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Journey Carriers A Community Toolkit for Understanding Medical Assistance in Dying (MAiD)

Acknowledgements Contributors

The Journey Carriers Toolkit was guided and informed by the generosity, experiences, and insights of members of the Indigenous Mental Wellness Workforce. We acknowledge the time, care, and knowledge shared by individuals working across diverse community contexts who support people, families, and communities navigating conversations related to Medical Assistance in Dying (MAiD). This includes, among others, Resolution Health Support Workers, Cultural Support Workers, members of Mental Wellness Teams, Crisis Response Teams, and other trusted helpers who contributed reflections, identified needs, and shared practical guidance rooted in community realities. Their contributions helped ensure this resource reflects strengths-based, culturally grounded, and relational approaches to end-of-life care and decision-making.

Contribution of FPWC Staff and Teams

This toolkit was developed by First Peoples Wellness Circle staff. We acknowledge the contributions of the Special Projects Team, whose work supported the research, writing, review, coordination, and knowledge translation of this resource. This toolkit reflects a collaborative effort grounded in shared values and a commitment to supporting Indigenous mental wellness, dignity, and informed choice.

Ownership

The knowledge reflected in this toolkit is held collectively by the individuals and communities who contributed to this work. First Peoples Wellness Circle acts as a steward of this knowledge and carries a responsibility to use it respectfully, ethically, and in ways that honour community experience and intent.

Funders

This resource was supported by funding from Indigenous Services Canada.

Suggested Citation

First Peoples Wellness Circle. 2026. Journey Carriers: A Community Toolkit for Understanding Medical Assistance in Dying (MAiD). North Bay, Ontario.

Journey Carriers

The Pasqueflower The pasqueflower is among the first blooms of spring. It symbolizes transition, resilience, and the quiet strength required in moments of profound change. Within this toolkit, it reflects a wholistic understanding of Medical Assistance in Dying (MAiD) that honours autonomy, dignity, and relational responsibility. Growing close to the earth and emerging amid shifting seasons, the pasqueflower reminds us that courage and gentleness can coexist. This is helpful to keep in mind, since conversations and decisions related to MAiD affect individuals, families, care providers, and communities. They can bring strong emotions and a sense of urgency. The pasqueflower calls us to stay close to the ground: to steady ourselves, allow space for what arises, and choose our next steps with care. As people navigate MAiD in different roles, the pasqueflower invites humility and compassion. Even in complex and tender spaces, we are connected, and how we walk with one another matters.

Table of Contents

Section 1: Introduction

Section 2: Understanding MAiD

Section 3: MAiD at a Glance: Pathway Overview

Section 4: Realities That Shape MAiD Conversations

Section 5: Cultural, Spiritual, and Relational Considerations

Section 6: Tools to Support Individuals, Families, and Helpers

Section 7: Grief, Bereavement, and Cultural Supports

Section 8: Glossary

Section 9: Resources

Use these icons in the toolkit to support your learning journey:

Facts/Tips

Journey Carriers

Activities

Gentle Reflections

Glossary/Resources

Introduction

Section 1

The toolkit offers clear and gentle guidance that builds on the strengths, teachings, and relational approaches already present in Indigenous families and communities. It honours Indigenous perspectives on care, decisionmaking, and end of life, and recognizes the importance of connection to family, community, land, and spirit. Families and helpers shared that information about Medical Assistance in Dying (MAiD) can feel difficult to navigate, or is often presented in ways that do not reflect Indigenous realities. This toolkit brings together explanations, tools, and considerations that support conversations in ways that feel safe, grounded, and culturally aligned. While MAiD is a legal and medical process, this resource does not provide clinical advice. Families are encouraged to speak directly with healthcare providers for medical or legal guidance. It walks alongside the strong caregiving traditions and cultural practices held in communities. It supports clarity and conversation, and helps families explore what feels right for them.

Purpose of the Toolkit The Journey Carriers Toolkit was developed by First Peoples Wellness Circle to support the Indigenous Mental Wellness Workforce. This includes Resolution Health Support Workers, Cultural Support Workers, Mental Wellness Teams, Crisis Response Teams, and other trusted helpers who walk alongside families during times of illness, care, and transition.

Journey Carriers Toolkit – Introduction

Indigenous Understandings of Life, Care, and End of Life

The Role of Ceremony and Cultural Practices

For many Indigenous Peoples, conversations about illness, care, and the end of life are connected to teachings, relationships, land, and spirit. While each Nation carries its own knowledge and practices, many families share common themes that shape how they understand illness and difficult decisions.

• • • • • •

This section does not define what Indigenous teachings “should” look like. It creates space for the diverse understandings already present across Nations, families, and communities.

Ceremony may guide: Reflection Emotional preparation Clarity Healing The spirit’s transition Support for family and community

Ceremony is not only a ritual; it is medicine, grounding, and connection.

Strengths Passed Through Generations Indigenous Peoples carry generations of: Life and Death as Part of a Larger Journey Across many Indigenous traditions, life does not end—it changes. Families may understand dying as a transition where: • • • •

The spirit continues its journey Ancestors welcome loved ones Teachings guide the spirit Connection remains after physical death

These teachings can offer grounding and comfort, especially when decisions feel heavy or unclear.

• • • • •

Caregiving Collective responsibility Compassion Resilience Ways of supporting loved ones through illness and transition

These strengths guide families even in difficult or confusing moments.

