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Aboriginal health care ethics – a missing discipline

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,

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Aboriginal health care ethics – a missing discipline

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  1. Aboriginal health care ethics – a missing discipline Jaro Kotalik, MD, MA, FRCPC Centre for Health Care Ethics Lakehead University & NOSM Sudbury, June 5, 2009

  2. 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

  3. 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

  4. Why is the morbidity and mortality of aboriginal population so high? • Genetics • Environment • Poverty-social structure-lifestyle- lack of prevention • Health Care Delivery

  5. 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

  6. Do we understanding of values and interest?

  7. Wisdom Love Respect Integrity Honesty Humility Truth Discernment Compassion Respect for privacy and confidentiality Integrity Trustworthiness Conscientiousness Veracity Fidelity First Nations Sacred Teachings & Western Virtues

  8. 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

  9. Health in First Nations’ teachings Mental Spiritual Physical Emotional

  10. 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

  11. What are the challenges of shaping best possible patient – professional relationship across a racial, cultural and economic gap?

  12. Professional –patient power imbalance • Social –economic strata • General education • Technology • Language • Social support • Personal histories • Knowledge of diseases and its management

  13. 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

  14. 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 ?

  15. 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

  16. 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

  17. THANK YOU Questions and comments? Contact: jkotalik@lakeheadu.ca 807 435 1808

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