This book examines the intersections of bioethics, human rights and health equity. It does so through the contextual lenses of nation states while presenting global themes on rights, colonialism and bioethics. The book is framed by the following propositions on indigenous health: it is a human rights issue; it is located within the politics of colonization; and subjugated indigenous knowledges require restoring.

The introduction of the National Health and Medical Research Council guidelines for the ethical conduct of Indigenous health research: Values and Ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research (NHMRC, 2003), has prompted renewed debate about the ethical assessment of Indigenous health research in Australia. Concern has been expressed that these guidelines provide inadequate protection of Indigenous interests and that their introduction will result in a rolling back of (...) important Indigenous research reform gains of the past three decades. Another view is that the participatory focus of the Guidelines will help ensure that key Indigenous values are positioned as central to the development of research involving Indigenous interests. In this article we provide an overview of recent commentary on the Guidelines, and canvass practical proposals for their implementation into practice. In particular, we present a case for applying the Values and Ethics Guidelines as a foundation for establishing negotiated research agreements between Indigenous peoples and professional researchers at the local community level. The intention of this proposal is to give voice to the concerns and perspectives of Indigenous peoples through research, and to provide a framework for monitoring research after ethics approval has been granted. (shrink)

Herbert, Michael Indigenous health is everybody's responsibility. This is true from the national policy level, to state governments and clinics on the ground. Whichever way a particular health issue is approached, and new perspectives are certainly needed, the bottom line is that the determinants of health always reflect back to the living conditions, education, past injustices, and socioeconomic circumstances of the Aboriginal population.

In 1991, the Australian Commonwealth Parliament unanimously passed the Council for Aboriginal Reconciliation Act 1991. This Act implemented a 10-year process that aimed to reconcile Indigenous and non-Indigenous people by the end of 2000. One of the highest priorities of the reconciliation process was to address Indigenous socio-economic disadvantage, including health, education and housing. However, despite this prioritising, both the Keating Government (1991–1996) and the Howard Government (1996–2000) failed to substantially improve socio-economic outcomes for Indigenous (...) people over the reconciliation decade. In this paper, I examine one of the most prominent socio-economic areas, that of Indigenous health. First, I discuss the appalling levels of Indigenous health throughout the reconciliation decade by analysing a number of health indicators, including life expectancy, infant mortality rate, standard mortality ratios, hospital rates and health Infrastructure. This analysis reveals significant and often worsening disadvantage in these health indicators. Second, I analyse a number of policies and programs concerning Indigenous socio-economic disadvantage that were developed by Commonwealth Governments in the 1990s. I argue that these policies and programs largely failed to address Indigenous socio-economic disadvantage. I also discuss alternative policies and programs that could reduce the significant levels of socio-economic disadvantage suffered by Indigenous people. (shrink)

We seek to bring Black bodies and lives into full view within the enterprise of Indigenous health research to interrogate the unquestioned good that is taken to characterize contemporary Indigenous health research. We articulate a Black bioethics that is not premised upon a false logic of beneficence, rather we think through a Black bioethics premised upon an unconditional love for the Black body. We achieve this by examining the accounts of two Black mothers, fictional and factual (...) rendering visible the racial violence Black bodies have been subjected to. We call for a Black bioethics that reimagines the Black body as beautiful and belonging—to both someone and somewhere. (shrink)

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples’ health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non‐Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non‐Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings (...) from the inductive thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal‐led curriculum. Of relevance to this is educator training in how to decentre non‐Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well‐designed professional development. (shrink)

In precolonial Africa, women were the major authorities in herbal remedies within their own homes and at the community level, where they focused on disease prevention and cure. Such roles were pushed to the periphery of Africa’s health discourse by the introduction of Western modes of healing. Furthermore, missionaries branded African indigenous medicine (AIM) as evil and categorised it within the sphere of witchcraft. However, the emergence of new diseases which conventional medicine has found difficult to cure seems (...) to have caused Africans to rethink their position on AIM. For example, there appears to have been a resurgence of interest in utilising AIMs during the coronavirus disease 2019 (COVID-19) pandemic. Greater utilisation, while positive, may lead to herbs and plants becoming extinct if the harvesting is done haphazardly. Therefore, the intention of this article is to examine the intersections of gender and health in the COVID-19 context. The article seeks to establish the role that was and continues to be played by women in the utilisation of AIM within the context of COVID-19. The focus of the paper is on finding out the ways in which women are safeguarding plants and trees whose leaves, roots and barks are envisioned as effective in preventing infection as well as curing the disease. Data were gathered through informal interviews. Theoretically, the article makes use of gender and Afrocentricity as theories informing the study.Contribution: The article highlights the need for placing women at the centre of both health and environmental discourses for sustainable development. It argues for the recentring of women in Earth discourses. Hence, its contribution is in retrieving women’s voices in health and Earth discourses in Zimbabwe for sustainable development to be achieved. (shrink)

