Protesters outside the Ontario Court of Justice on November 14 applauded Justice Gethin Edward’s decision to reject an advance by the McMaster Children’s Hospital in Hamilton. The hospital requested that the Brant Family Children’s Services (BFCS) and a First Nations family force their 11-year-old girl to resume her chemotherapy treatments. Contrary to news sources calling the case “groundbreaking”, the issue has been considered before. The circumstances of Makayla Sault and Jada Johnson, the two Aboriginal girls who have protested Western medical treatments, both involve almost identical scenarios and outcomes. Justice Edward’s judgment affirmed the rights of First Nations to practice their own medicine. However, when the situation is deconstructed, it is evident that instrumental variables are being overlooked, such as the health status of Indigenous communities, the science behind natural healing methods, and the motives behind the Aboriginal parents’ rejection of conventional medicine.
Studies have demonstrated that Aboriginal people in Canada bear a disproportionate burden of illness compared with the general population. Mortality and morbidity rates are higher in their population than in the general Canadian populace at large. The infant mortality rates averaged from the years 1986 to 1990 were 13.8 per 1000 live births among Aboriginal infants and 16.3 per 1000 among Inuit infants, compared to only 7.3 per 1000 among all Canadian infants. Poverty, cultural barriers and jurisdictional problems are factors that have contributed to this problem.
In the province of Ontario, the Health Care Consent Act does not specify an age of consent to treatment. Instead, these 11-year-old girls that have been diagnosed with leukemia are left to decide which types of medicine and treatments they should pursue. One can only imagine the pressure that surrounds the ill child- as doctors are telling her one thing, her family and friends are pushing her towards another direction. In a life or death scenario, when a child decides to forgo the treatment the hospital has started to administer, the Consent and Capacity Board assumes the power to determine if the child has the capacity to make her own decisions about her care.
The Health Care Act states that the court may make the order if it is satisfied that:
(i) the treatment will or is likely to improve substantially the condition of the person to whom it is to be administered, and the person’s condition will not or is not likely to improve without the treatment, or
(ii) the person’s condition will or is likely to deteriorate substantially, or to deteriorate rapidly, without the treatment, and the treatment will or is likely to prevent the deterioration or to reduce substantially its extent or its rate;
(b) that the benefit the person is expected to obtain from the treatment outweighs the risk of harm to him or her.
McMaster doctors say that the girl has approximately a 90 to 95 per cent chance of survival with chemotherapy treatments, but faces almost certain death without conventional treatment. In September, the child’s mother stopped the chemotherapy, and instead took her to Florida to receive herbal treatments at Hippocrates Health Institute – the same place where Makayla Sault, the previous Aboriginal child cancer patient, visited. “There appears to be little science to back up the natural and traditional treatments the institute offers, from wheat grass to raw-food diets and infrared saunas”, said Joe Schwarcz, director of McGill University’s Office for Science and Society.
On the other hand, the case is a reminder to health-care providers that they must factor in the wishes and beliefs of the patient when administering treatment. “No longer are we going to let people come and take our kids,” said Chief Ava Hill. “We’ve been practicing traditional medicine, we’ve never stopped, and now we’re just going to do it more openly.” Many supporters praised the decision as an acknowledgement of First Nations’ continued culture and autonomy.
The significance of the legal outcome lies in the implication that forgoing a little girl’s chemotherapy treatment is justified by the political stance of supporting the aspirations of Aboriginal society for self-determination. “It reaffirms our right to be Indian and to practice our medicines in the traditional way”, said Chief Ava Hill. But is the constitutional right for Aboriginals, especially Aboriginal children, to forgo chemotherapy in favor of traditional medicine truly a valid argument? Knowing what we know about the science, we might ask if the ruling could potentially mark the start of a devastating downward spiral for the health and well being of First Nations people.
Aboriginal leaders in Canada need to accept greater responsibility for improving the health status of their communities. At the same time, there is a need for greater acceptance by Aboriginal people of existing initiatives for health promotion and disease prevention.
Current concerns about health problems and services, as expressed by indigenous people describe a need for a community-controlled and culturally appropriate approach to healing in indigenous communities. Developing an indigenous people’s health program to ensure that Aboriginal society has the capacity, the resources and the appropriate political environment in which to implement community healing might allow for a more positive balance to be struck in the future.