One of the most significant transformations to Canadian Healthcare has been the passage of Medical Assistance in Dying (MAiD) in 2016, an amendment to the Criminal Code which allows patients to seek a physician’s help ending their life when they are facing a painful and ‘reasonably foreseeable’ death (Carter v. Canada, 2015; Health Canada, 2019). With barely half a decade of MAiD in our collective experience, the federal government has passed Bill C-7, a controversial piece of legislation which eliminates the requirement of a ‘reasonably foreseeable’ death, potentially expanding MAiD’s availability to more patients than ever before (Department of Justice, 2020).

To date, no research on MAiD in Canada has focused on cultural safety, nor has research on MAiD been led by Indigenous communities (Hemlock AID, 2020). Furthermore, while the legislation allows faith-based facilities to decline to provide MAiD, neither the legislation nor the forms establish a clear framework for ensuring patients’ spiritual needs – Indigenous or otherwise - are met (Carter v. Canada, 2015; BC Ministry of Health, 2020). However, death does not discriminate. People who self-identify as Indigenous will experience death in the health care system, and some may request MAiD. Cultural safety is just as important for a medically assisted death as it is for care in a cardiac unit, pain clinic, or medical imaging facility, and cultural safety cannot take place if the healthcare system is neither culturally sensitive nor culturally aware (Cajax & Schill, 2019). 

Originally, this project was designed with a focus on Indigenous patients, families, and their experience of MAiD. However, after extensive consultation with Indigenous colleagues, and an ethics review with FNHA, it was determined that the project was neither led or designed by enough of an Indigenous majority, or closely tied to a specific Indigenous community to allow for the research itself to be culturally safe. Concerns included power dynamics, cultural practices around death, and the potential for generalizing Indigenous experience rather than recognizing the great diversity of indigenous peoples in BC. Out of respect for this feedback, we shifted to focus how settlers can contribute to an environment that might feel more culturally safe. We hope this research opens a conversation and inspires Indigenous researchers and communities to lead their own research in the future.

Sharing this research, and hopefully inspiring other healthcare leaders to engage in the 6-week self-reflection module, and implement the recommendations in their daily practice. If education, consultation, orientation to opportunity, recognition of identity, and relationships are central aspects of an increasingly larger number of healthcare leaders’ approach to their work, Indigenous professionals, patients, and communities will have an easier time offering and implementing culturally safe policies and programs.