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Background

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 intended to reflect the experience of dying as a process or a continuity of events, whether as a result of terminal illness, chronic conditions, or serious frailties. The project considers 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. The LCO is now preparing to establish a distinct engagement process to identify and hear about Indigenous laws and experiences in the last stages of life. This will take place in early 2019. This distinct Indigenous engagement process extends general LSL consultations conducted from June 2017 – May 2018. Those consultations materials, are available on the Last Stages of Life Project page. 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 Time Line

  • 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

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

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 outcome of the Indigenous Engagement is to incorporate First Nation, Métis and Inuit recommendations on the Last Stages of Life in a final report to the Ministry of the Attorney General.

Next Steps

The Law Commission will hold 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.

Resources

How can I get involved?

The Law Commission’s Indigenous Engagement period will run through January – April 2019. The Law Commission invites your participation through:

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     

Email: lawcommission@lco-cdo.org                                       

Phone (416) 650-8401    Toll-Free  (866) 950-8406