CMA apology a first step toward healing medical harms against Indigenous people, advocates say
Canadian Medical Association apologized last month for its role in the health-care system's historic harms
Advocates are optimistic about a historic apology for harms experienced by Indigenous people in health care — but they say those harms are not "remote parts of history."
"Harms from racism in the medical profession continue today and they continue with ourselves, with our relatives, with our community members," said Dr. Marcia Anderson, vice-dean of Indigenous health, social justice and anti-racism at the Rady Faculty of Health Sciences at the University of Manitoba.
Forced and coerced sterilization, medical experimentation and child apprehensions are documented parts of the health-care profession's harmful effects on Indigenous communities, and recent cases like those of Brian Sinclair and Joyce Echaquan have kept the issue in sharp focus.
Dr. Alika Lafontaine was the first Indigenous president of the Canadian Medical Association (CMA), and served in the role from 2022 to 2023. He was born and raised in Treaty 4 territory in southern Saskatchewan and has Métis, Oji-Cree and Pacific Islander ancestry.
After years of internal work — going through more than 150 years of documents and archives to identify racist and outdated language and practices — he sought to change the way Indigenous health care is delivered.
To him, this starts with the truth.
Lafontaine led the association, in September, to an official apology, presented by current CMA President Dr. Joss Reimer, for its role in harms against Indigenous people in the health-care system.
"For the first time, a national medical advocacy association with the gravitas that the CMA has is going to say these things happened," Lafontaine told Unreserved host Rosanna Deerchild.
"It decreases the threshold of how hard people have to work in order to be heard."
The apology acknowledged the harmful impacts of certain medical treatments, including sterilization and experimentation, in addition to the Indian hospital system — segregated hospitals, which isolated Indigenous patients and created lasting trauma.
History of forced and coerced sterilization
While Anderson — who is Cree Anishinaabe with family roots in Norway House Cree Nation and Peguis First Nation — has heard stories from family members who have experienced harm in the health-care system, she has also witnessed them herself.
In her first year of medical school, she spent a summer in Nunavut. There, Anderson saw a young Inuk mother who was concerned about infertility.
After reviewing her chart, Anderson realized she had an IUD — a semi-permanent form of contraception.
"She was really surprised. She did not have any knowledge of having this IUD in. It was clear to me then that she had not given informed consent," said Anderson.
She would later learn about the history of forced sterilization in Canada, and the more recent Senate investigations and class action lawsuits in Saskatchewan around coerced sterilization.
Some of the anti-Indigenous biases that operate in health care are ingrained so deeply that they seem like perfectly reasonable explanations- Dr. Marcia Anderson
"I remember reading through some of the cases from the Saskatchewan class action lawsuit, where it was described that women were told things like, 'If you don't do this, your children are going to get apprehended, or you're not going to be able to see your kids,'" she said.
Anderson continued to see examples of overt racism.
During her third year of medical school, she says a senior resident told her, "the best thing for Canada would be if Native people stopped reproducing."
In her current role as an educator, Anderson continues to raise awareness about racism in health care — and how even seemingly benign instances have a harmful cumulative effect.
Importance of naming racism
A focus of the CMA work is to change how racism is treated in complaints. Whether against doctors, or to hospitals, a lack of specific language in the association's standards means racist interactions can be classified as unprofessional communication.
"Often what happens is something that is clearly racism gets recategorized as communication, or being overwhelmed at work or other things," said Lafontaine.
"If there's not a standard to violate, they then have to try and put a round peg in a square hole."
He is pushing for changes in how racism is defined in the CMA Code of Ethics and Professionalism, and says that would have a ripple effect as many tribunals quote the CMA standards.
Anderson also takes issue with how racism is dealt with in health-care, and believes naming racism is an important step.
She says Indigenous patients are often mislabeled as being substance involved, homeless, non-compliant or inappropriate users of the health-care system.
"Our systems are not well set up to safely receive those complaints, and they often don't have the expertise to really evaluate or analyze them," she said.
"Some of the anti-Indigenous biases that operate in health care are ingrained so deeply that they seem like perfectly reasonable explanations."
Moving forward, starting with the truth
Marion Crowe is understanding when people say that accessing health-care can be tough for everyone, but says the experience is different for Indigenous people who have experienced unwanted treatments, a lack of education around trauma-informed care and blatant ignorance.
"This didn't happen to the rest of the population and there is something very atrocious to own, recognize and try to learn from," said Crowe, who is Cree from the Piapot First Nation in Treaty 4 territory in southern Saskatchewan.
Crowe has been working to eradicate racism in health care her whole life — from the mailroom at Health Canada where she started her career to her position as CEO of the First Nations Health Managers Association. She is also involved with Rise Above Racism, an awareness campaign started following the death of Joyce Echaquan.
She welcomes the CMA apology, but says it came under the shadow of several recent examples of harm experienced by Indigenous people.
Last month, a photo of an Indigenous elder laying on the floor of a Thunder Bay hospital circulated on social media.
"I think it's especially important for folks like me who see these lived experiences first-hand to share them, to amplify them, but also to work in partnership — ensuring it never happens again and that there is zero tolerance for racism," she said.
The apology has since become Crowe's North Star, guiding the way toward real change in the system. But, she doesn't know if her father would accept it.
"He is the last living person of horrific experiments that happened at the Fort Qu'Appelle Indian Hospital. He sits listening to that apology in a hospital room with half a lung on each side of his body," Crowe said. "He's in his 60s."
There is a documented history of medical experimentation on Indigenous children.
Crowe's father was subjected to tuberculosis treatments, but there is also evidence that nutritional policy was shaped by experiments on close to 1,000 children in residential schools during the 1940s and '50s.
While the true impact of the CMA apology remains to be seen, Crowe sees it as a first step. She believes that as the CMA makes changes, other organizations will follow suit.
She says she has hope for the system, and great respect for the Indigenous health leaders whose life work it is to end racism in health. To her, it's about fixing the system for the seven generations that come next.
Anderson is also optimistic, despite what she's been through.
"Something that makes me hopeful is we have a number of pieces of a puzzle coming together. We're not just kind of working on one thing and hoping that will make a difference," she said.
"There are these concerted actions at the national level, and then here at the provincial level as well."
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