In colonial societies such as Canada the implications of colonialism and ethnocide (or cultural genocide) for ethical decision‐making are ill‐understood yet have profound implications in health ethics and other spheres. They combine to shape racism in health care in ways, sometimes obvious, more often subtle, that are inadequately understood and often wholly unnoticed. Along with overt experiences of interpersonal racism, Indigenous people with health care needs are confronted by systemic racism in the shaping of institutional structures, (...) hospital policies and in resource allocation decisions. Above all, racism is a function of state law – of the unilateral imposition of the settler society law on Indigenous communities. Indeed, the laws, including health laws, are social determinants of the ill‐health of Indigenous peoples. This article describes the problem of Indigenous ethnocide and explores its ethical implications. It thereby problematizes the role of law in health ethics. (shrink)

The Truth and Reconciliation Commission of Canada made it clear that understanding the historical, social, cultural, and political landscape that shapes the relationships between Indigenous peoples and social institutions, including the health care system, is crucial to achieving social justice. How to translate this recognition into more equitable health policy and practice remains a challenge. In particular, there is limited understanding of ways to respond to situations in which conventional practices mandated by the state and regulated by (...) its legal apparatus come into direct conflict with the values and autonomy of Indigenous individuals, communities, and nations. In this paper, we consider two cases of conflict between Indigenous and biomedical perspectives to clarify some of the competing values. We argue for the importance of person‐ and people‐centered approaches to health care. These value conflicts must be understood at multiple levels to clarify their personal, social, cultural, and political dimensions. Taking into account the divergence between epistemic cultures and communities allows us to understand the multiple narratives deployed in decision‐making processes in clinical, community, and juridical contexts. Recognizing the knowledge claims of Indigenous peoples in health care can help clinicians avoid reinforcing the divides created by the structural and institutional legacy of colonialism. This analysis also provides ways to adjudicate conflicts in health care decision‐making by disentangling cultural, political, medical, and pragmatic issues to allow for respectful dialogue. Insofar as the engagement with cultural pluralism in health care rights is conducted with reciprocal recognition, the medical community and Indigenous peoples can address together the difficult question of how to integrate different epistemic cultures in the health care system. (shrink)

With the increased acceptance of complementary and alternative medicine (CAM) within society, new research reflects deeper folk health histories beyond formal medical spaces. The contested relationships between formal and informal medicine have deep provenance and as scientific medicine began to professionalise in the 19th century, lay health knowledges were simultaneously absorbed and disempowered (Porter 1997). In particular, the ‘medical gaze’ and the responses of informal medicine to this gaze were framed around themes of power, regulation, authenticity and narrative (...) reputation. These responses were emplaced and mobile; enacted within multiple settings by multiple agents and structures over time. The work is drawn from secondary material from Ireland, which identify more indigenous narratives of health and act as potential sources for medical humanities. While assumptions have been made as to the place of folk-medicine being essentially rural, evidence will be presented which shows a more complex network of health beliefs and practices. The narratives of informal practice and folk-medicine drawn from evidence from Ireland point to more fluid and hybrid relations with formal medicine and suggest that the complementary nature of the two models reflected wider cultural debates and models of belief (Del Casino Jnr., Health & Place 10:59-73, 2004). (shrink)

Over the past few years, intercultural health has become an emerging issue in health policy. Intercultural health is an approach in health that aims at reducing the gap between indigenous and western health systems, on the basis of mutual respect and equal recognition of these knowledge systems. This article questions the applicability of such a concept in the context of Chile. Here, conflicting interests between the Mapuche and the Chilean state are related to aspects (...) of economic development, modernity processes, integration, intercultural relations, and indigenous rights and are deeply reflected also in projects for an intercultural health system. By analysing the experience of the intercultural practice of Makewe Hospital, this article argues that effective and equitable intercultural health practices will not take place unless there will be an integral valorisation of the Mapuche culture from a broader perspective. (shrink)

