Medical Ethics Respecting the Haudenosaune & Two Row Wampum

The Two Row Wampum as I understand it describes the movement over time of two vessels, a ship and a canoe, travelling in parallel down the river of life. The ship represents the settler societies of Turtle Island, such as Canada and the US, and the canoe represents the Onkwehon:we people.

Although the two rows of this wampum do not overlap, this does not mean that they do not interact.  In fact, they are free to engage with one another in a spirit of peace, friendship and respect, which includes the sharing of their medicines. The distinctiveness of the rows is meant to emphasize that neither society will interfere in the affairs of the other.

The actions of McMaster Children’s Hospital and the threat of Children’s Aid Society (“CAS”) involvement to force Makayla Sault into treatment against the wishes of herself, her family and her community violate this historic agreement.

Within Canadian society, the Consent and Capacity Board and CAS are meant to intervene in cases where families are behaving in ways or making decisions that that may result in the physical or psychological harm of a child.  There is much to criticize about the ways in which these organizations operate due to the underlying injustices of racism, poverty and sexism that exist within our society.  It’s true that the current system, combined with these underlying and unaddressed injustices, leads to higher rates of apprehension of particular people and communities, for example racialized or impoverished families.

In my opinion however, there is a clear need for organizations such as the Consent and Capacity Board and CAS to exist.   There are well-documented cases within the ship (Canadian society) where parents have attempted to deny their children life saving blood transfusions (or other medical treatments) and the state intervened to ensure that the life saving treatments were carried through.  I take no issue with this.

However, CAS and the provincial Consent and Capacity Board do not have jurisdiction over the people and territories of New Credit and Six Nations. It is my understanding that the people of New Credit and Six Nations do not see themselves as part of the ship of Canadian settler society.  These Nations are allies, not subjects of the British Crown and were fundamental to Canada achieving and maintaining its nationhood in the American Revolutionary wars and the War of 1812. However, these Nations never surrendered their sovereignty to the Crown or to Canada.

The decision in Makayla’s case must come from within the canoe and Onkwehon:we society.  In my view, an Onkewehon:we decision making body which can consider Makayla’s case and reach a resolution with the family is needed (perhaps, in my ignorance, I am not aware of  an already existing Onkwehon:we institution with this function).  A process such as this could result in the family pursuing traditional medicines or it could result in the family electing to continue with the prescribed chemotherapy.

By behaving in a manner consistent with a colonial master’s mentality, McMaster Children’s Hospital and members of the medical team have very unfortunately created a lack of trust and a break in the therapeutic bond between the medical team and the family.  Threats of apprehension of Onkwehon:we children, the dis-respect of elders in family meetings, and denigrating remarks about traditional medicines have no place in a respectful two row relationship.  Such actions, comments and behaviours extinguish the opportunity to build trust with the family, trust that is necessary to encourage the family to pursue a very difficult two year treatment plan marked by severe and even life threatening side effects.

As a medical doctor trained within Canadian society with no experience of traditional Onkwehon:we medicines, I am not sure that the family is making the right choice by refusing chemotherapy.  However it is not my right as a member of Canadian society to impose my will upon Onkwehon:we people.

Although the Canadian medical system provides excellent quality care, Onkwehon:we people have many reasons to distrust it. In the 1940’s and 1950’s, for example, Onkwehon:we children were starved under medical supervision for Canadian nutrition studies.  Apartheid segregated care was also commonplace for Onkwehon:we peoples across this country. In such instances, separate substandard wards or hospitals provided a different level of care to Ongwehon:we versus non-Onkwehon:we peoples. These are just a few well-known examples.

Onkwehon:we people have many reasons to distrust CAS.  Multiple generations of their children were kidnapped and put in residential schools where they were stripped of their language and traditions, physically and sexually abused and often died of treatable diseases (due to malnutrition and medical neglect).  Thousands more children were kidnapped from their parents and adopted into non-Onkwehon:we families during the so called “60’s scoop.” Again, these are just a few well known examples.

It is a great tragedy that the threats of child apprehension and forced treatment from Canadian society are adding to the Sault family’s suffering. It is perhaps a greater tragedy that this case has the potential to alienate other Onkwehon:we families from building trust and seeking care within the Canadian medical system which provides some of the best healthcare in the world.

The ship of Canada is on a collision course with the canoe of Six Nations/New Credit.  Those of us in the ship have a unique opportunity to change its course and avoid a catastrophic confrontation.  It will require bold action on the part of McMaster Children’s Hospital, the CAS and the Consent and Capacity Board.  Through their actions, these organizations will have to recognize and acknowledge their lack of authority over Onkwehon:we people and institutions, and continue to reach out in peace friendship and respect.

