Mitchell, Guichon, & Wong (2015). Caring for children, focusing on children.

Mitchell, I., Guichon, J. R., & Wong, S. (2015). Caring for children, focusing on children. Paediatrics & Child Health, 20(6), 293–295. https://doi.org/10.1093/pch/20.6.293

“Two First Nations girls with leukemia received a significant amount of media attention in 2014 and 2015. In both cases, the parents refused to continue chemotherapy, the only proven effective treatment; they opted instead for a combination of traditional Aboriginal healing approaches and alternative therapies offered in a facility outside of the country.” (p 293)

“The present commentary aims to review the academic assessment of the situation, to describe responsibilities of physicians in such cases and to propose a course of action for them.” (p 293)

“In reaction to the initial judgement, a _Canadian Medical Association Journal_ (CMAJ) commentary (4) highlighted the richness of Indigenous approaches to healing and emphasized the absolute necessity that health provider interactions with Indigenous patients be based on trust and respect, especially given the awful legacy (8) of residential schools. We agree with their commentary; clearly, the overarching need is for mutual trust. Medical practitioners and institutions must focus on respect for Indigenous patients, their families and community traditions, while accepting that Indigenous leaders are a central part of the attempt to find mutual respect and to focus on the preservation of their young people’s health and lives.

“The CMAJ commentary, however, made a number of factual errors and lacked understanding of the legal and ethical responsibilities of all physicians, including paediatricians, when faced with a situation in which parents of any background deny lifesaving treatment for their child.” (p 293)

“The description of chemotherapy as ‘toxic medications with severe adverse effects’ (4), without any qualification, obscures the fact that chemotherapy provides, to date, the only evidence-based treatment for the survival of JJ.” (p 294)

“A more recent report claims that ‘Racism against Indigenous peoples in the healthcare system is so pervasive that people strategize around anticipated racism before visiting the emergency department or, in some cases, avoid care altogether’ (13).” (p 294)

“Paediatricians must accept that Indigenous physicians have a vital role in helping to bridge a vast cultural divide. … To this end, training on how to make patients and families of varying cultures feel safe to seek and undergo treatment should be an essential part of early training for all health care professionals.” (p 294)

“At the outset, realize that an institutional policy that welcomes and recognises Indigenous culture is useless without an individual commitment to follow through and sincerely welcome the child, the family and community values.” (p 294)

Selected References

  • 4. Richardson L, Stanbrook MB. Caring for Aboriginal patients requires trust and respect, not courtrooms. CMAJ 2015;187:162
  • 8. Truth and Reconciliation Commision of Canada, Honouring the truth, reconciling for the future: summary of the final report of the Truth and Reconciliation Commision of Canada. 2015 <www.trc. ca/websites/trcinstitution/File/2015/Exec_Summary_2015_06_25_ web_o.pdf> (Accessed July 1, 2015).
  • 13. Allan B, Smylie J. First Peoples, second class treatment: The role of racism in the health and wellbeing of Indigenous peoples in Canada. Toronto: the Wellesley Institute, 2015, page 2. <www. wellesleyinstitute.com/wp-content/uploads/2015/02/Summary-First- Peoples-Second-Class-Treatment-Final.pdf> (Accessed May 3, 2015).
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