People who identify as members of religious communities, such as the Amish and Low German Mennonites, face challenges obtaining quality health care and engagement in research due in part to stereotypes that are conveyed through media and popular discourses. There is also a growing concern that even when these groups are engaged in research, the guiding frameworks of the research fail to consider the sociocultural or historical relations of power, further skewing power imbalances inherent in the research relationship. This (...) paper aims at discussing the uses of cultural safety in the context of health research and knowledge translation with groups of people that are associated with a specific religion. Research with the Amish and Low German Mennonites is provided as examples to illustrate the use of cultural safety in this context. From these examples, we discuss how the use of cultural safety, grounded in critical theoretical perspectives, offers new insight into health research with populations that are traditionally labeled as minority, vulnerable, or marginalized, especially when a dominant characteristic is a unique religious perspective. (shrink)

Objectives To characterize recruitment approaches to research on the brain and mind that involves Indigenous peoples. Methods We conducted a secondary analysis of a Harding et al. (2021) scoping review. Reviewers screened studies (_n_ = 66) for sampling methods, recruitment and engagement, positionality statements, and details on ethics approvals. Synthesis We identified twenty-nine (29) English-language articles relevant to the analysis. Of these, 52% (_n_ = 15/29) reported a mix of sampling methods; 45% (_n_ = 13/29) contained statements or information (...) about author positionalities. While, overall, 24% (_n_ = 7/29) of the studies were missing information about ethics protocols, we observe an improvement over time in the reporting of approvals and use of community-engaged participant recruitment methods. Current brain research studies demonstrate ways of collaborating with Indigenous communities that meet existing ethics guidelines. To be wholly responsive to the needs of Indigenous peoples, however, researchers may need to exceed existing ethical benchmarks.. Positionality statements successfully detailed the relationships of the research teams with the communities with which they work, and contextualized recruitment methods. Conclusion Improved quality and meaningfulness of brain research with Indigenous peoples and trust in the research process and public health will be enhanced when remaining gaps in protecting and reporting of participant recruitment methods are closed. (shrink)

Indigenous health is becoming a top priority globally. The aim is to ensure equal health opportunities, with a focus on Indigenous populations who have faced historical disparities. Effective health interventions in Indigenous communities must incorporate Indigenous knowledge, beliefs, and worldviews to be culturally appropriate.

The paper describes the unique health ethics challenges of working with Indigenous peoples. It explores the distorting impacts of colonial law and economic policy on clinical ethics decision making and makes some practical recommendations for overcoming or subverting them.

State and international laws have often been instruments of oppression against Indigenous peoples, enabling and casting a veil of legitimacy over state actions that dispossess, assimilate, and discriminate. In the contemporary setting such law has, at times, come to be harnessed to support or protect Indigenous interests, including addressing Indigenous health deficits and associated injustices.

Indigenous women are more likely to suffer from poor health than non-Indigenous women, usually with one long term condition or several chronic diseases at once. High psychological distress, asthma, eye problems, diabetes and heart disease are common and we are ten times more likely than non-Indigenous women to have kidney disease. Our life expectancy is sixty-three years compared to non-Indigenous women’s mortality rate of eighty-three years. The delivery of inclusive health services is thus an (...) important part of improving our life chances. However, even when such services are provided Indigenous women are reluctant to use them. In this article I discuss some of the impediments to the use of such services by considering how Indigenous women configure space and place in their everyday encounters within a health provision context. (shrink)

Background Current requirements for ethical research in Canada, specifically the standard of active or signed parental consent, can leave Indigenous children and youth with inequitable access to research opportunities or health screening. Our objective was to examine the literature to identify culturally safe research consent processes that respect the rights of Indigenous children, the rights and responsibilities of parents or caregivers, and community protocols. Methods We followed PRISMA guidelines and Arksey and O’Malley’s approach for charting and synthesizing (...) evidence. We searched MEDLINE, PsycINFO, ERIC, CINAHL, Google Scholar, Web of Science, Informit Indigenous Collection, Bibliography of Native North Americans, and Sociological Abstracts. We included peer-reviewed primary and theoretical research articles written in English from January 1, 2000, to March 31, 2022, examining Indigenous approaches for obtaining informed consent from parents, families, children, or youth. Eligible records were uploaded to Covidence for title and abstract screening. We appraised the findings using a Two-Eyed Seeing approach. These findings were inductively coded using NVivo 12 and analyzed thematically. Results We identified 2,984 records and 11 eligible studies were included after screening. Three key recommendations emerged: addressing tensions in the ethics of consent, embracing wise practices, and using relational approaches to consent. Tensions in consent concerned Research Ethics Board consent requirements that fall short of protecting Indigenous children and communities when culturally incongruent. Wise practices included allowing parents and children to consent together, land-based consenting, and involving communities in decision-making. Using relational approaches to consent embodied community engagement and relationship building while acknowledging consent for Indigenous children cannot be obtained in isolation from family and community. Conclusions Very few studies discussed obtaining child consent in Indigenous communities. While Indigenous communities are not a monolith, the literature identified a need for community-driven, decolonized consent processes prioritizing Indigenous values and protocols. Further research is needed to examine nuances of Indigenized consent processes and determine how to operationalize them, enabling culturally appropriate, equitable access to research and services for all Indigenous children. (shrink)