Relational Decision-Making Indigenous decision-making often involves: • • • • •

Family Community Elders and Knowledge Carriers Those who hold responsibility for the person Land, ceremony, and spirit

Journey Carriers Toolkit – Introduction

The person may be at the centre, but decisions are supported by relationships. Choice is not isolated: it is held within a web of connections.

Why MAiD Conversations Can Feel Different for Indigenous Families

Gentle Reflection

Families shared that MAiD brings up many layers, including:

Are there teachings, stories, or experiences that shape how you understand illness or end of life?

•

The impacts of colonization on trust in health systems

•

Past experiences with institutions

What has guided your family through past times of illness or transition?

•

Jurisdictional barriers and access issues

•

Fear of being pressured due to limited care options

•

Teachings about suffering, purpose, or the spirit

•

The desire to honour ancestors and tradition

•

The wish to avoid burdening family members

•

Cultural responsibilities around care and transition

MAiD may raise sensitive questions about autonomy, consent, and what it means to support someone at the end of life in culturally aligned ways.

Acknowledging Inequities and Realities Many Indigenous communities experience:

Journey Carriers Toolkit – Introduction

•

Limited palliative or home care

•

Lack of culturally safe care

•

Fewer local health resources

•

Long-distance travel for medical services

MAiD is shaped by these realities— not because families are unprepared, but because systems have not always supported them. Acknowledging inequities helps create safer, clearer conversations.

Who This Toolkit Is For This toolkit can support:

It can be used when:

•

Members of the Indigenous Mental Wellness Workforce

•

Someone begins asking questions about MAiD

•

Family caregivers and loved ones

•

Community helpers and supporters

Families want help understanding what MAiD is

•

Workers are navigating emotional or complex conversations

•

An individual is exploring options for comfort and care

•

Communities want information grounded in relational and cultural approaches

•

Elders and Knowledge Carriers who guide end-of-life conversations Individuals who are curious about or considering MAiD

A Few Things to Keep in Mind Conversations about MAiD can bring forward many emotions. Each family carries its own strengths, history, and cultural grounding into these moments. This toolkit does not direct anyone toward or away from MAiD. It supports safety, clarity, and culturally aligned decision-making in whatever path a family chooses.

Whether you are helping someone at home, supporting someone from a distance, or responding to a new question, this toolkit can be adapted to your role, your community, and your way of working.

How This Toolkit Was Created The content in this toolkit follows a Two-Eyed Seeing approach. It brings together Indigenous and Western ways of understanding care, choice, and end of life. It recognizes the importance of: •

Family and community-based decision-making

•

Ceremony and cultural practices

•

The impacts of colonization and inequities on current experiences

•

Distinctions across Nations, languages, and teachings

Journey Carriers Toolkit – Introduction

This toolkit does not present one “right” path. It offers options, tools, and considerations that can be shaped by each family’s teachings, beliefs, and supports.

Section 2

Understanding MAiD

Journey Carriers

What MAiD Is

What MAiD Is Not

Eligibility

Assessments and Consent

MAiD Within a Circle of Care

Consent, Capacity, and Power of Attorney

Why This Section Matters

What MAiD Is

Gentle Reflection

MAiD is a legal medical option in Canada where a doctor or nurse practitioner provides medication that intentionally ends a person’s life. It is available only to adults who request it themselves and who meet specific legal criteria.

What questions or feelings come up for you as you learn about MAiD? What parts of this information feel clear, and what parts feel heavy or confusing?

Important to know:

It is normal for understanding to unfold slowly. Questions and mixed emotions are part of learning about difficult topics.

MAiD is always voluntary. The person must understand the process and give consent at every step.

Some people learn about MAiD to explore all available options. Others may not consider it at all. Understanding MAiD helps people ask informed questions and make decisions that feel right for them.

What MAiD Is Not MAiD is often misunderstood. It may help to know that MAiD is not: • • • • • • •

Something a provider can pressure someone into Something a family member can request on someone else’s behalf Available for anyone under 18 Available based on dementia alone once a person is no longer able to provide informed consent (except in limited circumstances under Quebec law) Available for mental illness alone (federal pause until at least March 17, 2027) A replacement for comfort-focused or palliative care An emergency decision that must be made quickly

Eligibility To be eligible for MAiD, a person must:

• • • • • •

Be 18 years or older Be eligible for health services in Canada Have a serious and incurable illness, disease, or disability Be in an advanced state of irreversible decline in capability Be experiencing suffering they find unbearable Be able to make their own decisions and give informed consent

Families do not need to interpret this alone. Healthcare providers walk through this with the person at their own pace.

Journey Carriers Toolkit – Understanding MAiD

Assessments and Consent If someone wishes to explore MAiD, two independent healthcare providers must complete assessments. These conversations help ensure that: • • • • •

The person understands their condition The choice is voluntary All care options have been explained Legal requirements are met The person has capacity to make the decision

Consent, Capacity, and Power of Attorney MAiD requires that the person themselves make the request and provide informed consent. Even if someone has a power of attorney or is a substitute decision-maker for other health decisions, they cannot request MAiD or consent to MAiD on another person’s behalf.

Assessments can happen in person or virtually.

The law requires that:

The person can pause or stop the process at any time. Consent must be ongoing.

