A Cross-Cultural Dialogue on Health Care Ethics ed. by Harold Coward, Pinit Ratanakul (review)

HUMANITIES 157 today originating in Canada and Mexico and not the United States. Considering the diverse history of Mexico, one would not expect it to follow the American lead. But remembering that Canada and the United States were both recipients of English common law, we can but admire the progress in Canada in the last generation in meeting unique challenges in innovative ways. A necessary addition to any decent library on the aboriginal peoples. (VINE DELORIA, JR) Harold Coward and Pinit Ratanakul, editors. A Cross-Cultural Dialogue on Health Care Ethics Wilfrid Laurier University Press 1999. xii, 274. $29.95 K=aila Paulette, a First Nations baby, died of liver failure one month before his first birthday. Standard medical therapy for his liver dysfunction would have been organ transplantation. A liver transplant offered, according to his paediatrician, an 80B85 per cent survival rate. His mother, Lesley, refused to allow the recommended transplant: partly because the information she gathered put the five-year survival rate at closer to 60B65 per cent; partly because of quite reasonable fears for his post-transplant quality of life. Mostly, however, her refusal was based upon her somewhat controversial interpretation of Native cultural and spiritual values. Irresolvable disagreement about the appropriate treatment for K=aila led to a court challenge (Saskatchewan v. P. 1990). The court=s verdict was a mixed victory/defeat for both sides. The Paulettes won their case, so their son died without surgery. But the court based its decision on the lack of adequate evidence that medical technology would provide more benefit than harm for this child. Parental authority was upheld, but only because in this particular case medical technology was found to be dubiously beneficial to the child. It seems clear from the court=s reasoning that once a technology improves to the point where it can assure recipients of the likelihood of a good quality of life, the state will be authorized to override parental judgment which appeals to the spiritual/cultural/community values of the parents. In our pluralistic liberal society, competent adults are legally entitled to refuse life-saving treatment, even in circumstances where the dominant culture feels that their decision is wrong-headed or even foolish. But this individual discretion does not extend to decisions made on behalf of their children. I find this a sensible compromise, which puts me at odds with the contributors to this volume. Indeed, opposition to the court=s rationale in the K=aila case is a major connecting thread for many of the essays collected here. The authors seem surprisingly united in support of the view that, in a liberal pluralistic society such as Canada, members of minority cultures, 158 LETTERS IN CANADA 2000 whether Native or Hutterite or Chinese, should enjoy the absolute legal right to use their own cultural or spiritual values in deciding when their children=s quality of life is worth maintaining, as well as which technologies constitute an acceptable means to prolong life. Consider. What if transplant technology could have offered K=aila a 95 per cent chance of living a normal healthy life? What if K=aila=s otherwise fatal condition could have been cured by a single injection of a vaccine with no known adverse side-effects? Disappointingly, the contributors to this volume don=t explicitly confront such tough questions. It seems clear, however, that their near-total commitment to respect for the religious or cultural diversity of minority communities would force them, perhaps regretfully , to give to parents unchecked discretion over their children=s fate, with no protective role for state intervention. The authors do not discuss the sad case of Tyrrel Dueck, whose Christian fundamentalist parents prevented his receiving, in a timely fashion, the surgery and chemotherapy necessary to save his life, nor is there any careful analysis of the numerous Jehovah=s Witness cases involving denial of blood transfusion to their children. The authors would, presumably, uphold parental discretion in all such cases. If we, the dominant culture, intervene coercively in the name of child protection, we must do so by appealing to a set of attitudes and values which are sometimes conflicting and sometimes questionable. The authors are right to...