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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.
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.
Between January-June 2019 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 reviewing what we heard during these engagements and formulating a draft report with input from the Advisory Group. In the spring and summer of 2020, we will invite all the communities and groups we met with to review the draft report and continue the conversation. This will lead up to release of a Final Report in later 2020.
We also invite other interested individuals and communities to join in this conversation. Should you have any questions contact Ryan Fritsch, Project Lead, at email@example.com.
Public Engagement Documents
This distinct Indigenous engagement process extends general LSL consultations conducted from June 2017 – 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
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
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:
- To ensure First Nation, Métis and Inuit have an opportunity to inform the LCO of their experiences with the last stages of life including, Palliative Care, End-of-Life Care and Medical Assistance in Dying
- To ensure that First Nation, Métis and Inuit laws and protocols are acknowledged as distinct alongside western law and policy
- To ensure any findings and analysis of the Indigenous Engagement are situated in a legal context that includes the Constitution, treaties, the UN Declaration on the Rights of Indigenous Peoples, the 94 “calls to action” of the Truth and Reconciliation Commission, case law, and community legal traditions
- To include Indigenous academic research and the knowledge and experience of Indigenous-led health sector programs
- To ensure the engagement is geographically representative
- To ensure that any community engagement include follow-up
The Law Commission held engagement sessions in southern, eastern, western, near north and northern regions across Ontario with First Nation, Métis and Inuit Elders, youth, community, medical professionals, academic researchers, government and professional association members on Palliative Care, End-of-Life Care and Medical Assistance in Dying. Engagement will continue in the spring and summer of 2020 to review a draft report.
- “Speak Up Ontario, a partnership between Hospice Palliative Care Ontario (HPCO) and the Canadian Hospice Palliative Care Association (CHPCA), provides education and Ontario-based tools and resources that comply with Ontario laws.”
- Ontario Palliative Care Network, Action Plan 1: 2017 – 2020, Action Areas, Actions and Timelines
- Aboriginal Cancer Strategy III, 2015–2019 together we wiII
- First Nations Palliative Knowledge Exchange, 2018
- Palliative Care Gaps and Challenges – Summary of Themes, FNIHCC Ontario Region, November 2018
- Dying Alone: An Indigenous man’s journey at the end of life, Case report, Canadian Family Physician, September 2018
- Home and Community Care in First Nations Communities in Ontario, Chiefs of Ontario, June 2017
- GIPPEC Symposium Report, A Search for Solutions: A Gathering on Palliative and End-of-Life Care for First Nations, Inuit and Métis Peoples, November 2016.
- First Peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada, 2015
- Moving Forward Together: A Conference about Harmonizing Indigenous Wellness in Medicine and Health Practices, Six Nations, November 2015
- Developing Palliative Care Programs in First Nations Communities: A WORKBOOK, 2015
- Recommendations to Improve Quality and Access to End-of-Life Care in First Nations Communities: Policy Implications from the “Improving End-of-Life Care in First Nations Communities” Research Project, December 2014
- Law Commission of Ontario: Past and Future
How can I get involved?
The LCO is currently reviewing what we heard during the initial engagements and formulating a draft report with input from the Advisory Group. In the spring and summer of 2020, we will invite all the communities and groups we met with to review the draft report and continue the conversation. This will lead up to release of a Final Report in later 2020.
We also invite other interested individuals and communities to join in this conversation. Should you have any questions contact Ryan Fritsch, Project Lead, at firstname.lastname@example.org. Or you may contact:
Law Commission of Ontario
Project on Last Stages of Life
2032 Ignat Kaneff Building, Osgoode Hall Law School,
York University 4700 Keele Street, Toronto, ON M3J 1P3
Phone (416) 650-8401 Toll-Free (866) 950-8406