• • • •

Consent can also be withdrawn at any time.

MAiD Within a Circle of Care MAiD is only one of many supports available to people living with serious illness. Families often find it helpful to explore: • • • • • • •

The request must come from the person The person must understand the information being shared The decision must be voluntary (free from pressure) The person must have decision-making capacity during key parts of the process

In some situations, a person who has been found eligible for MAiD may be able to complete a written waiver of final consent, which can allow MAiD to proceed if they lose capacity later (for example, when natural death is reasonably foreseeable). This option applies only in certain situations. A MAiD assessor or provider can explain whether this applies in a specific situation.

Comfort-focused or palliative care Pain and symptom management Hospice services Home-based support Emotional, cultural, and spiritual care Ceremony or teachings Family or community caregiving

Learning about MAiD does not mean choosing MAiD. It simply helps families understand the full picture of care.

Journey Carriers Toolkit – Understanding MAiD

Why This Section Matters Understanding MAiD helps families and helpers: • • • • •

Move through conversations with less fear Bring informed questions to healthcare teams Explore all care options Make decisions grounded in values and teachings Move at a pace that feels safe

Getting more information about MAiD supports clarity during a difficult and emotional time.

Gentle Reflection Do you feel you have enough information right now, or would more time or support help? What would help this conversation feel slower or less pressured? There is no expectation to decide right away. It is okay to pause, ask for clarification, or return to this conversation later.

CarriersToolkit – Understanding MAiD Journey Carriers

Section 3

MAiD at a Glance

Journey Carriers

Overview of What the MAiD Pathway Can Look Like

Purpose of This Section

MAiD at a Glance A simple and gentle overview of what the MAiD pathway can look like.

First assessment A trained MAiD assessor, such as a doctor or nurse practitioner, meets with the person to: • • • • •

Families and helpers often share that MAiD can feel overwhelming at first. This section offers a steady and easy-to-follow picture of the steps someone may move through. Every province and territory organizes MAiD in its own way, so the experience may look slightly different depending on where someone lives. This is not meant to guide decisions. It is simply here to support understanding.

Understand their situation Explain the MAiD process Discuss eligibility Talk about care options Answer questions

This conversation can happen in person or virtually. The person may pause here if they need more time. Only MAiD assessors and providers determine eligibility and capacity under the law.

A person can pause or stop at any step. There is never an obligation to continue.

Overview of What the MAiD Pathway Can Look Like

First questions or curiosity Someone may first hear about MAiD and feel unsure, emotional, or overwhelmed. Others may simply want more information. At this stage, people often: • • •

Second assessment A second provider meets with the person. This confirms that: • • • •

Ask a helper, Elder, family member, or provider for support Want clarity about what MAiD really means Explore all available care and comfort options

The choice is voluntary The person understands what MAiD means The legal criteria are met The information has been shared clearly

Both assessors must agree before MAiD can move forward.

There is no requirement to move beyond this step.

Asking for more information If the person wants to know more, they may ask: • • •

“Can I learn more about MAiD?” “What supports are available besides MAiD?” “What can care look like going forward?”

Some people explore MAiD. Others explore palliative care, home supports, or cultural and ceremonial practices. All are valid.

Journey Carriers Toolkit – MAiD at a Glance

Time for reflection There is no rush. Reflection is an important part of the process. People may: • • • • •

Talk with family Meet with Elders or Knowledge Carriers Hold ceremony or prayer Revisit questions Pause for as long as needed

Choosing to pause is a valid choice. Choosing not to continue is also valid.

Ongoing consent If a person chooses to continue, they must give: • • •

Voluntary consent Informed consent Consent at every stage

Aftercare for family and community After someone passes, families may need space, guidance, or grounding supports. These may include: • • • • • •

Consent can be withdrawn at any time, including on the day MAiD is scheduled.

Ceremony or prayer Teachings Time on the land Gatherings Grief supports Help connecting with community resources

Grief is not linear. Families and helpers may seek support at different times.

Planning the details If the person wishes to proceed, they may talk about: • • • •

Where they would like to be Who they want with them Any cultural or ceremonial needs What matters most on that day

Families and helpers can support this if the person wants them involved.

MAiD occurs (if the person chooses it) A trained MAiD provider, such as a doctor or nurse practitioner, administers the medication. Not all providers offer MAiD, and access is coordinated through MAiD programs or referral services. This happens only with clear, ongoing consent.

Purpose of This Section This overview helps people: • • • • • •

Understand that they can move slowly Know what to expect in a general way Feel less overwhelmed Ask questions Recognize that MAiD is voluntary Explore all their options

A person can pause, stop, or change direction at any point. The pathway is grounded in choice, clarity, and care.

Journey Carriers Toolkit – MAiD at a Glance

Section 4

Realities That Shape MAiD Conversations

Creating a Safe and Supportive Environment

Differences Across Regions

Access to Hospice, Home Care, and Other Supports

Communication and Information Needs

Decision-Making During Difficult Moments

Understanding Consent

Emotional Realities

Why This Section Matters

35 29

Creating a Safe and Supportive Environment Every family’s experience with serious illness is shaped by their relationships, strengths, and teachings, as well as the systems that surround them. When MAiD enters the conversation, it is often during periods of change, exhaustion, or uncertainty. These conversations do not happen in isolation. They happen within real lives, real histories, and real communities. This section offers grounding to help individuals, families, and helpers understand the many factors that can shape conversations about MAiD, especially in Indigenous contexts. This is not meant to direct decisions. It simply helps bring clarity and understanding during a difficult time.

