This paper explores the bioethical issues associated with the diagnosis and treatment of vulvar cancer for Indigenous women in East Arnhem Land, Northern Territory, Australia. Based on a qualitative study of a vulvar cancer cluster of Indigenous women, the article highlights four main topics of bioethical concern drawn from the findings: informed consent, removal of body parts, pain management, and issues at the interface of Indigenous and Western health care. The article seeks to make a contribution towards Indigenous health and bioethics and bring to light areas of further research.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Aboriginal Workforce Development Unit [AWDU]. 2012. Good health—great jobs: NSW Health Aboriginal Health Worker Project. North Sydney: NSW Ministry of Health. http://www0.health.nsw.gov.au/policies/ib/2014/IB2014_001.html. Accessed 2 June 2014.
Al-Delaimy, W.K., and J.A. Waldon. 2006. Hair in Maori culture: An example of transcultural research. Australian and New Zealand Journal of Public Health 30(5): 486–487.
Ashburn, M.A., and P.S. Staats. 1999. Management of chronic pain. The Lancet 353(9167): 1865–1870.
Burton, O.R. 2007. Why bioethics cannot figure out what to do with race. American Journal of Bioethics 7(2): 6–12.
Byard, R.W., and W.C. Chivell. 2005. The interaction of death, sorcery and coronial/forensic practices within traditional indigenous communities. Journal of Clinical Forensic Medicine 12(5): 242–244.
Condon, J.R., A.R. Rumbold, J.C. Thorn, M.M. O’Brien, M.J. Davy, and I. Zardawi. 2009. A cluster of vulvar cancer and vulvar intraepithelial neoplasia in young Australian indigenous women. Cancer Causes & Control 20(1): 67–74.
Condon, J., P. McGrath, J. Stankovich, et al. 2011–2012. A vulvar cancer cluster in young Indigenous women in Arnhem Land: Investigation of community knowledge, genetic susceptibility and supportive care. National Health and Medical Research Council Project Grant (No. 1003817).
Creswell, J.W. 2003. Research design: Qualitative, quantitative, and mixed method approaches, 2nd ed. Thousand Oaks, CA: Sage.
Crombie, I.K. 1996. Research in health care: Design, conduct and interpretation of health services research. New York: John Wiley & Sons.
Fenwick, C., and J. Stevens. 2004. Post-operative pain experiences of central Australian aboriginal women. What do we understand? The Australian Journal of Rural Health 12(1): 22–27.
Fenwick, C. 2001. Resource tackles aboriginal pain issues. Australian Nursing Journal 8(6): 37.
Fenwick, C. 2006. Assessing pain across the cultural gap: Central Australian indigenous peoples’ pain assessment. Contemporary Nurse 22(2): 218–227.
Hallberg, L.R.-M., and S.G. Carlsson. 2000. Coping with fibromyalgia: A qualitative study. Scandinavian Journal of Caring Sciences 14(1): 29–36.
Holloway, I. 2008. A-Z of qualitative research in nursing and healthcare, 2nd ed. Oxford: Blackwell Publishing.
Honeyman, P.T., and E.A. Jacobs. 1996. Effects of culture on back pain in Australian aboriginals. Spine 21(7): 841–843.
Joura, E. 2002. Epidemiology and precursors of vulvar cancer: Review article. Journal of Women’s Imaging 4(3): 126–129. 148–149.
Kaebnick, G.E. 2001. Bioethics and race. The Hastings Center Report 31(5): 3.
Kazanowski, M.K., and M.S. Laccetti. 2002. Pain. Thorofare, NJ: SLACK Incorporated.
Lanneau, G.S., P.A. Argenta, M.S. Lanneau, et al. 2009. Vulvar cancer in young women: Demographic features and outcome evaluation. American Journal of Obstetrics and Gynecology 200(6): 645.e1–645.e5. doi:10.1016/j.ajog.2009.01.014.
Likes, W.M. 2009. Vulvar cancer in the wake of increasing incidence. The Nurse Practitioner 34(2): 45–50.
Lovat, T.J., and K.R. Mitchell. 1991. Bioethics for medical and health professionals: History, principles and case studies. Wentworth Falls, NSW: Social Science Press.
Macintyre, P.E., and L.B. Ready. 2001. Acute pain management: A practical guide, 2nd ed. Philadelphia: W.B. Saunders.
Manderson, L., and E. Hoban. 2006. Cervical cancer services for indigenous women: Advocacy, community-based research and policy change in Australia. Women and Health 43(4): 69–88.
Marolt, N., and R.R. Malnaršič. 2009. Women’s knowledge of vulvar self-examination. Obzornik Zdravstvene Nege [Slovenian Nursing Review] 43(2): 103–109.
Marshall, P., and B. Koenig. 2004. Accounting for culture in a globalized bioethics. The Journal of Law, Medicine & Ethics 32(2): 252–266.
