@NightShiftMD, Dr. Brian Goldman, tackled the issue of First Nations’ right to choose traditional treatments for themselves and their children with, I believe, the correct balance between respect and the need to ask tough questions. You can hear his conversations on the subject in the latest episode of CBC’s White Coat, Black Art.
We are weaning ourselves off of paternalistic medicine, in which medical doctors were deified and their decisions obeyed to the letter. The type of participatory medicine which is replacing it elevates the patient to the level of a dignified decision-maker who requires information and guidance to make an enlightened decision that will affect his or her health.
But what of children?
If an adult chooses to refuse chemotherapy to pursue pseudomedical homeopathy or Reiki, the most cynical of critical thinkers might mutter “social Darwinism” under their breaths. However, when these believers in disproven nonsense need to make medical decisions regarding their children, what is the role of the State?
Dr. Goldman spoke to Dr. Nadine Caron, a surgical oncologist at the University of Northern British Columbia, a First Nations woman herself, and someone who feels that there is more to medicine than evidence.
When boldly asked by Dr. Goldman about the lack of scientific evidence for First Nations “medicine”, she displayed the sort of relativism that readers of this blog will be familiar with by now. “I think there is other ways, uh, where you can garner knowledge and wisdom, and the aboriginal ways of knowing are simply different. And it’s so important to say that they are not wrong; they’re different.”
This relativistic nonsense leads medical practitioners like Dr. Caron to claim that patients need to find the treatment that “works for them”. The problem is that most patients aren’t doctors. Most patients aren’t scientists. Most patients do not understand what a clinical trial is, why placebo controls are important, what the peer review process brings to the table, and how to judge whether a published study is robust or just plain baloney. I’m glad Dr. Caron provides information to her patients, but a science education is not possible within the confines of a public healthcare system.
Some of her aboriginal patients refuse surgery and opt instead for traditional First Nations remedies. Dr. Goldman formulated the tough question that was on my lips: “Can you share the outcomes of any of these patients?” The three examples that popped into Dr. Caron’s mind showed a balance that I don’t suspect the full numbers would reach: one changed her mind and had surgery, one died, one is still alive.
How could conventional medicine fail First Nations patients? Dr. Caron states that few clinical trials test chemotherapeutic drugs, for instance, in First Nations individuals. What if they don’t work as well as they do in the Caucasians often recruited for these trials? The solution to the problem, of course, is not to resort to magical nonsense but to conduct further studies on First Nations patients. There are genetic factors that can affect a patient’s response to treatment. Throwing Western medicine out the window and replacing it with millennia-old wishful thinking is not the logical answer.
I’ve previously written about why Western medicine is not relative. Traditional remedies often either lack rigorous testing or have been thoroughly disproved. The ethical question that I am left with, at the end of this episode of White Coat, Black Art, is what should the State do with children whose parents refuse Western medical treatment.
Should these sick children be taken away from their parents and forced to undergo chemotherapy, with all of its (temporary) side effects? Is refusing treatment for your child in this context equivalent to neglect? Is foregoing chemotherapy and administering traditional herbs that fly in the face of evidence abuse? What is the cost of saving a child’s life if you traumatize him or her by separating the child from his or her parents?
There’s no doubt in my mind that replacing a Western medical treatment with a 90% chance of success for disproven herbal remedies is wrong. It is not different but simply wrong. But is the State forcing a child to undergo this treatment against the parents’ will right or wrong?
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