Three Levels of Autonomy and One Long-Term Solution for Native American Health Care
2020; American Medical Association; Volume: 22; Issue: 10 Linguagem: Inglês
10.1001/amajethics.2020.856
ISSN2376-6980
AutoresSiobhan Wescott, Beth Mittelstet,
Tópico(s)Innovations in Medical Education
ResumoNative Americans have twice the poverty rate of the general US population, suffer significant health inequity, and are chronically underrepresented, at only 0.08%, in the US physician workforce.The COVID-19 pandemic has illuminated key ethical, clinical, and economic complexities in health decision making among Native patients.This article discusses 3 levels of autonomy relevant to health decisions, including taking care of our own by increasing numbers of Native medical students.Three Levels of Autonomy Individual, familial.The first level of autonomy for health care decisions among Native Americans-the individual level-is more complex than most appreciate.Historical trauma casts a long shadow over Native Americans' health care interactions today.For instance, in the 1970s, about one-third of Native children were removed from their families and tribes and taken to boarding schools or "adopted out" to White families before passage of the Indian Child Welfare Act of 1978, which ended forcible government-sanctioned removal of Native children from their families and tribes. 1 Even more disturbing, approximately 3000 Native women were involuntarily sterilized by a federally funded program. 1 Non-Native health care workers might think they are giving a compliment when saying, "What an adorable baby!I could just take him home with me."But to Native parents whose autonomy was undermined by federal child-removal policies, that remark can be threatening and retraumatizing.Tribal.The second level of autonomy in health care decision making among Native Americans is the tribal level.A test of this type of autonomy arose in 2020: Does a US
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