Health status disparities between Native Americans, Europeans, and Americans have persisted since colonization and continue to shape the landscape of our current health care systems. European doctrines of discovery and conquest gave rise to theories that indigenous peoples were inherently genetically inferior and thus more susceptible to disease. Native American cultural practices, spiritual beliefs, individual behaviors, and communal approach to life were systematically undermined by European socioeconomic values, public policy, and sense of paternalism and assumed responsibility to morally correct the inferior, suffering, and morally deprived indigenous citizens. Lack of clear consensus regarding who is responsible for health disparities among indigenous peoples has allowed actors to self-select understandings of disease and proposed interventions. This has resulted in in oscillating approaches of paternalism and self-determinism regarding indigenous health care. The current trend is toward devolution of responsibility to indigenous community. This begs the question of whether policies of self-determination have been pursued out of respect for Native American cultural sovereignty, or as a means to absolve federal responsibility for perpetuating the restrictive socioeconomic standing and disparate health conditions of native peoples.
A 2004 lawsuit regarding improper use of DNA samples from members of the Havasupai Tribe illustrates how the historical legacy of Native American vulnerability shapes current bioethical debates and the perpetuation of conditions of vulnerability for Native Americans. Analysis of the case points to 3 important bioethical considerations: the breadth of informed consent, the need to address local considerations of “research”, the treatment of genetic research material. The case shows that elements of genetic determinism, and lack of attention paid to cultural norms continue today, despite the presence of both paternalistic and self-determined systems.