EDITOR'S COLUMN

Truth and Reconciliation

Murray Sinclair

“I have described a mountain, and showed a path. We call on you to do the climbing.”

- Justice Murray Sinclair “He Who Writes in the Sky”

Martin McKneally

The mountain of evidence of predatory and misguided colonialist educational policy, “taking the Indian out of the child”, overwhelms our capacity to respond as individuals. My resolution to respond was stimulated by hearing He Who Writes in the Sky speak at the Museum of Human Rights in Winnipeg, a few days before the release of the report of the Truth and Reconciliation Commission. The oral presentation was profoundly moving. I decided to use this column to offer three compass corrections to help us follow the path to reconciliation.

1. Use Universal Precautions

Catherine Classen, Academic Leader of the Trauma Therapy program at Women’s College Hospital, gave us a wise lesson on retraumatizing at the Sue MacRae Lecture on Ethics and Patient-Centred Care. She advised us to “use universal precautions”, treating every patient as vulnerable to unintended retraumatization. For many patients, and especially aboriginal patients, the impact of the institutional setting, combined with the powerful role and persona of the surgeon can trigger latent, sometimes deeply hidden responses to earlier trauma. “Time conceals all wounds; it does not always heal. Interpersonal trauma experienced in childhood has especially pernicious consequences that can span a lifetime. Given the high prevalence of psychological trauma [one in two women, one in three men], and its often devastating effects, there is both an ethical and clinical obligation to provide care that is trauma-informed.”

I had always thought post-traumatic patients were a small minority, in the competent care of others like Cathleen - never as my own patients. Even when treating indigenous and other patients who were likely to be trauma-conditioned, I didn’t see the mountain.

© The glass panel hanging in the conference room of the Surgery office, is a reproduction by Bernard Langer of one of the four paintings in the series “Homage to Grandfather” by Daphne Odjig,.an internationally recognized Canadian First Nations artist. It is called “Learning”.

2. Adopt Indigenous Values

Jason Pennington, profiled nearby, helped me think about indigenous values that we can honor and adopt as we react to the tragic knowledge imparted in Justice Sinclair’s report. John Bohnen drew attention to Jason’s work to instill these values in our medical students. Jason tells us not to reinforc e victimhood by asking paternalistically “What can I do to help?”. We can adopt indigenous values that will inform, augment and strengthen our own practice. Aboriginal reverence for air, land and water, for community and family can be learned and practiced to help us overcome the emphasis on individualism, autonomy, ownership, and independence from the community that is overvalued in our own tribal customs, laws and ethics.

3. Adopt Indigenous Customs

When pediatric neurosurgeon Patrick McDonald was completing an MHSc in bioethics, he told a riveting story from his early days in practice in Winnipeg. He had safely removed all that could be resected of a brain tumor in a young aboriginal child. When the tumor recurred a few years later, he asked the boy’s mother whether he should attempt further surgical treatment, knowing that the operation could cause severe neurological damage. Mother said “I cannot [be the substitute decision maker as your tribal customs dictate]”. She asked for a second meeting. To Patrick’s surprise, a large group then filled the office. They said “This boy makes our village better because we all care about him. We want him to live, even if he is more disabled.” When Patrick asked for a decision, Grandmother, the only person in the room who had been silent, spoke for all, giving the patient and the surgeon an indigenous communal form of consent that cannot be found in our ethics, law, or surgery books.

There is a mountain to be climbed. Indigenous guides can help us on the path.

Martin McKneally