Differences Across Regions MAiD is guided by federal law, but each province and territory organizes services in its own way. This means that the MAiD process may look different depending on where someone lives. Families may notice differences in: • • • • • •

How referrals are made How long steps take Whether a MAiD coordination team exists Whether assessments can be done virtually What supports are available locally Whether travel is required

Access to Hospice, Home Care, and Other Supports Many Indigenous communities experience unequal access to health supports. Some families may have access to hospice, palliative care, home visits, or symptom management, while others may have very limited options. Access may be shaped by: • • • • • • • •

Distance from larger health centres Staffing shortages Limited home-care availability Lack of respite care Gaps in after-hours support Jurisdictional challenges Lack of culturally safe care Weather or transportation issues

These realities do not reflect the quality of care or love within the family. They reflect longstanding inequities in the healthcare system. Helpers can support families by: • • • • •

Validating their concerns Helping them ask about available supports Assisting with navigation Slowing the pace of conversations Helping families prepare questions for healthcare teams

Families deserve care that respects their needs, teachings, and circumstances, wherever they live.

For many Indigenous families, these differences can be layered with other circumstances, like rural or remote living, transportation barriers, seasonal roads, or limited local services. These differences are not a reflection of a family’s strength or ability to care. They are the reality of how health systems are structured. Understanding these variations can reduce confusion and help families feel less alone.

Journey Carriers Toolkit – Realities That Shape MAiD Conversations

Communication and Information Needs

Decision-Making During Difficult Moments

Serious illness often brings more information than families can process. Appointments may be rushed. Providers may use unfamiliar words. People may be tired, emotional, or in pain when important information is shared.

Conversations about MAiD often arise during times of:

It is common for families to feel unsure about: • • • • •

What they were told What their options are Who they should speak to next Whether MAiD is being suggested What the next steps might look like

Families do not need perfect understanding in one conversation. Clarity can grow over time. Helpers support families by offering: • • • • •

Calm, steady explanations Time to revisit information Simple language Help preparing questions Encouragement to slow the conversation if needed

Clear information supports emotional safety and reduces fear.

• • • • • •

Pain Fatigue Sudden changes in health Caregiver burnout Emotional overwhelm Worry about burdening others

These moments can make decisions feel heavier, even when there is time. Helpers can offer grounding by: • • • • • •

Reminding families that MAiD is not an emergency Slowing conversations down Encouraging breaks Supporting cultural or ceremonial grounding Helping families think about what matters most Allowing time for reflection or family meetings

Moving slowly is a sign of care, not uncertainty.

Understanding Consent MAiD requires that the person understands their situation, makes the request themselves, and gives ongoing consent. The law requires that: • • • •

The decision comes from the person The person understands the information The choice is voluntary Consent continues at every step

Helpers do not assess consent or capacity. Healthcare providers do that. But helpers can prepare families by: • • •

Encouraging them to express their wishes clearly Helping them think about how to share information Reminding them that they can pause or stop at any time

Consent is about clarity, not pressure. 32

Journey Carriers Toolkit – Realities That Shape MAiD Conversations

Emotional Realities

Why This Section Matters

When MAiD enters the conversation, many emotions may surface at once.

These realities help families and helpers:

Families have shared feelings of:

Helpers offer grounding when they:

• • • • • • • • • •

• • •

Fear Sadness Relief Confusion Hope for comfort Uncertainty Anger Protectiveness Cultural concern Love

• •

Listen without judgement Acknowledge all emotions as valid Hold space for silence, tears, or reflection Support cultural or spiritual practices Sit with families during heavy moments

• • • • • •

Feel less overwhelmed Understand that variations across regions are normal Recognize that questions and confusion are valid Identify supports that may help Move through conversations at their own pace Feel seen, respected, and understood

This section does not tell families what decisions to make. It simply acknowledges the landscape they are navigating and creates space for clarity, compassion, and connection.

Emotional support is as important as medical care.

There is no single right way to feel.

Gentle Reflection What emotions feel closest to the surface right now? What helps you feel steadier when emotions feel heavy?

There is no right or wrong way to feel. Emotions may shift over time, and support can look different from day to day.

Journey Carriers Toolkit – Realities That Shape MAiD Conversations

Section 5

Cultural, Spiritual, and Relational Considerations

Journey Carriers

Family and Community Roles

Teachings and Beliefs About Life, Death, and Transition

Ceremony and Cultural Practices

The Need for Time and Space

Supporting Clarity and Shared Understanding

The Role of Elders and Knowledge Carriers

Why Cultural, Spiritual, and Relational Considerations Matter

Cultural, Spiritual, and Relational Considerations Across Indigenous Nations, conversations about illness, care, and end of life are deeply connected to culture, relationships, and spirit. Teachings do not all look the same. Each family carries its own ways of understanding life, transition, and care. This section does not define what culture or spirituality should look like. Instead, it creates space for the knowledge, practices, and strengths already held by families and communities. MAiD can be an emotional and difficult topic. For many Indigenous people, decisions about care are tied to family, community, ancestors, land, and spiritual beliefs. Helpers can support families by encouraging grounding, clarity, and connection during these conversations.

