Clarke (2017). Grounding care practices in theory.

Clarke, S. (2017). Grounding care practices in theory: Exploring the potential for the ethics of care to provide theoretical justification for patient-centered care (Thesis). McGill University, Montreal. Retrieved from http://digitool.library.mcgill.ca/R/?func=dbin-jump-full&object_id=145586

[“Chapter Five: Challenging The Dominant Discourse Of A Controversial Case: An Ethics Of Care Approach To The Stories Of J.J. & Makayla” (p 68) …]

“… the families’ supporters argue for the importance of valuing traditional healing practices as fundamental cultural values that ought to be preserved and respected no matter what Western medicine might favour or predict.” (p 69)

“An ethics of care approach, as this thesis has argued, has often been presented as a complement to traditional moral theories. For example, the duty to care has justified the need for relational [page break] concern, given that healthcare that lacks a relational approach can lead to increased patient suffering (Nordhaug & Nortvedt 2011).” (p 69-70)

“J.J., a Haudenosaunee girl from Six Nations of the Grand River First Nation, was diagnosed and began treatment for acute lymphoblastic leukemia at a Hamilton hospital in August 2014. Her physicians recommended chemotherapy and predicted a survival rate of 90-95 percent with this treatment. After 12 days of chemotherapy, J.J.’s mother removed her from treatment, stating that this decision represented J.J.’s wishes. Her family turned exclusively to treatment they felt was in line with their traditional healing practices. Given the proven efficacy of the physician-prescribed chemotherapy treatment the J.J.’s high likelihood of remission, her physicians took legal action to ensure she received their recommended treatment. A court decision favouring the hospital would have allowed for actions including J.J.’s removal from her community and family in order to ensure she was in hospital and receive the recommended treatment. However, the hospital was unsuccessful; the local Children’s Aid society determined that J.J. was not in need of protection and a court subsequently ruled that compelling J.J. to receive chemotherapy would conflict with her mother’s Aboriginal right to choose indigenous medicine. In both cases, conflict arose between the healthcare team and the families who both sought to uphold the best interest of the children.” (p 77)

“One commentator argued that when ‘the life of a child hangs in the balance’, courts should take the child’s best interests as the deciding criterion (Mullin 2014). They argue [page break] that in these cases, because courts acted in interests that were not guided by survival, the child’s best interests were not accounted for. Ultimately, authors implicitly or explicitly equated best interests with the interest of survival.” (p 72-73)

“Another commentator compares evidence for parental care to scientifically measured treatment options, arguing that parental care’s empirically unproven success ought to not be given value in medical decision-making (Globe and Mail 2014). Finally, the same commentator writes that the life of a child is cheapened when misguided parents are able to do ‘as they see fit, evidence be damned’ (Schuklenk 2014).” (p 73)

“… the judge in J.J.’s original case argued that the law ought to preserve Aboriginal people’s right to pursue care according to their own values and traditions, especially in cases where failure to uphold this right threatens to severely disrupt otherwise supportive and caring families, e.g., through the physical removal of the child from her family’s custody (The Globe and Mail, 2015).” (p 74)

“An ethics of care approach prioritizes relationships as morally relevant in themselves. This analysis illuminates unique ethical issues in the case at hand; all parties involved must consider the effect that their decision will have on sustaining relational ties between the young girls and their support systems. … two facts: 1) that a patient’s best interests are always situated and dependent upon a complex web of relationships and 2) that these relationships must be given moral status when determining said best interest. … An ethics of care approach may provoke the following question: what is the best outcome of medical treatment, and how is treatment truly in a patient’s best interest, if it compromises the relationships and constitutive needs of a vulnerable patient?” (p 75)

“Medical professionals are now accustomed to customizing their care to a patient’s individual needs and preferences; care is always situated within culture, so cultural differences cannot be kept separate from care.” (p 75)

“Traditional aboriginal care is often compared to evidence-based care in a hierarchical way, in which aboriginal healing practices are sometimes seen as a threat to the supremacy of Western medical evidence.” (p 76)

“It has been widely assumed in reacting to this case that the best interests of the children can be equated with survival. There has been little further exploration of this assumption. However, the concept of best interests encompasses more than just survival. Further, it is not an objective concept; persons hold different conceptions of the good, based on our individually-held value systems and these inform what best interests mean for each individual.” (p 77)

“A relational account of autonomy recognizes the way that oppressive social structures undermine the autonomous capacity of vulnerable agents.” (p 79)

“Health professionals are often encouraged to consider evidence as the guiding source for difficult decision. While evidence-based practice is [page break] valuable, medical evidence does not exist outside of the relational context of treatment.” (p 79-80)

[“Chapter Six: Conclusion” (p 82) …]

“… the stories of J.J. and Makayla Sault, two aboriginal girls who decided, with their families, to reject medical treatments recommended by physicians at a McMaster hospital, choosing instead to pursue treatment they deemed to be in line with their own Aboriginal beliefs. … while the legal duties of health professionals will always be of moral importance, ethical considerations become particularly important, and pragmatic, when these legal duties are distorted by complex, contradicting values. This thesis concludes with the view that traditional ethical models do not have the same capacity as the duty to care in providing [page break] ethical guidance in these circumstances. Because the duty to care and patient-centered care share similar theoretical foundations, and share common ground in their moral values, a health care professional who is concerned with providing patient-centered care ought to consider the features and obligations of the duty to care.” (p 83-84)

Selected References

  • Mullin, A. (2014) Aboriginal rights and the welfare of First Nations children. Impact Ethics (blog). Viewed 1 December 2016. Retrieved from: https://impactethics.ca/2014/11/20/aboriginal-rights-and-the-welfare-of-first-nations-children/
  • Schuklenk, U. (2014). Aboriginal or not, there is no parental right to harm your child. The Globe and Mail. Viewed 1 December 2016. Retrieved from http://www.theglobeandmail.com/opinion/aboriginal-or-not-there-is-no-parental-right-to-harm-your-child/article21635493/
  • Nordhaug, M., & Nortvedt, P. (2011). Justice and proximity: problems for an ethics of care. Health Care Analysis, 19(1), 3-14. [Not listed in original references. –oki]
  • Grant, K. (April 24, 2015). Aboriginal girl now receiving both chemo and traditional medicine. The Globe and Mail. Viewed 1 December 2016. Retrieved from http://www.theglobeandmail.com/news/national/case-over-cancer-treatment-for-native-girl-is-resolved/article24101800/
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