Ethical Engagement with Indigenous Populations in Alberta and Beyond Open Access

Furr, Caitlyn Cook (Spring 2019)

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Indigenous populations have long been oppressed and experience disparities in health, education, and across many sectors of socioeconomic life. Recognizing disparity in healthcare, Clare Brant wrote “Native Ethics and Rules of Behaviour” in 1990 as a guiding tool for psychotherapists. We engaged in an archaeology of knowledge search to understand how Brant’s notions of behavioural characteristics of Indigenous patients have traveled through the literature and influenced, not only medical literature, but also fields including research, social work, education, and others. In addition to the literature, we conducted focus group interviews with Indigenous patients at the Elbow River Healing Lodge in Calgary, AB to understand Indigenous patients’ experiences with communication in healthcare settings. Two candidate theories were drafted, and the results of the literature search and interviews were analyzed through the lens of those theories:

Theory 1: Present in Indigenous culture is the underlying ethical principle of community harmony and conflict suppression. 

Theory 2: Western modes of communication do not acknowledge Indigenous ways of knowing, seen in various Western systems, (education, social work, and healthcare).

The results of the analysis were reported according to a realist review framework, identifying the context in which Indigenous populations are operating in healthcare and other sectors, the mechanisms acting on the context, and the outcome of that interaction. The results revealed a context in which Indigenous values differ from those of the Western medical system but are largely ignored. Though there are multiple mechanisms, or relevant behaviours that could be identified, the most salient in the literature and focus groups interviews that were selected for this study include non-interference and sharing. These behavioural norms differ from those in the dominant Western society, and at their core, non-interference and sharing cultivate relationalism in communities. The outcome of a lack of understanding of these mechanisms of behaviour is ruptures in the healthcare relationship and reinforcement of health disparities for Indigenous populations. 

Clare Brant’s work has been helpful in building understanding among non-Indigenous medical professionals, but his notion that Indigenous behaviour aims to suppress conflict may be more germane if reframed. We believe that relationalism is at the core of Indigenous behaviours, and that healthcare relationships can be restored through the adoption of mechanisms like non-interference and sharing, promoting relationalism. Such restoration has the potential to transform health disparities and create a more equitable environment. 

Table of Contents

Chapter 1: Introduction

Chapter 2: Review of the Literature

A.   Ethical Principles in the Literature

B.   Indigenous Knowledge in the Literature

Chapter 3: Methods and Results from the Realist Review Lens

A.   Methods

i.              Archaeology of Knowledge

ii.            Patient Voices from the Elbow River Healing Lodge

B.   Results from the Realist Review Lens

i.              Context

ii.            Mechanism

1.    Non-interference

2.   Sharing

iii.          Outcome

Chapter 4: Discussion, Conclusions, and Implications

A.   Discussion

B.   Conclusions

C.   Implications

i.              Spirituality as an Underlying Factor for Health

ii.            Implications for Public Health

Additional Pages: 

A.   Appendices

B.   References

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