Family and Community Roles Many Indigenous families make decisions together. Illness often brings together: • • • • •

Children and grandchildren Siblings and extended family Caregivers and close friends Community members Elders and Knowledge Carriers

Decision-making may be a collective act rather than an individual one. Shared responsibility is a form of strength and a reflection of care. Helpers can support this by: • • • • •

Asking the person who they want involved Allowing more time for family discussions Helping clarify information in large groups Supporting communication between family and care teams Respecting that decisions may move slowly

Collective decision-making is not a barrier. It reflects the deep relational ties that many families carry.

Journey Carriers Toolkit – Cultural, Spiritual, and Relational Considerations

Teachings and Beliefs About Life, Death, and Transition Indigenous Peoples hold diverse teachings about: • • • • • •

The spirit’s journey The role of ancestors Transitions at end of life The relationship between land, body, and spirit Preparing for the next part of the journey The ongoing presence of loved ones who have passed

These teachings can guide how families understand suffering, comfort, and choice. They can offer grounding during moments of uncertainty. Helpers do not need to interpret or explain these teachings. Simply making room for them can bring strength and clarity.

Gentle Reflection Are there teachings, beliefs, or practices that you would like to bring into this conversation? What does care look like when it feels culturally or spiritually aligned for you?

Ceremony and Cultural Practices Ceremony is a source of strength for many families, especially during times of transition or grief. Cultural practices may include: • • • • • • • •

Smudging Prayer Songs or drumming Quiet reflection Traditional medicines Time on the land Preparing the space Connecting with an Elder or Knowledge Carrier

Families may use ceremony to: • • • • • •

Bring comfort Prepare emotionally or spiritually Honour loved ones Support decision-making Guide the spirit Come together as a family

Some families may choose not to use ceremony at certain times. This is also valid. Cultural expression belongs to the family and is guided by their own teachings and experiences. Helpers can support this by: • • • • •

Asking gently what practices feel important Helping families plan for ceremony if they wish Communicating cultural needs to the care team Ensuring privacy or space for spiritual practices Supporting connections with Elders or Knowledge Carriers

Ceremony can help families feel grounded, connected, and supported. These reflections belong to you and your family. There is no expectation to have answers right away, and teachings may reveal themselves over time.

Journey Carriers Toolkit – Cultural, Spiritual, and Relational Considerations

The Need for Time and Space

Supporting Clarity and Shared Understanding

Illness can create a sense of urgency, but decisions about care do not need to happen quickly. Families often need time to:

Family members do not always carry the same view of illness or end-of-life care. This does not mean they are in conflict. It means they care deeply and are navigating something difficult.

• • • • • • •

Meet together Connect with Elders or Knowledge Carriers Reflect on teachings Gather emotional strength Understand options Consider what aligns with their values Think about how choices affect the family and community

Helpers play an important role in slowing the pace. Pausing creates space for clarity, grounding, and emotional safety. A reminder like, “You do not have to decide today,” can ease pressure.

Differences may arise in: • • • • • •

How teachings guide the decision What suffering means How much treatment should continue What comfort looks like What MAiD means culturally or spiritually How quickly decisions should be made

Helpers support clarity by: • • • • •

Using simple, steady language Slowing the conversation down Helping families express their perspectives Summarizing information gently Making space for the person’s voice to remain central

Shared understanding does not mean agreement. It means everyone feels heard, informed, and honoured.

Journey Carriers Toolkit – Cultural, Spiritual, and Relational Considerations

The Role of Elders and Knowledge Carriers Many families seek guidance from Elders or Knowledge Carriers during difficult conversations. They may: • • • • • •

Share teachings Offer emotional and spiritual grounding Support preparation Guide ceremony Help families reflect on values and relationships Bring calm, strength, and reassurance

Helpers can support this by: • • • •

Asking whether the family would like guidance Helping them make connections if requested Respecting when families prefer to speak privately Holding space for teachings shared in confidence

Elders bring grounding and continuity that clinical care cannot replace.

Why Cultural, Spiritual, and Relational Considerations Matter When conversations honour culture, relationships, and spirit, families often feel: • • • • • •

More grounded Less overwhelmed More connected to their teachings More confident in their decisions More supported by their community More able to move at a comfortable pace

MAiD is never only a medical conversation. It touches on identity, family, history, teachings, and community. This section does not prescribe one way of approaching these moments. It simply acknowledges the many forms of wisdom and care that Indigenous families carry and supports helpers in walking alongside them with respect, clarity, and compassion.

Gentle Reflection Is there an Elder, Knowledge Carrier, or trusted person you would like to involve or speak with? Involving others is a choice, not a requirement. Support can be invited at any stage, or not at all.

Journey Carriers Toolkit – Cultural, Spiritual, and Relational Considerations

Section 6

Tools to Support Individuals, Families, and Helpers

Journey Carriers

How to Use These Tools

Worksheet 1: Preparing for Difficult Conversations

Worksheet 2: Questions to Ask the Care Team

Worksheet 3: Values, Needs, and Priorities Reflection Page

Worksheet 4: Conversation Tracker

Worksheet 5: Decision Clarity and Consent Reflection Page

Worksheet 6: Cultural and Ceremonial Support Page

Worksheet 7: Helper and Worker Reflection Page

61 47

Tools to Support Individuals, Families, and Helpers Conversations about serious illness and MAiD can be emotional, confusing, or overwhelming—not only for families and helpers, but also for the person who is living through the illness themselves. Everyone involved may carry questions, worries, hopes, or fears, and each person may move through information in their own way. These tools are here to support anyone navigating MAiD conversations, including: • • •

A person who is considering or learning about MAiD Family, loved ones, or caregivers Workers, helpers, and members of the Indigenous Mental Wellness Workforce

The tools offer grounding, structure, and reflection. They do not direct decisions or encourage any particular choice. They simply provide gentle support during moments that can feel heavy or uncertain.

