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Ethical and Legal Issues in Patient and Family-Centred Care: Canadian First Nations, Métis and Inuit People

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Paediatric Patient and Family-Centred Care: Ethical and Legal Issues

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 57))

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Abstract

There is a significant amount of reported research related to different aspects of utilization and access to healthcare among Aboriginal people in Canada. However, the topic of healthcare ethics related to specific cultural aspects of Aboriginal life remains understudied. In this chapter, the cultural history of Canadian Aboriginal people will be described and relationships between Aboriginal and non-Aboriginal people will be discussed. Further, these relationships will be examined in light of the existing health disparities. Examples of narratives from Aboriginal and non-Aboriginal perspectives will be the basis of exploring the common ethics and legal challenges that Aboriginal people face in healthcare decision-making. Also, the concepts of western bioethics and Aboriginal values will be compared and they will be further discussed within the developing models of patient and family-centred care in the paediatric setting.

“Well I believe that the child, each and every child, is a gift from the Creator and it’s your responsibility to take care of that gift. It’s your responsibility not to mislead them. I believe in telling a child their birth story, that’s what I do, because that sets them into the family….And at nighttime is usually when they really enjoy the story, and you don’t change it, it’s THEIR story. They’ll correct you if you miss something. They know their story, that’s how you know they are listening. You do those things for their security, so they know they are wanted and they belong to a family.

Ojibwe Elder, Freda MacDonald

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Notes

  1. 1.

    The term “Aboriginal people” is used throughout the text to collectively describe all original people in Canada and their descendants. It also includes the term “Indian” as defined in the Indian Act, 1985. The term “Indigenous” refers to any Indigenous people throughout the world.

  2. 2.

    This is a scientific hypothesis that may be in conflict with Aboriginal epistemology about the origin of the Aboriginal people.

  3. 3.

    These data are collected under the category of “Ethnic origin” on the Canada Census 2006 questionnaire. The available options to highlight Aboriginal ancestry are North American Indian, Métis or Inuit according to Statistics Canada.

  4. 4.

    The criteria for being registered as a status Indian through the federal Indian Register are fairly specific, according to the Indian Act. Some of self-identified Aboriginal people do not fulfil such criteria, including Métis. Other may lost the status or opt out from being registered.

  5. 5.

    For more comprehensive discussion of whether a systemic under-counting of Aboriginal people is a result of continuous colonizing and discriminatory policies in Canada, see, for example, Hanselmann (2001) and Potvin (2005) .

  6. 6.

    The terms “Indian” and “Indian lands” are taken directly from Section 91(24) of the Constitution Act, 1867.

  7. 7.

    The identifying information has been modified to maintain the confidentiality of the patient, his family, and his community. Prior to Adam’s discharge, I received their permission to share the story.

  8. 8.

    The family-centred rounds may be understood as sharing circles, as used in Aboriginal traditions. Children, their parents and other important people involved in childcare can share the child’s story of illness and recovery. Similarly, healthcare providers may consider this as an opportunity to communicate complicated diagnoses and care plans in a form of narrative that is more easily understood by non-healthcare providers.

  9. 9.

    Specific patient populations represent groups of people who share clear distinguishable criteria. Based on such criteria, ethically competent practitioners ought to take into account how such characteristics may alter their approach to care. Much of literature deals with challenges in providing ethical and culturally safe care for patients from diverse ethnics groups. However, the identifiable criteria can extend beyond ethnicity, including, for example, levels of ability/disability, sexual orientation or gender.

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Authors and Affiliations

  1. Alberta Health Services, Alberta, Canada

    Julija Kelečević

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  1. Julija Kelečević
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Correspondence to Julija Kelečević .

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  1. Dept. of Bioethics, The Hospital for Sick Children, Toronto, Canada

    Randi Zlotnik Shaul

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Kelečević, J. (2014). Ethical and Legal Issues in Patient and Family-Centred Care: Canadian First Nations, Métis and Inuit People. In: Zlotnik Shaul, R. (eds) Paediatric Patient and Family-Centred Care: Ethical and Legal Issues. International Library of Ethics, Law, and the New Medicine, vol 57. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0323-8_5

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  • DOI: https://doi.org/10.1007/978-1-4939-0323-8_5

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