FNHA End of Life Journey — Indigenous Palliative Care in BC

The First Nations Health Authority (FNHA) in British Columbia operates a BC Indigenous-specific end-of-life program called the End of Life Journey. It bridges Western palliative care and First Nations worldviews — acknowledging that dying, for many Indigenous people, is not only a medical event but can also be a sacred transition requiring spiritual, cultural, and communal support alongside clinical care.

What the End of Life Journey Program Provides

The FNHA's program operates on several levels:

Indigenous End-of-Life Guides (IEOLGs). These are community members — not medical professionals — nominated by Chiefs and community health directors to serve as companions to dying individuals and their families. Trained through a partnership between FNHA and Douglas College, the guides learn both Western palliative care concepts and traditional worldviews. They are "natural helpers" who walk alongside families through the dying process, ensuring that the person's spiritual and cultural wishes are respected within a medical system that often does not understand them.

An IEOLG does not replace a nurse, a doctor, or an Elder. They can help the family identify the hospital's smudging process and coordinate with staff. Fire-alarm, ventilation, body-release, and funeral-home arrangements remain subject to hospital policies and provincial rules.

Advance care planning support. The FNHA promotes advance care planning within a culturally safe framework — helping individuals document their wishes for end-of-life care in a way that reflects their cultural and spiritual values, not just their medical preferences. This includes specifying whether they want traditional ceremony at the time of death, who should prepare their body, whether they want smudging in the hospital room, and whether they want burial on-reserve.

For a registered Status Indian who was ordinarily resident on-reserve, advance care planning carries additional legal complexity. If that person dies without a will, ISC may administer the estate under federal jurisdiction; off-reserve estates generally follow provincial or territorial processes. The FNHA's advance care planning resources help individuals understand how residence affects estate administration and other arrangements.

Grief and bereavement support. The FNHA's "Healing Indigenous Hearts" guidebook, developed in partnership with Moms Stop the Harm, provides a peer-support framework for Indigenous families dealing with loss — particularly those who have lost loved ones to substance-use-related causes. It centres cultural connection, sharing circles, and land-based healing rather than clinical grief models.

How IEOLGs Work in Practice

An IEOLG typically becomes involved when a community member receives a terminal diagnosis or when an Elder's health begins declining. The guide visits the family at home, learns the individual's wishes, and begins coordinating between the health system and the community's traditional support structures.

If the person is hospitalized, the guide can work with the hospital's Indigenous Patient Navigator (where one exists) to discuss cultural needs — space for family to gather, access for an Elder, smudging, and traditional medicines. The Truth and Reconciliation Commission's Call to Action #22 calls on health-care systems to recognize and respect Indigenous healing practices; whether and how a hospital accommodates them depends on its policies and safety rules. The IEOLG can help the family ask about those processes.

As death approaches, the guide helps the family prepare for the transition. This includes practical matters (contacting the Band office, gathering documents for ISC estate services, confirming funeral funding eligibility) and spiritual matters (arranging for an Elder, confirming the firekeeper, notifying the clan system if applicable).

Beyond British Columbia

The FNHA program is BC-specific, but its model has influenced Indigenous health organizations across Canada. In Ontario, Indigenous Patient Navigators perform a similar bridging function within the hospital system. In Manitoba and Saskatchewan, Friendship Centres and tribal councils offer bereavement support programs. Nationally, the Canadian Partnership Against Cancer's "Beginning the Journey into the Spirit World" report maps Indigenous palliative care approaches across the country and identifies gaps.

The core principle is consistent: dying Indigenous people deserve care that respects their worldview, not just their diagnosis. A palliative care plan that addresses pain management but ignores the person's need for smudging, ceremony, or a four-day funeral is incomplete by any standard.

What to Do If Someone Is Dying

If a First Nations family member in BC has received a terminal diagnosis, contact the FNHA directly to ask about the End of Life Journey program and whether an Indigenous End-of-Life Guide is available in your community. Outside BC, contact your Band health director, regional Friendship Centre, or hospital's Indigenous Patient Navigator to learn what culturally safe end-of-life support exists in your area.

Our First Nations Canadian Funeral Guide covers the full continuum from advance care planning through the four-day funeral to the one-year memorial, including the FNHA resources, ISC estate processes, and the funding sources available to First Nations families.