with the design, implementation and analysis of Indigenous Engagement
  • 2019 – January – June conducted engagement sessions in communities and groups
  • 2019 – 2020 – continued engagement around a draft report

Indigenous Engagement

LCO established an Indigenous Engagement Advisory Group in 2018 to ensure that First Nation, Métis and Inuit lens applied on the Last Stages of Life project (LSL). The Indigenous Engagement Advisory Group helped establish priorities for the engagement. These are: