Contextualizing Medical Assistance in Dying in Nunavut: Colonial Legacies, Cultural Realities, and Ethical Tensions

Medical assistance in dying (MAID) has become one of the most contested areas of health policy in Canada, yet little empirical research has examined how Inuit communities understand and experience MAID within their own social and cultural contexts. This exploratory qualitative study examined perspectives on MAID among Inuit community members in Nunavut, with particular attention to how ethical decision-making is shaped by relationships, access to care, and Inuit knowledge systems. Guided by Inuit Qaujimajatuqangit and the Piliriqatigiinniq Research Model, semi-structured interviews were conducted with community members with lived experience of disability and family members. Thematic analysis identified four central themes: understandings of medical assistance in dying, the influence of Inuit cultural perspectives, the right to choose, and ethical concerns and moral dilemmas. The analysis also identified two contextual factors that cut across themes, the framing of MAID in relation to access to health and social services and the need for relational safeguards. Participants also consistently evaluated assisted dying in relation to the presence of trusted relationships, and the cultural safety of the decision-making processes. Concerns about suicide normalization, inadequate supports, and structural inequities were prominent. Findings highlight tensions between individual-choice frameworks embedded in MAID legislation and Inuit values emphasizing relational responsibility, collective decision-making, and community centered care. This study underscores the importance of Inuit-led consultation, culturally grounded safeguards, and investment in health and social services to ensure that end-of-life policies are ethically responsive and contextually relevant in Nunavut.