Honoring indigenous culture amid serious illness

My stomach dropped the first time I had to inform my patient and their family that smudging was prohibited in the hospital. Smudging, the burning of sacred herbs such as sage, is a traditional ceremony practiced by many Indigenous Peoples. This ritual helps clean the energy of a physical space, object, or person, and can be meditative in times of stress and/or discomfort, such as during hospitalization. I knew in that moment that I was unconsciously perpetuating unnecessary trauma and grief that Indigenous Peoples have experienced for centuries.

In recent years, some Western-oriented healthcare settings have created dedicated spaces where Indigenous ceremonies can be safely performed. However, in the United States, space for these rituals remains a significant barrier, contributing to low utilization of palliative care despite disproportionate rates of serious illness among Indigenous Peoples.

Palliative care is an interdisciplinary approach to care that emphasizes quality of life from time of diagnosis until death and enables individuals to die in their location of choice. However, limited access to these services on or near reservations/reserves often renders Indigenous Peoples in need of more frequent hospitalizations and intensive care unit admissions compared to other populations.

It has been well-established that most people want to die at home; pervasive health inequities stemming from colonialism have stripped that reality from many Indigenous Peoples. Regardless of location, we must honor the beliefs, rituals, and ceremonies of all patients regardless of race, color, or creed.

What you can do:

1. Recognize and honor that culture is nuanced.

The National Consensus Project (NCP) Clinical Practice Guidelines provides a blueprint for the provision of high-quality palliative care, of which one domain is “culture.” We must embrace diversity and encompass an attitude of cultural humility, recognizing that each Indigenous community has their own set of values, preferences, and ideals that may guide their wishes for care.

2. Never make assumptions.

If a patient or family member identifies themselves as Indigenous (often referred to as Native American, or American Indian/Alaska Native in the United States), that doesn’t automatically mean they engage in traditional ceremonies and rituals. We must ask questions and be open to collaboratively developing a plan of care that suits unique patient and family needs.

3. Leverage resources and educational materials created by, and for, Indigenous Peoples.

Developed in Canada, the Indigenous Health and Well-being Guide contains a comprehensive Palliative Care Toolkit for Indigenous Communities, which may be applicable in some circumstances.

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.