Should mainstream medical teams work with Traditional Indigenous Healers?
Mainstream medicine teams may consider it contrary to a patient’s best interest to work with practitioners of traditional indigenous healing when treating Aboriginal patients. This is partially due to a perceived lack of evidence for traditional indigenous healing or for integrated care. As well, there is a growing trend of refusal, by adult and minor Aboriginal patients – including pediatric cancer patients – of potentially life-saving medical treatment. This is due to a lack of trust for mainstream medicine on the part of Aboriginal communities – this is understandable, given their history of abuse, neglect, misinformation and disregard for their choices at the hands of medical personnel.
If mainstream health care professionals really feel they have something to offer their Aboriginal patients, they need to find a way to rebuild trust in the hope that uptake can be increased, at least in those incidences when mainstream medicine can help where traditional indigenous healing falls short. But to build this trust, we need to remember that mainstream medicine, itself, sometimes also falls short and that a truly patient-centered strategy may involve looking to other healing systems to fill our gaps. This is where integrative care may be called for. But is it ethical to enter into such an arrangement with traditional indigenous healers?
I reviewed some cases in which Aboriginal patients chose traditional indigenous healing over mainstream medicine – my goal was to examine two questions: does the choice for traditional indigenous medicine, by Aboriginal patients or their communities, reflect a neglect for the patient’s best interest?; and, as I stated above, is it ethical for mainstream medical teams to work towards integrating traditional indigenous healing into a patient’s treatment plan? I conducted a multimedia review, and Western bioethical analysis, of the medical and histo-cultural elements of these cases along with a review of literature surrounding traditional indigenous healing and its integration into treatment.
What were the results?
From a Western bioethical perspective, the decision to favour traditional indigenous healing did not reflect a disregard for Aboriginal patients’ best interest. Of particular importance was the analysis with respect to Aboriginal children who opt out (or are opted out, by their parent/communities) of mainstream medical treatments. Canada’s history comprises a number of bleak situations where Aboriginal children were pulled from their families, ostensibly for their own good, and made to suffer abuses that still ring in our Canadian consciousness today. This understandably makes Aboriginal communities wary when they are faced with rhetoric such as ‘pulling a child away from their parent and forcing them into treatment,” no matter how well-intentioned the action may be. As well, it turns out that there were medical elements in some of these cases that suggested the patients’ long-term well-being was not actually guaranteed with mainstream medical treatments. Thus, backing out of mainstream medicine and choosing traditional indigenous healing was actually quite understandable and ethically defensible.
The other thing I found was that a growing body of evidence exists for the efficacy of certain traditional indigenous healing practices and, especially, for the benefits of regimens that integrate mainstream medicine and traditional indigenous healing or other alternative healing systems. In one reference I found, the author (a physician) noted that the advantages of integrative therapy for cancer patients are: “…to reduce the side effects of conventional treatment, to improve cancer symptoms, to enhance emotional health, to improve quality of life, and sometimes to enhance the effect of conventional treatments.” But collaboration is key. Furthermore, for an integrated approach to be successful, both parties must enter into the collaboration without an agenda of supremacy.
In short, it is not against the tenets or ethics of evidence-based health care for medical teams to work with traditional indigenous healers to provide integrative treatment for Aboriginal patients. In fact, although more study is needed, offering to provide culturally-sensitive, inter-professional care may result in more favourable patient outcomes. However, this approach must be undertaken in a manner that is egalitarian and bilaterally respectful of cultural practices.
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