New Oregon law allows patients to receive their amputated body parts for cultural, spiritual beliefs

A new Oregon law will allow health facilities to return amputated body parts to patients for cultural, traditional and spiritual reasons. For some members of the Confederated Tribes of Warm Springs, and others, the practice is necessary to ensure a smooth transition to the spirit world. Shilo Tippett is the manager of caregiver inclusion and experience at St. Charles Health System. Wilson Wewa is an oral historian and spiritual leader with the Confederated Tribes of Warm Springs. They join us with more details on the new law and what it will mean for patient care.

Note: This transcript was computer generated and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. A new Oregon law will allow hospitals to return amputated body parts to patients for cultural, traditional or spiritual reasons. For some members of the Confederated Tribes of Warm Springs, keeping a body together can help ensure a smooth transition to the spirit world. But in the past state law made this either difficult or impossible. Senate Bill 189 which was spearheaded by the Saint Charles Health System and the Warm Springs Tribe will change that. Shilo Tippett is the manager of Caregiver Inclusion and Experience at Saint Charles Health System. She’s an enrolled member of the Confederated Tribes of Warm Springs and she helped push for this new law. Wilson Wewa is an oral historian and spiritual leader with the Confederated Tribes of Warm Springs. He has also served as a director of senior services for the Tribe for the last 40 years. They both join me now. Welcome to Think Out Loud.

Shilo Tippett: Hi, Dave. Thanks for having us.

Wilson Wewa: Glad to be here.

Miller: It’s great to have both of you on. Shilo Tippett, first. What kinds of medical situations could lead to amputations?

Tippett: I do want to say thanks for highlighting this story because it is such a significant change that’s coming for Oregon law that will impact all Oregonians. There are a number of issues, just like anyone else that may require amputation or removal of a body part for people. Oregonians and others. Things like motor vehicle accidents where there’s damage to a body part and a variety of chronic illnesses that can result in the need for amputation.

Miller: What in the past has happened to body parts that are removed?

Tippett: In the past, by Oregon law, we’re not able to return amputated body parts to individuals. They are seen as pathological waste. So they’re sent to our lab in Health Care Systems, where they are disposed of according to Oregon law.

Miller: Wilson, what kinds of conversations have you had over the years with Tribal members about this?

Wewa: It’s been real difficult to counsel our Tribal members. Most of them are in the latter part of their lives. Because of neuropathy or because of amputations and not being able to receive their amputation back from the hospital, it has caused some trauma because of our cultural beliefs in being whole, and in our spirituality. One of our sayings is, “One body, one mind.” And so if you look at the deeper context in the language of “one body” that means the whole body. That means the whole spiritual realm of the body. So when there’s an amputation, most of our Tribal members know that we need to be whole at the time of our leaving this world to the next.

In the past, I think there was some leeway in allowing our people to receive the body parts. But as time has gone on, a lot of education was needed to convince hospital systems, the State of Oregon, people that do their legal thinking, the importance of body parts to Tribal members. And it’s been a battle. And it has caused a lot of trauma with our Tribal people because they have the expectation that we will take care of the body part in a correct way, our spiritual way. So that when their time comes to leave this world, they’ll be back together again as one. And so trying to convince both the hospital systems and the patient that we’re moving in that direction has been hard. This new bill that has been passed is going to alleviate a lot of the trauma that I’ve seen our people have to endure.

Miller: Did this ever lead people to choose to not get the care that health professionals said they needed?

Wewa: Absolutely. It has led to, unfortunately, the death of some of our people because they’ve chosen not to get an amputation. And because of the gangrene, because of the neuropathy, because of the strep that was associated with the reasoning for having an amputation was allowed to take its place. So the person that could have benefited from an amputation chose not to be amputated and lived a short life thereafter. It meant our community, the family of the deceased, had to live with that trauma of losing their loved one.

Miller: Dr. Tippett, when did this issue come to your attention?

Tippett: Like Wilson said, it’s been going on for a while. But last year, probably September-ish, we really got active about making some changes. But it came to me last spring. There was another issue that came up with the Tribal member who was hesitant to seek the medical care needed because they weren’t able to have their amputated body part returned to them. And so we just grouped together key players and thought a lot. We met a lot and had a lot of discussions on what we could do to make this right. Not just do what we could within the law, but we really wanted to see what we could do in accordance with the beliefs and traditions of our Tribal people.

Miller: And I should note that, obviously, we have been talking about a specific cultural and spiritual belief that is tied to the Warm Springs Tribe. But it’s not totally unique. Members of other cultures and faiths around the world also have very long standing understandings of keeping a body together for various ways. So this is, if not universal, it’s also not super uncommon among people all over the world. But I’m curious, Dr. Tippett, how you, at Saint Charles, involved the Warm Springs Tribe in the legislative process?

