In Indigenous communities, MAiD is a fraught conversation

National Observer

2 days ago

During the darkest days of the COVID-19 pandemic, James Frank Palmater faced relentless, crushing pain. A massive heart attack had reduced his heart function to only 15 per cent. The isolation of social distancing in his palliative care ward deepened his suffering.
Two and a half weeks after the infarction, he sought Medical Assistance in Dying (MAiD).
His partner, Mary Palmater, an Indigenous elder living in New Brunswick, supported him fully. 'We always had a pact,' she said. 'If he decided, I would support him 100 per cent and vice versa.'
During her husband's final days at a Fredericton hospice, staff explained the MAiD process carefully and made room for cultural traditions, including allowing a drummer to be present during his passing, which brought the family an immense measure of peace.
'They bent over backwards to accommodate it,' she said. 'Even a few months after, they kept in contact with me, just to see how I was doing.'
The degree of care, cultural safety and communication they received should be widely available across Indigenous communities in Canada, she said.
'People should know their options,' she said. 'If there's no hope and no return, people should be supported to go with dignity.'
'When people pass in our communities, our whole community shuts down for a period of time. ... It's not something we take lightly whatsoever,' said Josie Nepinak, president of the Native Women's Association of Canada.
Yet this experience is an exception, not a norm: many Indigenous communities face persistent barriers that call into question whether MAiD is truly a free choice or a forced response to systemic issues.
According to the document obtained by Canada's National Observer through an access-to-information request, since late 2023, the federal government has invested more than $3.3 million to support Indigenous-led consultations across the country. These include roundtables, sharing circles and surveys that involve hundreds of participants from diverse Indigenous communities — urban, rural and remote — as well as 2SLGBTQI+ groups, elders and health practitioners. With the mental health crisis and high suicide rates in Indigenous communities, these efforts pave the way for a broader conversation around MAiD, which has largely remained unexplored until now.
State of choice
Medical assistance in dying became legal in Canada in 2016 for adults with 'grievous and irremediable' conditions where death is 'reasonably foreseeable.' Since then, eligibility has gradually expanded, including plans to broaden access to those with mental illness as their sole condition — a change delayed until at least 2027 amid widespread concern.
Brendon Moore, national chief of Congress of Aboriginal People — a group that represents the interests of Indigenous people is concerned that expanding MAiD, especially for those with mental illness as a sole condition — is especially troubling in communities that already experience the highest rates of suicide as a result of intergenerational trauma and systemic racism.
The nightmare scenario: MAiD could substitute investments in living supports and mental health care if underlying conditions aren't addressed first.
'We're looking for an equitable opportunity to live first,' he said. 'If we had culturally safe palliative care and mental health support, some people might choose that path instead of moving toward MAiD.'
The Congress of Aboriginal Peoples grew concerned about MAiD after seeing an increase in requests from Indigenous inmates, who continue to be overrepresented in the federal correctional system.
'We believe compassionate release should be prioritized, allowing individuals the opportunity to make end-of-life decisions with dignity, surrounded by family and cultural support and not from within a prison cell,' Moore said.
This problem reflects broader systemic struggles confronting Indigenous communities nationally.
Moore said many Indigenous people, especially those living off-reserve, were left out of the MAiD national discussion. Their group stepped in to voice their concerns because these laws impact Indigenous communities that had no role in shaping them.
'Our main concern is that medical assistance in dying will become the easier choice for people within our communities that are continuing to struggle with the systemic barriers that are placed in front of them,' Moore said.
Culturally safe care
Josie Nepinak, president of the Native Women's Association of Canada, which has been at the forefront of research into MAiD's impact on Indigenous women, Two Spirit, and gender-diverse people, said communities are deeply divided. Some people see it as supporting personal choice, while others feel it conflicts with their spiritual and cultural beliefs about family and traditions.
The most pressing challenge, she said, is the lack of culturally safe healthcare — which undermines true, informed choice.
According to a Native Women's Association of Canada report funded by Indigenous Services Canada as part of a national effort, 85 per cent of providers serving Indigenous communities have had no formal cultural safety training for MAiD, leaving 'many Indigenous patients without true support at the most vulnerable times in their lives,' Nepinak said. Even Indigenous healthcare providers reported inadequate support for navigating the tensions between rigid Western healthcare systems and Indigenous cultural beliefs.
Urban Indigenous organizations like the National Association of Friendship Centres provide vital culturally appropriate services to a large population of Indigenous people annually, offering healthcare navigation, mental health support and cultural connection.
Jocelyn Formsma, CEO of the association, said many Indigenous people have to leave home to get health care — often traveling from remote reserves or northern communities to urban centers for everything from cancer treatments to palliative care.
'There's no guarantee that they're able to access culturally relevant health care services when they do come to the city,' she said.
While a handful of hospitals and some provinces are trying to add Indigenous programming, it's 'still kind of part and parcel of the mainstream system,' she said.
Friendship centres have stepped in to offer basic health clinics, navigation programs, hospital visits and support during serious illnesses or end-of-life care. In some communities, they provide rides to appointments, help families understand their options and ensure people are treated with respect and cultural understanding. But most friendship centres lack regular funding or formal recognition for this work, so support is 'ad hoc, depending on the community you're in,' Formsma said.
Without better access and culturally safe care, MAiD risks being chosen as a result of lack of hope, resources or social connection rather than true free will, Nepinak said.
'When people pass in our communities, our whole community shuts down for a period of time. ... It's not something we take lightly whatsoever,' she said.
Surface engagement
A Health Canada spokesperson told Canada's National Observer it's continuing to work with Indigenous communities on MAID and end-of-life care and to increase participation in that consultation, the survey was shared with Indigenous Services Canada, provinces and territories and various Indigenous organizations.
However, Moore described their efforts as 'surface engagement' that only 'touch[ed] on the topic,' lacking the resources for meaningful dialogue involving knowledge keepers and elders.
Moore said MAiD makes sense in some cases, but for most Indigenous communities, the reality remains much more complex. Meaningful consultation would require investing heavily in ongoing community conversations, allowing time for reflection and multiple rounds of feedback, which has not been provided so far.
'We're really still in the baby steps of reconciliation. Reconciliation is meant to bring us back to par with the average Canadian and their rights, but this is a very Western perspective, not something you find in many of our ways. It's deeply concerning that work is moving forward on things like this and attempting to make it law, when we still haven't made much progress on reconciliation,' Moore said.
The department stated that it will share more details about its consultations later this summer but has not responded to further questions.