If the ship does not desist from threats of apprehension and forced treatment, I fear there is the potential for violent confrontation and the creation of a fundamental lack of trust between Onkwehon:we families and the Canadian medical system.   This lack of trust could very well result in Onkwehon:we children and families not seeking care from the Canadian medical system and, in turn, lead to Onkwehon:we people unnecessarily suffering from illnesses, and disabilities that are treatable using western medicine.

Dr. Chris Keefer is an emergency physician at Brantford General Hospital.

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  1. Thank you for your very insightful article. A piercing analysis of this situation, that strikes exactly the right tone.

    PS. I wish you didn’t use the (offensive) term “western medicine”.

      1. I don’t want to derail this discussion from the main issue at hand, so without any intention to expand further: I think it is offensive because it erases and invalidates the work of non-western doctors, biochemists, scientists the world over, as well as the contributions to scientific knowledge of non-western countries (eg. arabs, chinese, japanese, persians, …) or “western” but non-imperialist countries (e.g. the soviets, the cubans, …). In a addition, I think that in a sense it is a racist and imperialist conception of scientific knowledge, ascribing rational thought and evidence-based reasoning as the domain of the Whites, while the rest are relegated to the real limits of “traditional” medicine, essentially replaying the racist stereotype of the “noble savage”.

        I repeat that I do not want to derail the discussion. Chris Keefer’s article is very poignant, insightful and careful, and puts the focus exactly where it should be.

        1. I agree that we shouldn’t derail this super important discussion, but for the purposes of having a more accurate language in the future, what term would you use to describe the medicine practiced in teh CDN system?

        2. It is not for me to say what terms should be used on Two Row Times. That’s why my original comment was phrased in terms of a personal wish, and then took only as much space as was required to answer a direct question. That said, in terms of having a meaningful discussion about terms (I don’t think this is the place to do this, and I’m taking too much space already), I think that the Wikipedia article on the term “scientific medicine” has some info about the coloring of the different terms (negative/positive), while the articles on “evidence-based medicine” and “evidence-based practice” have sections about the practice’s limitations and its relation to tradition.

  2. Nyaweh Dr. Keefer for sharing. Reasonableness is an essential Haudenosaune value, and your words reflect this. I am a Jewish man who has had the honor and blessing of knowing and learning from traditional First Nations elders for most of my 60+ years. I work as a heath and cultural educator and so am deeply concerned about the bridges between allopathic and traditional indigenous health care. Personally I believe that this is a matter of the parents carefully considering the wisdom and spiritual vision of their child but clearly being the adult decision makers. They are certainly aware of the options: allopathic care, indigenous care, or collaborative care. The situation is complex and painful for all of us who are parents (though I certainly don’t equate my concern with the pain of the child’s family), especially since this is one of the few cancers in which allopathic medicine has a decent track record. Yet, in my view it is just for the parents to invoke their rights as members of a sovereign nation and refuse chemotherapy, favoring the time-tested methods of indigenous healing. It is appalling that the hospital’s lead oncologist called the practices of the original people “100% ineffective” and “anyone who says traditional medicine works should be thrown in jail.” Various articles about the child cite the American Cancer Society’s section on Native American medicine which claims “Available scientific evidence does not support claims that Native American healing can cure cancer or any other disease.” Here’s the real irony. There is a great deal of scientific evidence, and my own lectures have been sponsored by many medical schools and hospitals, including a Grand Rounds lecture on Native American/First Nations medicine at the Mayo Clinic. More recently I have written a chapter on Native American treatment of wilderness trauma in the standard medical school text (published by Stanford Med School), Wilderness Medicine. I have seen reports of advanced cancers, including stage IV leiomyosarcoma and other inoperable, untreatable cancers going into remission as a result of indigenous medicine. Much of the info on the American Cancer Society page is taken from one of my articles, published in a peer-reviewed medical journal and part of the first U.S. medical textbook on CAM (Complementary and Alternative Medicine). But the American Cancer Society decided to editorialize and add their biased on uninformed comments about lack of evidence! No healing system in the world, whether allopathic, complementary, or indigenous, can cure all diseases or has all the answers. Nor do different healing systems have the same definitions of health, healing, or cure. Indigenous medicine doesn’t need need to prove its efficacy or the validity of its values and principles to physicians any more than physicians need to prove their worth to Native healers. Respectful dialogue is necessary as well as honoring the rights of original peoples. DaNaho

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