Increasingly, the role of health research in improving the discrepancies in health outcomes between Indigenous and non-Indigenous populations in developed countries is being recognised. Along with this comes the recognition that health research must be conducted in a manner that is culturally appropriate and ethically sound. Two key documents have been produced in Australia, known as The Road Map and The Guidelines, to provide theoretical and philosophical direction to the ethics of Indigenous health (...) research. These documents identify research themes considered critical to improving the health of the nation’s Indigenous peoples. They also provide values that, from an Indigenous perspective, are foundational to an ethical research process. This paper examines these research themes and values within the context of a current longitudinal birth cohort study of Indigenous infants and children in south-west Sydney: the Gudaga Study. Considerable time and effort have been invested in being true to the values stated in these documents: reciprocity; respect; equality; responsibility; survival and protection; and spirit and integrity. We have learnt that it is vital to be true to these values when conducting Indigenous health research—to quite literally “walk the talk”. (shrink)

Indigenous psychologies are informed by their cosmogonies and cosmologies, philosophies, spirituality and religions, traditions and customs, and knowledge and praxis systems. This paper reviews some conceptions of consciousness, psyche, spirit, mental and physical health, relations to all Earth Beings (human and nonhuman), ancestors, nature, and altered states of consciousness among the Nahua and Maya of Mexico. Colonization has threatened these rich legacies by imposing the conquerors' cosmologies. However, these Indigenous communities continue to use plants, mushrooms, and some (...) animals to generate altered states of consciousness, enacting sacred rituals and healing. The conclusion recommends learning from these knowledge and praxes systems and their related consciousness and spiritual states to expand the emergence of decolonial psychology that may offer alternatives to address the challenges of our time. (shrink)

Indigenous Peoples, Consent and Benefit Sharing is the first in-depth account of the Hoodia bioprospecting case and use of San traditional knowledge, placing it in the global context of indigenous peoples’ rights, consent and benefit-sharing. It is unique as the first interdisciplinary analysis of consent and benefit sharing in which philosophers apply their minds to questions of justice in the Convention on Biological Diversity (CBD), lawyers interrogate the use of intellectual property rights to protect traditional knowledge, environmental scientists (...) analyse implications for national policies, anthropologists grapple with the commodification of knowledge and, uniquely, case experts from Asia, Australia and North America bring their collective expertise and experiences to bear on the San-Hoodia case. -/- While much of the focus is on bioprospecting and natural product development, Indigenous Peoples, Consent and Benefit-Sharing also draws important lessons about informed consent and benefit-sharing from the health sciences and sectors such as mining. Policymakers around the world are under significant pressure to resolve the challenges of implementing the CBD. This book’s analysis and recommendations will help them. -/- ‘It is good to see philosophers engaging with the UN Convention on Biological Diversity, and doing so by looking in depth at a real situation in which it has been invoked.’ Peter Singer, Ira W. DeCamp Professor of Bioethics in the University Center for Human Values, Princeton University . (shrink)

Most healthcare providers work from ethical principles based on a Western model of practice that may not adhere to the cultural values intrinsic to Indigenous peoples. Breaking bad news is an important topic of ethical concern in health research. While much has been documented on BBN globally, the ethical implications of receiving bad news, from an Indigenous patient perspective in particular, is an area that requires further inquiry. This article discusses the experiences of Māori lung cancer patients (...) and their families, in order to investigate the ethical implications of receiving bad news. Data collection occurred through 23 semistructured interviews and nine focus groups with Māori lung cancer patients and their families in four districts in the Midland Region of New Zealand: Waikato, Bay of Plenty, Lakes and Tairāwhiti. The findings of this study were categorised into two key themes: communication and context. Avenues for best practice include understanding the centrality of the HCP–patient relationship and family ties in the healthcare journey, and providing patients with the full range of viable treatment options including hope, clear advice and guidance when the situation calls for it. Overall, the findings of this study hold implications for providing culturally safe and humanistic cancer care when BBN to Māori and Indigenous patients. (shrink)

Mixtecs and Zapotecs, originating from the Oaxaca area in Mexico, are among the largest indigenous groups of workers in California. Many adults in this community only access the health care system when sick and as a last resort. This article describes the development of a radionovela to inform the community about the importance of preventive health care. It was developed following the Sabido Method. The methodology to develop a radionovela may be of interest to other public (...) class='Hi'>health practitioners who want to develop educational materials in an engaging format, especially for communities that rely on oral, not written information. (shrink)

This article explores aspects of law's potential for ameliorating the health deficit which Indigenous peoples experience around the globe, with a focus on international law and international legal forums. It considers the challenges and benefits of using these tools and forums to affect changes within domestic systems.

