Aboriginal Bioethics  

Oleh:

Ellerby, Jonathan H.

Jenis: Article from Books - E-Book
Dalam koleksi: The Cambridge Textbook of Bioethics, page 383-390.
Topik: Aboriginal Bioethics; Diversity and Pluralism; Population
Fulltext: Aboriginal Bioethics.pdf (286.64KB)

Isi artikel

Mr. A, a 70-year-old Aboriginal elder who speaks only Ojibway, is admitted to a tertiary care hospital for diagnostic investigation of possible prostate cancer. Initially, only a female interpreter is available, and she has dif?culty translating the physician’s references to the penis while obtaining consent for cystoscopy. When asked to tell Mr. A that the procedure would aid in cancer diagnosis, she refuses to translate the concept of cancer directly and, instead, uses the word for ‘‘growth.’’ The patient responds that he does not fully understand the diagnostic test but trusts the interpreter and the urologist and agrees to sign the consent form. During cystoscopy, both his son and a male interpreter, are present to translate. Following the biopsy and other diagnostic tests, Mr. A, his son, the male interpreter, and the urologist meet. Addressing the son and the interpreter, the urologist explains that Mr. A has advanced cancer spreading to bone. When asked by the son about treatment, the urologist replies that any attempted curative treatment would probably cause more risk and discomfort than would pain relief and other palliative measures. The interpreter begins to translate the urologist’s summary, but his explanation of the diagnosis is interrupted by the son, who says that he will communicate directly with his father. He states that the interpreter should not have used the Ojibway word ‘‘manitoc,’’ which denotes cancer through the cultural metaphor of ‘‘being eaten from within,’’ and that direct reference to cancer and his father’s terminal prognosis will promote fear and pain. He adds that his father has given him responsibility to interpret and to act as his proxy decision maker. The son further opposes the physician’s attempt to communicate the prognosis directly to Mr. A, stating that direct references to death and dying may ‘‘bring death closer.’’ The urologist argues that Mr. A needs to understand his diagnosis and give informed consent for possible treatment or the more likely palliative measures. The son replies that he will not lie to his father but that he needs time to communicate with his father through a more gradual and indirect process. The physician and son ?nally agree that the son will involve other family members over the next 48 hours. The physician and family arrange to meet again in two days and, in the meantime, to hold a ‘‘sharing circle’’ (Table 47.1, below) in which patient, family members, and caregivers will discuss palliative care and answer Mr. A.’s questions.

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