McGrath, P. 2006. “The biggest worry…”: Research findings on pain management for Aboriginal peoples in Northern Territory, Australia. Rural and Remote Health 6(3): 549–563.
McGrath, P. 2000. Informed consent to peripheral blood stem cell transplantation. Cancer Strategy 2: 44–50.
McGrath, P., and H. Holewa. 2006a. The living model: A recourse manual for Indigenous palliative care service delivery. Trivandrum, India: Researchman Ltd.
McGrath, P., and H. Holewa. 2006b. Insights on aboriginal peoples’ views of cancer in Australia. Contemporary Nurse 22: 240–254.
McGrath, P., H. Holewa, and P. Etcheverry. 2011. Surviving the crisis of relocation for specialist treatment in haematology: Insights from New Zealand. Illness Crisis and Loss 19(3): 233–247.
McGrath, P., and E. Phillips. 2008a. Australian findings on aboriginal cultural practices associated with clothing, hair, possessions and use of name of deceased persons. International Journal of Nursing Practice 14(1): 57–66.
McGrath, P., and E. Phillips. 2008b. Western notions of informed consent and indigenous cultures: Australian findings at the interface. Journal of Bioethical Inquiry 5(1): 21–31.
McGrath, P., and N. Rawson. 2013a. Key factors impacting on diagnosis and treatment for vulvar cancer for indigenous women: Findings from Australia. Supportive Care in Cancer 21(10): 2769–2775.
McGrath, P., and N. Rawson. 2013b. The experience of relocation for specialist treatment for indigenous women diagnosed with vulvar cancer in East Arnhem land. Journal of Psychosocial Oncology 31(5): 540–555.
McGrath, P., N. Rawson, and L. Adidi. 2013. Challenges associated with qualitative interviewing for indigenous research: Insights from experience. International Journal of Multiple research Approaches 7(2): 260–270.
McMichael, C., M. Kirk, L. Manderson, E. Hoban, and H. Potts. 2000. Indigenous women’s perceptions of breast cancer diagnosis and treatment in Queensland. Australian and New Zealand Journal of Public Health 24(5): 515–519.
McMichael, T. 1989. A national aboriginal health strategy. Aboriginal Health Information Bulletin, no. 12: 12–14.
National Health and Medical Research Council [NHMRC]. 2003. Values and ethics: Guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research. Canberra: Commonwealth of Australia. http://www.nhmrc.gov.au/guidelines/publications/e52.
Noggle, B.J. 1995. Identifying and meeting the needs of ethnic minority patients. The Hospice Journal 10(2): 85–93.
Rothe, J.P., D. Ozegovic, and L.J. Carroll. 2009. Innovation in qualitative interviews: “sharing circles” in a first nations community. Injury Prevention 15(5): 334–340.
Sharma, D.N. 2012. Radiation in vulvar cancer. Currant Opinion in Obstetrics & Gynecology 24(1): 24–30.
Sofaer, B. 1992. Pain: A handbook for nurses. London: Chapman and Hall.
Sullivan K., C. Johnston, J. Colyer, et al. 2003. National Indigenous palliative care needs study: Final report. Canberra: Australian Government Department of Health and Ageing. http://pandora.nla.gov.au/pan/56044/20060529-0000/www.health.gov.au/internet/wcms/publishing.nsf/Content/5619BFE763995E17CA256F410011C5C3/$File/needall.pdf.
Thompson, S.C., S. Shahid, H.S. Greville, and D. Bessarab. 2011. “A whispered sort of stuff”: A community report on research around aboriginal people’s beliefs about cancer and experiences of cancer care in Western Australia. Perth: Cancer Council Western Australia.
Trudgen, R. 2000 Why warriors lie down and die: Djumbatj Mala. Darwin: Aboriginal Resource and Development Services Inc.
White, K., D. Wall, and L. Kristjanson. 2004. Out of sight of mind: Reframing remoteness in providing palliative care in remote Australia. Collegian 11(3): 29–33.
Woelber, L., L. Kock, F. Gieseking, et al. 2011. Clinical management of primary vulvar cancer. European Journal of Cancer 47(15): 2315–2321.
The authors would like to thank Associate Professor John Condon and the genetics team; Dr. Rebbekah McWhirter for administrative assistance; Mr. Hamish Holewa for assistance with Quadrant; and Elaine Lawurrpa Maypilama for reviewing the article for the Indigenous Reference Group. The project is a research collaboration between Menzies School of Health Research and Griffith University and is funded by a National Health and Medical Research Council Project Grant (No. 1003817).
About this article
Cite this article
McGrath, P., Rawson, N. & Adidi, L. Diagnosis and Treatment for Vulvar Cancer for Indigenous Women From East Arnhem Land, Northern Territory: Bioethical Reflections. Bioethical Inquiry 12, 343–352 (2015). https://doi.org/10.1007/s11673-014-9549-9
- Indigenous health
- Vulvar cancer
- Indigenous and Western health care