How to Use These Tools These tools can be used: • • • • • • •

Privately by the person who is exploring MAiD With a helper, Elder, or family member During conversations with healthcare teams When preparing for appointments After appointments to help understand what was shared During family meetings or community discussions By helpers who need guidance to structure difficult conversations

There is no single “right” way to use them. People can move through them at their own pace, skip pages that do not fit, or return to certain sections when they feel ready. These tools help individuals, families, and helpers: • • • • • • • •

Slow down Reflect on values, needs, and priorities Organize information Identify questions Understand their emotional reactions Centre cultural teachings or ceremony Move through conversations with greater steadiness Feel less overwhelmed and more supported

These pages are gentle companions, not instructions.

Journey Carriers Toolkit – Tools to Support Individuals, Families, and Helpers

Included Worksheets

Journey Carriers Toolkit – Tools to Support Individuals, Families, and Helpers

Worksheet

Description

Preparing for Difficult Conversations

For individuals, families, and helpers, talking about serious illness or MAiD can bring up many emotions. This page helps you prepare gently.

Questions to Ask the Care Team

Use during or before appointments. Bring this page with you. Add your own questions.

Values, Needs, and Priorities Reflection Page

For individuals or families to complete alone or together.

Conversation Tracker

To help remember what was discussed.

Decision Clarity and Consent Reflection Page

For the person exploring MAiD and/or their family.

Cultural and Ceremonial Support Page

To honour teachings, practices, and grounding supports.

Helper and Worker Reflection Page

For helpers, workers, or responders supporting MAiD conversations.

Journey Carriers Toolkit – Tools to Support Individuals, Families, and Helpers

Worksheet 1

Preparing for Difficult Conversations For individuals, families, and helpers Talking about serious illness or MAiD can bring up many emotions. This page helps you prepare gently.

1/2

During the Conversation

2/2

If things feel rushed or confusing, you can say: “Can we slow down?” “Can you explain that in a different way?” “I need a moment.” “I’m trying to understand what this means for me/us.”

Before the Conversation

Notes or things that stood out:

How am I feeling today? (Write anything that comes up: emotions, fears, hopes, physical feelings.) What is weighing on me? What do I want to understand or ask about? Who do I want beside me for support? Are there cultural or spiritual supports I want to bring in (smudge, prayer, medicine, teachings, a grounding object, etc.) ?

After the Conversation What stayed with me after the discussion? What still feels unclear? Who do I want to talk to next (family, helper, Elder, Knowledge Carrier)? What supports do I need moving forward?

Journey Carriers Toolkit – Worksheet 1: Preparing for Difficult Conversations

Worksheet 2

1/2

2/2

Questions to Ask the Care Team

Cultural and Spiritual Supports

Use during or before appointments

Can ceremony be part of my care?

Bring this page with you. Add your own questions.

Who can I speak to about cultural needs? Is there space for smudge, prayer, song, or medicines?

Understanding My/Our Care Options What comfort-focused care is available to me/us? What supports exist at home? What can we expect in the coming weeks or months? What options exist for managing symptoms or pain?

Follow-Up Who do I call if I have more questions later? How do I ask for more time if I need it?

Understanding MAiD How does MAiD work where I live? What steps are involved? What does consent look like in this process? What happens if I change my mind?

Journey Carriers Toolkit – Worksheet 2: Questions to Ask the Care Team

Worksheet 3

Values, Needs, and Priorities Reflection Page For individuals or families to complete alone or together

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What fears or worries do I/we carry?

What matters most to me/us right now?

What do I/we hope for in the coming days, weeks, or months? What brings comfort, peace, or grounding?

What supports feel important right now? What teachings, beliefs, or traditions guide me/us?

Journey Carriers Toolkit – Worksheet 3: Values, Needs, and Priorities Reflection

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Worksheet 4

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Worksheet 5

Conversation Tracker

Decision Clarity and Consent Reflection Page

To help remember what was discussed

For the person exploring MAiD and/or their family

Date of conversation:

What do I understand about my condition right now?

What feels unclear or unresolved?

How do I feel emotionally? Spiritually? Physically?

What information do I still need?

Do I feel rushed, pressured, or uncertain? (If yes, it is okay to pause.)

What do I want more time to think about?

Who was present:

What was shared today?

What felt important or meaningful?

What felt confusing or unclear?

Questions I/we still have:

Next steps:

Cultural or spiritual needs identified: Do I want to pause, continue, or revisit this later?

Journey Carriers Toolkit – Worksheet 4: Conversation Tracker

Journey Carriers Toolkit – Worksheet 5: Decision Clarity and Consent Reflection

Worksheet 6

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Worksheet 7

Cultural and Ceremonial Support Page

Helper and Worker Reflection Page

To honour teachings, practices, and grounding supports

For helpers, workers, or responders supporting MAiD conversations

Teachings or beliefs that guide me/us:

How did today’s conversation affect me emotionally or spiritually?