Different cultures show different understandings of consciousness, soul, and spirit. Native indigenous traditions have recently seen a resurgence of interest and are being used in psychotherapy, mental health counselling, and psychiatry. The main aim of this review is to explore and summarize the native indigenous concepts of consciousness, soul, and spirit. Following a systematic review search, the peer-reviewed literature presenting research from 55 different cultural groups across regions of the world was retrieved. Information relating to native concepts (...) of consciousness, soul, and spirit were excerpted from the sources and contrasted. Contrasting these indigenous concepts revealed important implications for understanding consciousness within a cross-cultural perspective and has practical implications for applied approaches utilizing native indigenous traditions. (shrink)

Researchers seeking to engage in projects related to Tribal communities and their citizens, lands, and non-human relatives are responsible for understanding and abiding by each Tribal nation’s research laws and review processes. Few studies, however, have described the many diverse forms of Tribal research review systems across the United States (US). This study provides one of the most comprehensive examinations of research review processes administered by Tribal Research Review Boards (TRRBs) in the US. Through a systematic analysis, we consider TRRBs’ (...) online presence, online documentation, and themes across documents, for five entity types: Tribal nations and Tribal consortiums, Tribal colleges and universities, Tribal health organizations, Indian Health Services, and other Tribal organizations. Results include an assessment of online presence for 98 potential TRRBs, identification of 118 publicly available online documents, and analysis of 41 themes across four document types: Tribal research codes and TRRBs’ guidelines, applications, and post-approval documents. Altogether, this research provides a macro-level analysis of the most common types of TRRBs in the US in an effort to increase researchers’ understanding of these important processes as they prepare to ethically engage Tribal communities in research. These results aim to empower Tribal decision makers as they align their TRRBs’ online visibility and documentation with community priorities and strengthen their protections for the rights and wellbeing of their citizens and community. Ultimately, by expanding our knowledge of TRRBs across the US, this contribution seeks to uphold Tribal sovereignty in research and promote ethical approaches to research with Indigenous communities. (shrink)

A history of colonization inflicts psychological, physical, and structural disadvantages that endure across generations. For an increasing number of Indigenous Australians, environmental epigenetics offers an important explanatory framework that links the social past with the biological present, providing a culturally relevant way of understanding the various intergenerational effects of historical trauma. In this paper, we critically examine the strategic uptake of environmental epigenetics by Indigenous researchers and policy advocates. We focus on the relationship between epigenetic processes and (...) class='Hi'>Indigenous views of Country and health—views that locate health not in individual bodies but within relational contexts of Indigenous ontologies that embody interconnected environments of kin/animals/matter/bodies across time and space. This drawing together of Indigenous experience and epigenetic knowledge has strengthened calls for action including state-supported calls for financial reparations. We examine the consequences of this reimagining of disease responsibility in the context of “strategic biological essentialism,” a distinct form of biopolitics that, in this case, incorporates environmental determinism. We conclude that the shaping of the right to protection from biosocial injury is potentially empowering but also has the capacity to conceal forms of governance through claimants’ identification as “damaged,” thus furthering State justification of biopolitical intervention in Indigenous lives. (shrink)

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non‐Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health‐seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions (...) and improve health outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two‐Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self‐identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma‐informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families. (shrink)

Our language and metaphors about environmental issues reflect and affect how we perceive and manage them. Discourse on invasive species is dominated by aggressive language of aliens and invasion, which contributes to the use of war-like metaphors to promote combative control. This language has been criticised for undermining scientific objectivity, misleading discourse, and restricting how invasive species are perceived and managed. Calls have been made for alternative metaphors that open up new management possibilities and reconnect with a deeper conservation ethic. (...) Here, we turn to Indigenous perspectives because they are increasingly recognised as offering important and novel voices in invasive species discourse. We examine how Australian Aboriginal elders and land managers (rangers) speak about 'environmental weeds' (the term used to describe invasive plants in Australia) and weed management. Based on qualitative research with five Aboriginal groups in the Kimberley region of Western Australia, our findings indicate that Aboriginal elders speak about weeds through passive, neutral language and prefer metaphors for weed management that focus on health, care and creation. We outline the influence that this language has for how rangers practice weed work and discuss its implications for the mainstream paradigm. (shrink)

Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed (...) study design and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives. (shrink)

As nursing professionals, we believe access to healthcare is fundamental to health and that it is a determinant of health. Therefore, evidence suggesting access to healthcare is problematic for many Indigenous peoples is concerning. While biomedical perspectives underlie our current understanding of access, considering alternate perspectives could expand our awareness of and ability to address this issue. In this paper, we critique how access to healthcare is understood through a biomedical lens, how a postcolonial theoretical lens can (...) extend that understanding, and the subsequent implications this alternative view raises for the nursing profession. Drawing on peer‐reviewed published and gray literature concerning healthcare access and Indigenous peoples to inform this critique, we focus on the underlying theoretical lens shaping our current understanding of access. A postcolonial analysis provides a way of understanding healthcare as a social space and social relationship, presenting a unique perspective on access to healthcare. The novelty of this finding is of particular importance for the profession of nursing, as we are well situated to influence these social aspects, improving access to healthcare services broadly, and among Indigenous peoples specifically. (shrink)

Environmental epigenetics is increasingly employed to understand the health outcomes of communities who have experienced historical trauma and structural violence. Epigenetics provides a way to think about traumatic events and sustained deprivation as biological “exposures” that contribute to ill-health across generations. In Australia, some Indigenous researchers and clinicians are embracing epigenetic science as a framework for theorising the slow violence of colonialism as it plays out in intergenerational legacies of trauma and illness. However, there is dispute, contention, (...) and caution as well as enthusiasm among these research communities.In this article, we trace strategies of “refusal” (Simpson, 2014) in response to epigenetics in Indigenous contexts. Drawing on ethnographic fieldwork conducted in Australia with researchers and clinicians in Indigenous health, we explore how some construct epigenetics as useless knowledge and a distraction from implementing anti-colonial change, rather than a tool with which to enact change. Secondly, we explore how epigenetics narrows definitions of colonial harm through the optic of molecular trauma, reproducing conditions in which Indigenous people are made intelligible through a lens of “damaged” bodies. Faced with these two concerns, many turn away from epigenetics altogether, refusing its novelty and supposed benefit for Indigenous health equity and resisting the pull of postgenomics. (shrink)

Background Many indigenous people have died or been harmed because of inadequately monitored research. Strong regulations in Human Research Ethics (HRE) are required to address these injustices and to ensure that peoples’ participation in health research is safe. Indigenous peoples advocate that research that respects indigenous principles can contribute to addressing their health inequities. This scoping literature review aims to analyze existing peer reviewed and grey literature to explore how indigenous values and principles from (...) countries of Oceania are incorporated into HRE and the governance of research involving human participants. Methods A scoping literature review framework was used for this study. A search for peer reviewed and grey literature from Google, bibliographies, and electronic databases such as SCOPUS, SPRINGER, Medline (Ovid) and JBI Database of Systematic Reviews was conducted, limited to the years 2002–2020. Sixty (60) documents that focused on indigenous knowledge from Oceania region and HRE were included, from which key findings and themes were synthesized. Results Charting the data showed that more than half the eligible documents were peer-reviewed journal articles (54%). Other sources included: International Declarations on Human Research (8%); book chapters (8%); government documents (8%); HRE Guidelines or protocols (13%); news articles (7%) and PhD thesis (2%). The literature was from Australia, Cook Islands, Guam, New Zealand, Fiji, Samoa, Tonga and Vanuatu, some of which focused specifically on HREs in the Pacific Region. Issues emerging from the literature were grouped into five themes (i) indigenous and cultural principles of HRE; (ii) informed consent in indigenous settings in Oceania; (iii) vulnerability and minority status of indigenous populations exploited for research; (iv) research ethics governance for Oceania indigenous peoples; and (v) research ethics committees in Oceania. Respect, relationship building, and trust were priority indigenous HRE principles that encompass the principles of partnership, capacity building, reciprocity, and equality. Relationship building and trust imply the equal distribution of benefits for indigenous population and researchers. Conclusion Indigenous principles of HRE identified were interconnected and interdependent. Recommendations were to incorporate indigenous principles of research in HRE regulations and processes of all countries with indigenous populations. This is especially pertinent for emerging national research committees in LMIC countries, including Fiji and Tonga. Relationship building among researchers and indigenous populations is key to successful research with indigenous populations. HRE principles important for relationship building include respect that is reciprocal among researchers and indigenous people. Elements of the principle of respect highlighted are empathy, collaboration, sharing of benefits, reciprocity, appreciation, empowerment, protection, safety and awareness of culture and languages. Indigenous ontology from the Oceania region involves spirituality, connectedness to land, religious beliefs and a participatory approach to HRE and should be respected in research. An ethical governance mechanism of HRE is one that incorporates indigenous principles and applications for the purpose of maximizing the protection of the dignity and rights of indigenous peoples of Oceania. (shrink)