Tippett: I think that it’s a great question. We just got some alignment. There was already work being done within the Tribe. The desire that Oregon law would uphold Tribal law. We heard again and again, Tribal law’s older than Oregon law. So why can’t we uphold that? So we just got some alignment of work that was already being done and it couldn’t have happened without it. That’s a really great part of the story is that we decided to really proactively learn from the community of Warm Springs so that we could make appropriate changes.

So it started last year. We went down to Warm Springs to a health fair that happens annually and we interviewed almost 80 people to ask, did you know about this law where, as Oregon law states, we’re not allowed to release amputated body parts back to the patient? Did you know about that? And what are your thoughts on it? And the overall picture that we got from community members was that we should have our amputated body parts back. That’s the way it was before Oregon law. Those are traditions and customs and we want those body parts returned to us. So after getting that feedback, we knew we couldn’t sit on that. We knew we wanted to really work to help pave a path to changing Oregon law. So from there, we met with the Culture and Heritage Department in Warm Springs. We met with their Overseeing Board and they gave us the go ahead. They said, “You have our support. When you meet with Tribal Council, let them know that you met with us and they backed us 100%.” Which was really great.

So we then met with the Oregon Tribal cluster meeting, to let them know our plan. So the other tribes in our region could be aware and speak up if they needed to. And then ultimately, we went to Tribal Council. There was a great discussion, the Tribal lobbyist was there and Wilson was there, and gave some great words. We had our attorneys there and we were given the go ahead to move forward. And that was around last fall. And so that we just hit it head on starting in January. So it’s been a process of about one, almost exactly, one year since it started that we’re able to impact change.

Miller: Who specifically will be able to receive body parts now, under this legislation. I assume you can’t just say, “Hey, I want my foot that was taken because of diabetes.” You have to say more than that. Right?

Tippett: Yeah, it’s for people who can show that they have spiritual, cultural and religious beliefs that would warrant the return of an amputated body part to them. So, yeah, it’s not just for everyone. There are guidelines that it’s for people who hold those beliefs.

Miller: And what will this mean on hospital’s parts? I mean, what will they need to do on their end once this law is fully implemented?

Wewa: As with any new law, I think there’s gonna be a trial and error phase and that it’s gonna have to be ironed out as it gets started and as it becomes public, through your interview and as people find out about it. There’s gonna be a trial phase that probably the State, that the Tribes that like you mentioned earlier. Other cultures that may want to be a beneficiary of this law are going to have to iron out. And I think that’s really important in order to meet the needs of the people. Because a lot of people have spiritual beliefs regarding their wholeness of body.

Tippett: I think raising awareness so that the public knows that this is an option externally. Internally, we have the usual work to do, like policy development and providing education to our large health care system around the new practice. I will share that while this has been so important to our Tribal people, it’s also extremely important to our health care workers. Over the years, there’s been people who work in the lab, leadership in our lab department, as well as surgeons and other health care providers who haven’t felt good about this at all.

They have not felt that it’s right morally that they haven’t been able to return an amputated body part to someone who holds such a significant spiritual belief that it needs to be returned to them. So the huge impact has also been on our health care workers who are slowly providing education to them about this upcoming change in law. And there’s a lot of celebration and excitement that finally, something that has been important to so many people is now achievable because of this partnership and the work we’ve done to change legislation.

Miller: Wilson Wewa, before we say goodbye, I’m curious what precedent you hope this sets for going forward, for how health care systems can respond in better ways to the cultural needs or spiritual needs, religious needs, human needs of the communities that they serve?

Wewa: [The precedent] that health care systems need to be aware that all cultures have eyes to the Creator, and Christianity is not the fix all. That more important than the healthcare profession that regardless of who the person is,

that they have some type of belief that ties them to their health. And because of that, healthcare systems need to be open to address people’s beliefs. And sometimes the laws aren’t conducive to that type of a relationship. And many times laws are made by people that have never had to deal with this type of a trauma within their own family or within their own culture. And because they haven’t had to deal with it, there hasn’t been the education out there to promote a better way of looking at people’s holistic health.

And so this is something that is long overdue and I think it’s going to pave the way, if we do it right, to a better understanding between the patient and the healthcare system in how to take care of themselves. It could also inevitably mean longevity for those people who choose to go through with the amputation and to receive their body part and extend their life because they’ve made that decision, rather than to keep their body whole and then to end up passing away as a result of wanting to keep their body whole. I think it’s a good opening for that.

Miller: Wilson Wewa and Shilo Tippett, thank you very much.

Tippett: Thank you.

Wewa: Thank you for highlighting this new approach to health care.

Miller: Wilson Wewa is a storyteller, oral historian and spiritual leader for the Confederated Tribes of Warm Springs. He has served as the director of Senior Services for the Tribe for the last 40 years. Shilo Tippet is a licensed clinical psychologist and enrolled member of the Confederate Tribes of Warm Springs and the manager of Caregiver Inclusion and Experience at the Saint Charles Health System. They both helped push for this bill that became a law. It’ll make it possible for hospitals to return amputated body parts to patients for cultural, traditional, or spiritual reasons.

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