Ceremonies or practices that feel important (smudging, prayer, song, medicines, land, reflection, etc.):

What felt heavy? What felt meaningful?

People I/we may want involved (Elders, Knowledge Carriers, family):

What grounding practices support my well-being?

Cultural needs to share with the care team:

What supports do I need before my next visit or call?

What brings grounding or connection during hard moments:

How can I continue offering culturally aligned, relational care?

Journey Carriers Toolkit – Worksheet 7: Helper and Worker Reflection

Journey Carriers Toolkit – Worksheet 6: Cultural and Ceremonial Support

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Section 7

Grief, Bereavement, and Cultural Supports

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Understanding Grief in Indigenous Contexts

Cultural and Spiritual Supports

Community-Based Grief Supports

Grief Has No Timeline

Caring for Helpers and Workers

Why This Section Matters

Walking alongside individuals, families, and communities after a loss

Cultural and Spiritual Supports

Grief is carried in many ways. For many Indigenous Peoples, grief is not only emotional, it can be spiritual, relational, physical, and connected to land, memory, and ancestors. When someone passes, especially during a difficult illness or complex decisionmaking process, families and helpers may need time, ceremony, and support to move gently through the experience.

• • • • • • •

This section offers grounding and places to begin. Families can choose the supports that fit their teachings, relationships, and needs.

Understanding Grief in Indigenous Contexts Grief may be shaped by: • • • • • • •

Family teachings Cultural or spiritual practices Community responsibilities The person’s role in the family Experiences of past loss or trauma Ceremony and connection to land Relationships with Elders, Knowledge Carriers, or helpers

Some families move through grief quietly. Others gather, hold ceremonies, or share stories. Some may want space. Others may seek guidance or support. All responses are valid. Helpers can support families by offering: • • • • •

Presence and steadiness Time and space Encouragement to honour teachings Support in connecting with cultural and spiritual helpers Reminders that grief has no timeline

Journey Carriers Toolkit – Grief, Bereavement, and Cultural Supports

Many families draw strength from: Elders Knowledge Carriers Traditional healers Ceremonial helpers or spiritual supporters Singers, drummers, or community helpers Time on the land Medicines and ceremony

These supports may offer: • • • • • •

Teachings for the spirit’s journey Smudging or prayer Songs or drumming Stories of comfort and continuity Guidance for families who are grieving Grounding practices that help people feel less alone

Helpers can ask gently: “Would you like to connect with an Elder or Knowledge Carrier during this time?” Families can choose what feels right for them.

Community-Based Grief Supports Many communities have local supports, including: • • • • • • •

Mental wellness teams Community health workers Bereavement gatherings or circles Friendship Centre programs Land-based healing activities Family or community grief groups Youth and caregiver supports

These spaces may help families and helpers come together, share stories, or receive guidance during difficult moments.

Grief Has No Timeline

Why This Section Matters

Grief may appear:

Grief is part of the caregiving journey.

• • • • • • •

By including grief in this toolkit, we recognize:

Immediately Weeks or months later During quiet moments During ceremony When families gather When memories arise On anniversaries or significant dates

There is no right way to grieve. Families and helpers deserve support that feels safe, steady, and culturally aligned.

• • • •

The emotional and spiritual impact of end-of-life decisions The importance of cultural grounding The strength of relational and community supports The need for care after the decision is made

Grief can be held, supported, and witnessed in ways that honour spirit, family, and community.

Caring for Helpers and Workers Helpers may experience: • • • • •

Emotional exhaustion Compassion fatigue Spiritual heaviness Worry for the family Grief of their own

Workers deserve space and support as well. A reflection page for helpers is included in Section 6. Helpers can reach out to colleagues, supervisors, or cultural supports when needed.

Journey Carriers Toolkit – Grief, Bereavement, and Cultural Supports

Section 8

Glossary

These definitions are meant to support understanding. They do not replace medical, legal, or cultural teachings. Families, individuals, and helpers can use these terms in whatever way feels most meaningful to them.

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• • •

Glossary

Advance Care Planning A process where a person thinks about and shares what kinds of care they would want in the future, especially if they might not be able to speak for themselves later on. Assessment (MAiD) Conversations with two independent healthcare providers to ensure someone meets the legal criteria for MAiD and understands their options. Assessments help confirm the decision is informed and voluntary. Capacity / Decision-Making Ability A person’s ability to understand their situation, consider options, and make their own decision. In MAiD, the person must have capacity at every step. Comfort-Focused Care (Palliative Care) Care that focuses on easing pain, supporting comfort, and improving quality of life. It can include emotional, spiritual, and cultural support.

Decline (Medical Decline) A gradual worsening of a person’s health, abilities, or condition that cannot be reversed.

Glossary

Hospice A type of care that focuses on comfort, dignity, and quality of life for people nearing end of life. It may take place at home, in a hospital, or in a dedicated hospice centre. MAiD (Medical Assistance in Dying) A legal medical option where a doctor or nurse practitioner provides medication that intentionally ends a person’s life. It is only available to adults who request it themselves and meet specific legal criteria. Suffering (as defined in MAiD legislation) Physical or emotional pain, distress, or experience that the person finds unbearable. Only the person themselves can determine what constitutes suffering.