This paper explores the bioethical issues associated with the diagnosis and treatment of vulvar cancer for Indigenous women in East Arnhem Land, Northern Territory, Australia. Based on a qualitative study of a vulvar cancer cluster of Indigenous women, the article highlights four main topics of bioethical concern drawn from the findings: informed consent, removal of body parts, pain management, and issues at the interface of Indigenous and Western health care. The article seeks to make a contribution (...) towards Indigenous health and bioethics and bring to light areas of further research. (shrink)

Indigenous understandings of consciousness represent an important inspiration for scientific discussions about the nature of consciousness. Despite the fact that Indigenous concepts are not outputs of a research driven by rigorous, scientific methods, they are of high significance, because they have been formed by hundreds of years of specific routes of cultural evolution. The evolution of Indigenous cultures proceeded in their native habitat. The meanings that emerged in this process represent adaptive solutions that were optimal in the (...) given environmental and social milieu. We argue that it would not be appropriate to handle these meanings as something that science considers to be wrong, or outdated relics of the human past. In contrast, Indigenous concepts and their meanings may be considered to be an important heritage of native human populations, but moreover, they are also an interesting material for analyses and inspiration for recent scientific debates. Furthermore, it is also necessary to mention another reason why the exploration of Indigenous concepts has been so topical recently. Thus far, much psychological theoretical development has been published in English as a result of research conducted in Western countries. The dominance of English and the superiority of research conducted by researchers from Western countries may be considered as a kind of barrier toward other ways of knowing. We argue that the traditional cultural knowledge coming from Indigenous societies may offer an interesting source of new thought for science. The weakening of the strong dependence of science on well-established academic circles dominated by Western theoretical perspectives may be beneficial for stimulating its further development (Sidik, 2022). Therefore, this special symposium of the Journal of Consciousness Studies aims to open the doors for other ways of knowing, For the knowing that emerged in native Indigenous cultures. We argue that the rich cultural heritage of these societies may stimulate the emergence of new analytical perspectives for scientific theorising about the nature of consciousness. For all these reasons, the Indigenous concepts of consciousness captured our interest, and we decided to start investigating them. In 2020 and 2021, we retrieved and analysed pieces of information from past ethnographical field evidence gathered in various Indigenous cultures. After removal of data about the cultures showing a high acceptance of influences from external religious traditions (e.g. Christianity, Islam or Buddhism), a comparative analysis of data from 55 Indigenous groups was conducted and published in the Journal of Consciousness Studies (Trnka and Lorencova, 2022). This primary project revealed many interesting results, but more importantly, it also showed many unexplored avenues that called for further exploration. This special symposium of the Journal of Consciousness Studies is a continuation and new development of research on the Indigenous understanding of consciousness. Past ethnographical evidence involved some valuable pieces of knowledge about Indigenous concepts of consciousness, but the relevant information was often fragmentary or even totally missing in some cases. Moreover, many authors of past ethnographic records applied a strong etic approach that clouded the understanding of native Indigenous thoughts. Therefore, the main goal of the recent symposium was to broaden the overall information basis for the analysis of Indigenous concepts of consciousness or closely related phenomena. In other words, the symposium aimed to bring more detailed knowledge of Indigenous concepts of consciousness, mind and body and their relations in various groups of Indigenous people. In 2022, we contacted potential contributors and were pleased by their positive reactions, which reflected the topicality of this research focus. The authors were asked to draft their papers with a special focus on (a) a cultural Indigenous understanding of the concept of consciousness, (b) a cultural Indigenous understanding of the mind-body differentiation (or consciousness-body differentiation) and (c) cultural metaphors and cultural beliefs related to consciousness, mind and body. Many of contributors were native members of Indigenous cultures that made the descriptions of Indigenous concepts more accurate and reliable. This enabled many truly emic, in-depth insights into the Indigenous concepts of consciousness and related phenomena to be gained. As a result, this issue of the Journal of Consciousness Studies introduces eight papers, each focused on a different geographical region/Indigenous groups: Nahua and Maya (Mexico), Guna (Panama), Mapuche (Chile), Maori (New Zealand), Telingit (Altai), Mongolian groups, Igbo (Nigeria) and Asabano (New Guinea). These papers are followed by one more general paper discussing magical consciousness on the case of an Aboriginal wise man (Australia). The symposium closes with our concluding editorial essay, which generalises the findings and introduces three theoretical models of understandings of consciousness inspired by the analysis of Indigenous concepts of consciousness. Aside from the importance for basic research, the exploration of Indigenous concepts of consciousness is also very important for informing practitioners from many applied spheres. Many current methods for treating addictions, traumatic life events, professional burnout and other mental health problems use features of Indigenous healing practices. A proper understanding of meanings related to mind, body and consciousness are quite important for Western psychotherapists to adapt the Indigenous practices to particular Western cultural milieus. Furthermore, a proper understanding of meanings related to mind, body, and consciousness is also important for treating ethnic, linguistic and culturally diverse populations (APA, 1990). For therapists, psychologists and physicians, understanding the meanings of these concepts may promote their own better care of their clients from various Indigenous ethnic groups. Last but not least, Indigenous concepts, meanings and languages are closely related to the continuation of the heritage of Indigenous people (United Nations, 2016). The world’s Indigenous languages have recently been under threat of disappearing; many Indigenous languages are endangered globally, and the rate of loss is high (United Nations, 2016). Importantly, recent research has also shown that the retention of Indigenous languages may be protective for the psychological and physical health of their speakers. All these areas represent fields for potential use of the findings presented in this symposium of the Journal of Consciousness Studies. As a concluding note, the editors of this symposium hope that this collection of papers will inspire academic scholars while also providing important information for practitioners from various spheres. (shrink)

