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?

8. 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

9. 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

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

11. 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

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

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

14. 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

15. 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 ?

16. 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

17. 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

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