The case for an Indigenous Bioethics

Indigenous communities in the Americas experience a disproportionate incidence of illness and disease compared to the general population. They also possess sophisticated ethical traditions which diverge and not infrequently conflict with Western-oriented bioethics. This culture gap between patient, provider and ethicist is no small public health concern—it can foster feelings of alienation and distrust which compromise the relationship between those in need of care and those able to offer it. Research ethicists have already made considerable efforts to bring sensitivity for aboriginal cultural mores into their discipline, but bioethicists have been slower out of the gate.

This is the argument made by an article last year in the American Journal of Bioethics. The authors Jaro Kotalik and Gerry Martin are well-situated to make such claims—Kotalik is a bioethicist and Martin is an Elder of the Mattagami Nation. The pair attempt to draw parallels between classical systems of virtue ethics and the Ojibwa narrative of the Seven Grandfathers, a fable with the central aim of transmitting the community’s moral compass from one generation to the next. Kotalik & Martin hope this exercise will show that aboriginal and mainstream bioethical frameworks are indeed, to quote First Nations intellectual Leroy Little Bear, “jagged worldviews colliding”. They share parallels, but they are far from perfect complements. Real work must therefore be done to smooth the contact point between them.

Kotalik & Martin make a provocative argument, but they paint a hazy picture of what this work entails. They doubt the possibility of an “aboriginal bioethics”, but they do speak of an “ethical framework” for the provision of healthcare in indigenous communities along the lines of what has been achieved in human research.

What would this look like? Well, some of the groundwork might already have been laid. Narrative bioethics, which has gained increasing traction in recent years, finds common ground with the oral traditions of many indigenous peoples by framing clinical ethical dilemmas with the devices of story. Communitarianism has also grown in popularity amongst bioethicists, paralleling the unbroken continuum between individual and community important to many aboriginal societies.

With these intellectual currents in place, an indigenous bioethics may or may not be possible. However, one thing is certain: it is only with the leadership of aboriginal communities articulating their vision of ethical healing that we’ll find out.

Gaelen Snell