Several themes arise here. First is the need to coalition with ecofeminists in struggle against ecocide of our planet earth. Second is the incredible violence committed against Native women in the name of continuing manifest destiny. Third is the overlapping of racism, sexism, and capitalism to create an imperial system of domination over the earth's resources. Fourth, there is a need to heal ourselves and our communities. Authors include Bonita Lawrence, Ana Mariella Bacigalupo, M.A. Jaimes* Guerrero, Andrea Smith, Lisa M. (...) Poupart, Anne Waters, Sheridan Hough, Donna Hightower Langston, Annette Arkeketa, and Steve Russell. (shrink)

Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma‐ and violence‐informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing (...) framework of equity‐oriented care for primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma‐ and violence‐informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice. (shrink)

This article contends that the environmental release of genetically engineered (GE) animals with heritable traits that are patented will present a challenge to the efforts of nations and indigenous peoples to engage in self‐determination. The environmental release of such animals has been proposed on the grounds that they could function as public health tools or as solutions to the problem of agricultural insect pests. This article brings into focus two political‐economic‐legal problems that would arise with the environmental release (...) of such organisms. To address those challenges, it is proposed that nations considering the environmental release of GE animals must take into account the underlying circumstances and policy failures that motivate arguments for the use of the modified animals. Moreover, countries must recognize that the UN International Covenant on Civil and Political Rights and the UN International Covenant on Economic, Social and Cultural Rights place on them an obligation to ensure that GE animals with patented heritable traits are not released without the substantive consent of the nations or indigenous peoples that could be affected. (shrink)

The challenge for those responsible for funding, brokering and assessing the merit of proposed Indigenous research is to identify and then work co-operatively with appropriate representatives of Indigenous interests in order to increase the flow of benefits from research to Indigenous peoples. Experience in Australia has shown that this is not a straightforward process. In this paper we indicate some reasons why it is important for the research community to broker research with representative Indigenous organisations and (...) to involve Indigenous peoples in the ethical assessment and conduct of research. We then identify some barriers to the achievement of these objectives and outline recently developed interventions from the field of health research that aim to promote a more effective working relationship between Indigenous peoples and members of the research community. (shrink)

Despite the United Nations Declaration of the Rights of Indigenous Peoples, assimilationist policies continue, whether official or effective. Such policies affect more than the right to group choice. The concern is whether indeed genocide or “only” ethnocide (or culturecide)—the elimination of a traditional culture—is at work. Discussions of the distinction between the two terms have been inconsistent enough that at least one commentator has declared that they cannot be used in analytical contexts. While these terms, I contend, have distinct (...) senses, yet in cases of governmental and other institutional assimilationist policy for indigenous peoples, such ethnocide effectively entails genocide. Insofar as any people’s cultural practices and beliefs are essential for life and health, individuals in groups value, if tacitly, their culture as highly as their language or any artifact: Thus, attempts to eradicate a culture through assimilation in fact eradicate individuals’ lives and health and so are effectively murderous. Acknowledgement by worldwide organizations that assimilationist ethnocide is effectively genocide should affect policy concerning indigenous peoples and thus has significance for international law. (shrink)