Three Levels of Autonomy and One Long-Term Solution for Native American Health Care

AMA J Ethics. 2020 Oct 1;22(10):E856-861. doi: 10.1001/amajethics.2020.856.


Native Americans have twice the poverty rate of the general US population, suffer significant health inequity, and are chronically underrepresented, at only 0.08%, in the US physician workforce. The COVID-19 pandemic has illuminated key ethical, clinical, and economic complexities in health decision making among Native patients. This article discusses 3 levels of autonomy relevant to health decisions, including taking care of our own by increasing numbers of Native medical students.

MeSH terms

  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / therapy
  • Coronavirus Infections* / virology
  • Decision Making
  • Education, Medical*
  • Health Equity*
  • Health Services, Indigenous*
  • Health Workforce*
  • Humans
  • Indians, North American*
  • Pandemics*
  • Personal Autonomy
  • Physicians*
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / therapy
  • Pneumonia, Viral* / virology
  • SARS-CoV-2