Consent Permission that is freely given, informed, and ongoing. In MAiD, the person must give consent throughout the entire process and can withdraw consent at any time.

Journey Carriers CarriersToolkit – Glossary

Section 9

Resources

These resources may be helpful for individuals, families, helpers, and members of the Trauma-Informed Mental Wellness Workforce navigating conversations related to Medical Assistance in Dying (MAiD). Not every resource will be available in every community. They are offered as starting points for connection, cultural grounding, grief support, and crisis care. Some resources are available in French to support comfort, understanding, and accessibility.

Journey Carriers

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Resources

Immediate Emotional Support and Crisis Lines

Grief and Bereavement

Hope for Wellness Helpline 24/7 culturally grounded emotional support for Indigenous people across Canada.

Canadian Grief Alliance National grief education and supportive programs across Canada.

1-855-242-3310 | hopeforwellness.ca

(Available in English and French; Cree, Ojibway, and Inuktitut upon request.) 9-8-8 Suicide Crisis Helpline 24/7 national crisis support for anyone experiencing distress. Call or text: 988 | 988.ca

(Available in English and French.)

MAiD-Specific Information and Family Support

aboutgrief.ca

(Available in English and French.)

Indigenous Cultural and Workforce Supports National Collaborating Centre for Indigenous Health Culturally grounded resources related to health, end-of-life care, and Indigenous wellness. NCCIH.ca

(Available in English and French.)

Dying With Dignity Canada Information on MAiD eligibility, safeguards, and resources for families before and after a medically assisted death.

First Peoples Wellness Circle Mental wellness resources and supports for First Nations communities and helpers.

EN: dyingwithdignity.ca | FR: dyingwithdignity.ca/fr/

FPWC.ca

(Available in English and French.)

Canadian Virtual Hospice Resources on serious illness, end-of-life care, grief, and cultural perspectives on dying.

Local/Community and Cultural Supports

EN: virtualhospice.ca | FR: portailpalliatif.ca

(Available in English and French.) Aperçu officiel de l’AMM (Santé Canada) Explication claire de l’aide médicale à mourir au Canada. Le deuil et l’AMM Brochure francophone sur les réactions au deuil après une AMM.

Resources

Journey Carriers CarriersToolkit – Resources

Depending on your region or Nation, families may be connected with: • • • •

Local Elders or Knowledge Carriers Traditional healers or spiritual supporters Indigenous-led wellness or community health programs Friendship Centres or community health teams

Helpers and families can ask healthcare providers, Indigenous organizations, or local health authorities about supports available in their area.

Provincial and Territorial MAiD Coordination Services Resources

Province/Territory

Service Name/Description

Link/How to Access

British Columbia

Regional Health Authorities (e.g., PHSA for MAiD)

PHSA – MAiD Office Medical Assistance in Dying (MAiD): Provincial Health Services Authority

Alberta

Provincial MAiD coordination through Alberta Health Services (AHS)/health system

MAiD listing under provincial resources (see national directory): CAMAP

Saskatchewan

Saskatchewan Health Authority – MAiD Program/coordination

Listed in national directory of MAiD resources by location: CAMAP

Manitoba

Province-wide MAiD Services (Shared Health Manitoba)

Listed in national directory of MAiD resources by location: CAMAP

Ontario

Ontario MAiD Care Coordination Service (OMAiDCCS) – 24/7 referral & assessment coordination

Medical assistance in dying and end-of-life decisions: Ontario | 1-866-286-4023 (TTY 1-844-953-3350)

Quebec

Provincial public health network (CISSS/CIUSSS depending on region), via official MAiD program

Medical aid in dying (MAiD): Quebec

New Brunswick

Regional health authorities: Horizon Health Network & Vitalité Health Network, depending on region

Listed in national directory of MAiD resources by location: CAMAP

Nova Scotia

Nova Scotia Health – MAiD Access & Resource Team

MAiD official page on NS Health site with phone & email contacts: Nova Scotia Health

Prince Edward Island

Health PEI – Provincial MAiD Program/coordination

Official PEI MAiD information page listed in national directory: CAMAP

Newfoundland and Labrador

NL Health Services – MAiD services across regional zones

MAiD program overview via regional healthservice listing: PEOLC Eastern Health

Yukon

Yukon Health & Social Services – MAiD coordination service

Listed in national directory of MAiD resources by location: CAMAP

Northwest Territories

NWT Health and Social Services Authority – territorial MAiD program

MAiD listing under provincial resources (see national directory): CAMAP

Nunavut

Nunavut Department of Health for MAiD information and navigation

Listed in national directory of MAiD resources by location: CAMAP

Where to find MAiD information and navigation across Canada. Most provinces and territories offer a MAiD coordination service or referral pathway. These services can help individuals, families, and helpers: • • • • •

Ask questions Understand local processes Learn about assessments Explore available supports Connect with MAiD-trained providers

Because contact details change over time, the most reliable way to find current information is to search: “MAiD + [province or territory] + coordination service”

Families, individuals, and helpers may contact their local health authority, hospital, or MAiD provider for region-specific guidance.

Journey Carriers CarriersToolkit – Resources

These services can support understanding, ease navigation, and help ensure conversations happen at a pace that feels safe and informed.

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