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Indigenous Health Care, Bioethics and the Influence of Place

In the target article, “Aboriginal Health Care and Bioethics: A Reflection on the Teaching of the Seven Grandfathers,” Jaro Kotalik and Gerry Martin rightly identify the importance of generating ethical guidance from a bioethics grounded in traditional Aboriginal knowledge (Kotalic and Martin 2016). For me, the article is a timely reminder of the importance of respecting, and learning from, indigenous peoples’ experiences. It brings to mind the underexplored significance of ethics of “place” within bioethics and highlights the practical benefits that an awareness of place within health care practice brings. The effect of human thought and activity on the places and landscapes where we dwell is well known. Humans change the land around them in a way and on a scale matched, for the most part, by no other animal. We know that the land is a reflection not only of our practical and technological capabilities, but also of our cultures and our societies—of our needs, hopes, preoccupations, and dreams (Malpas 1999). Even so, when thinking about the notion of place we must take definitional care. Place can be a particular location. It can be a series of locations where social life is enacted (in workplaces, malls, vehicles, health care services, universities, etc.). Place can also be experienced as locution. Humans may experience what has been recognized as a “sense of place” that is connected to their identity, community, and moral nature. Place in this sense is best thought of in a relational manner connecting to extensive economic, political, and cultural networks. Places are dynamic, not static, entities. They may be mobile and comprised of commuting paths that shift and change. The specificity and distinctiveness of a place may derive from the particularity of mixed influences on, and within, that place. Because the concept of place is grounded in sociospatial imaginations and reflected visions or fantasies of located connection, “place” is fundamental to relationships, understanding, and the production and dissemination of knowledge. Thus, the concept of “place” has different dimensions and can be appreciated and experienced as both location and locution (Agnew 2011). There is arguably no real possibility of understanding the nature of human experience unless an understanding of the ethics of place is included. It is easy to appreciate the practical importance of having an ethical sensitivity to place within health care. For instance, we know that when we understand the influence that ethics of place has on the distinct ethical nature of rural professional roles in rural health, we are better able to explain the complex ethical dimensions of situations where access, multiple overlapping relationships, confidentiality, cultural safety, team practice, and small community clinician stress may be issues (Crowden 2008a; 2010). There is no better example of the significance of place and experience than in indigenous health care, where values like reciprocity, respect, equality, cultural integrity, partnership, collaboration, spirit, and integrity are central. Indigenous peoples have distinct holistic relationships with the environment, air, land, and waters. A sense of place, experience, identity, and belonging is linked to creation stories, travel, trade, ceremonies, family,