Aboriginal health care ethics
– a missing discipline
Jaro Kotalik, MD, MA, FRCPC
Centre for Health Care Ethics
Lakehead University & NOSM
Sudbury, June 5, 2009
Our aboriginal population
• Of Canadian population, 4% aboriginal/First
Nations: N.A. Indians, Eskimos, Metis,
• 50 languages and cultures,
• 50% in one of 600 First Nations communities,
50% in other communities
• Northern Ontario: 12% of population and
growing
Health Status of First Nations
compared with other Canadians
• Aboriginals have an increased rate of
cardiovascular diseases, diabetes and
infections
• Mortality rate of infants is 3x higher
• Potential years of life lost due to injuries
is 3.5x higher
• Average lifespan: 7.4 y less for man and
5.2 y less for women
Why is the morbidity and
mortality of aboriginal population
so high?
• Genetics
• Environment
• Poverty-social structure-lifestyle- lack of
prevention
• Health Care Delivery
Successful disease prevention
and care for sick require:
• Effective intervention – evidenced based
medicine………biomedical science &
technology
• Understanding of values and interest & ideas
about health and illness, caring and nurturing,
of the population served.…health care ethics
• Creating patient-caregiver relationships of trust
and cooperation……..........health care ethics
• Effective communication respective of
individuals and groups….. health care ethics
Do we understanding of
values and interest?
First Nations Sacred Teachings &
Western Virtues
• Wisdom
• Love
• Respect
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Integrity
Honesty
Humility
Truth
• Discernment
• Compassion
• Respect for privacy
and confidentiality
• Integrity
• Trustworthiness
• Conscientiousness
• Veracity
• Fidelity
Worldview of First Nations
vs. Majority of population
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Unity of all creation vs. individualism
Interdependence of all vs. independence
Sharing, respect for all vs. deserts
Non interference vs. interventionism
Acceptance of the creator’s plan vs. fight
Balance vs. celebrating excesses
Traditional Medicine vs. medicine at the
cutting edge
Health in First Nations’ teachings
Mental
Spiritual
Physical
Emotional
Goals of the Health Policy & Planning
Department
• To improve the mental, spiritual, emotional,
physical and environmental well being of the
membership in consultation with First Nations;
• To promote improvement in health care services
available to the people of NAN;
• To promote self-government in health within the
Nishnawbe Aski Nation;
• To ensure respect and dignity is upheld through
the provision of culturally sensitive health
service delivery and personnel
What are the challenges of
shaping best possible
patient – professional
relationship across a racial,
cultural and economic gap?
Professional –patient power
imbalance
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Social –economic strata
General education
Technology
Language
Social support
Personal histories
Knowledge of diseases and its
management
How effective and respectful is
our communication?
• Language barrier
• Lack of adequate translation and
interpretation
• Time constrains
• Communication with a patient vs.
communication with an extended family
Health Care Ethics expanding its
wings….
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Professional ethics
Acute care ethics
Mental health care ethics
Pediatric ethics
Surgical ethics
Institutional ethics
Ethics of AIDS-HIV care
Aboriginal care ethics ?
The way ahead in aboriginal
health care ethics
• Listening, recording and considering the
experiences of First Nations patients, their
families and informal caregivers
• Learning from wisdom of elders, aboriginal
healers and chiefs who accompany patients
and their families on their journey through
illness and health
• Converting what we have learned into
educational programs for health care workers
of all institutions where First Nations receive
health care
Conclusions
•
More attention to ethical aspects of care
involving Aboriginal people has a potential to
enhance subjective experiences, acceptability
and effectiveness of preventive and therapeutic
interventions & health status
• In order to do that, we need to develop an
interdisciplinary research, education and
practice of aboriginal health care ethics as a
branch of health care ethics
THANK YOU
Questions and comments?
Contact: jkotalik@lakeheadu.ca
807 435 1808