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

• Integrity• Honesty• Humility• Truth

• Discernment• Compassion• Respect for privacy

and confidentiality• Integrity• Trustworthiness• Conscientiousness• Veracity• Fidelity

Worldview of First Nations vs. Majority of population

• 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

Physical

Mental

Spiritual

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

• 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….

• 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