The Value of Place

There is an (increasing) awareness and appreciation of the spiritual connection between Indigenous peoples and their traditional lands, and the ways in which this connection is related to health.

For persons not from Indigenous backgrounds, connections to land and place have less often been discussed. In reading the literature on rural health ethics, one can’t help but notice the ways in which many people talk about the meaning of being in a particular place, a geographical location, and how this gives them a sense of meaning and/or identity. Comments such as, “Seeing this view lets me know that everything is going to be ok…” or “This is the place where I feel most like myself” suggest that, for some, place is or may be something that we need to factor into decision-making. In other words, place can become a value similar to other values that we typically make use of to make decisions about health care, what treatment is best, etc. In ethics, there is frequently a focus on context – the details of a situation can make a difference to what is considered morally relevant and how possible alternatives are evaluated for their relative “rightness” or “wrongness.”

The value of place may be particularly relevant to consider when, for example, patients are facing potentially tough decisions about travelling to other locations for health care. Travelling across the province or even out of the province for some forms of health care means that these persons are “dislocated”.

For those who hold the value of place strongly, this feeling of dislocation may be particularly acute with a sense that they have “lost their place.”

With this may also come feelings of being “unsettled” or “not quite myself” as the view out the window and the geography changes. Attending to the value of place doesn’t mean that all travel for health care is wrong or bad. But it does raise questions about whether we (the health care system) take what it means to be “uprooted” in order to receive health care into sufficient account. How well do we help prepare people for travel or being away from their “place in the world” for extended periods? Can this value help us understand why some people may make choices to not travel or leave their place?

The value of place also encourages us to consider what it means to return to one’s place well versus needing additional care versus coming home to die…and what this re-entry to and return to one’s place means ethically as well as emotionally and physically.

Submitted by Dr. Christy Simpson, Ethics Collaboration Coordinator, NSHEN