Elder Martha Peet during a moment of silence as the Canadian Medical Association held a ceremony at the Victoria Conference Centre in B.C., on Sept. 18 to formally apologize for harms to Indigneous people.Chad Hipolito /The Globe and Mail
This is how you do reconciliation.
On Wednesday, the Canadian Medical Association hit all the right notes in issuing a historic apology for its role in perpetrating previous and continuing harms to Indigenous people in the health care system.
A proper apology begins with admitting your wrongs, and doing so sincerely and with humility.
Dr. Joss Reimer, president of the CMA (the voice of Canada’s physicians), read the carefully crafted words: “The Canadian Medical Association is deeply sorry for the harms First Nations, Inuit and Métis Peoples have experienced and continue to experience in the Canadian health system. The racism and discrimination that Indigenous patients and health care providers face is deplorable, and we are deeply ashamed.”
She went on to say that the CMA, and physicians themselves, did not live up to ethical standards, did not provide Indigenous people with an adequate standard of care, and failed to address systemic racism and discrimination in the health system.
In short, they took ownership of their history, warts and all.
This is leadership. Many institutions in Canada need to do the same.
More importantly, the CMA promised to do better in the future. And not just with a litany of platitudes, but a well-thought-out plan, overseen by an Indigenous Guiding Circle – a group of respected elders.
This is allyship.
As Dr. Alika Lafontaine, a past president of the CMA (and the organization’s first Indigenous leader) said: “The weight of history must be shared.”
An apology requires a giver and a receiver and, similarly, reconciliation requires the two to work together to correct wrongdoing and rebuild trust.
Canada’s physicians, and the health system more broadly, have a lot to be sorry for and ashamed of. Take, for example, the Indian hospital system, a segregated system that provided second-rate care. Consider the experimental research conducted on children and adults in both Indian hospitals and residential schools – everything from nutritional studies that involved starving children, to using Indigenous people as guinea pigs to test tuberculosis vaccines. A large number of Inuit TB patients were forced, often under traumatic conditions, to relocate to sanatoriums in the south for treatment. Many were separated from their families, lands and language for years at a time.
Canada also has a long and painful history of coerced medical procedures, such as the forced sterilization of Indigenous women to prevent them from having more children, a practice that was still being documented as late as 2019.
Physicians were complicit with abductors in the rounding up of children who were sent to residential schools, and in the Sixties Scoop. Physicians also actively participated in “birth alert” programs that disproportionately targeted Indigenous mothers who had their babies apprehended by social services agencies, a practice that continued into 2021.
The first step of reconciliation is speaking the truth, no matter how ugly. Canadians are not nearly knowledgeable enough about this shameful history.
Racism and discrimination against Indigenous people have been enduring features of Canada’s health care system. In 2008, Brian Sinclair was left uncared for in a Winnipeg emergency room for 34 hours before he was found dead; in 2020, Joyce Echaquan filmed the racist abuse and mockery she endured in a Quebec hospital before dying; that same year, Lillian Vanasse struggled to breathe in an Alberta hospital but was denied oxygen. These are just three examples of Indigenous patients who were ignored to death because of their ethnicity.
Beyond these high-profile cases of mistreatment, there is much systemic neglect. First Nations, Inuit and Métis people still have the worst outcomes for a wide range of health measures: Life expectancy, child mortality, diabetes, traumatic injury, suicide, substance use disorder, tuberculosis, and many more. During COVID, life expectancy declined by six years for First Nations people in B.C. – evidence that things aren’t improving.
Being truly sorry means committing to putting an end to this type of horror. There is a lot of heavy work ahead – not only to end racism and discrimination, but to rebuild trust.
The Canadian Medical Association has a plan, one it calls ReconciliACTION.
“The CMA apology is a good first step in acknowledging harm. But for the words to come alive and be truly meaningful, the apology must be followed by collective and individual actions to do better,” Dr. Lafontaine said.
Giving and receiving an apology is a delicate dance. But, done right, it has the power to repair harm, mend relationships, soothe wounds and heal broken spirits. All of which is needed if we’re going to improve the abysmal state of Indigenous health and, along the way, make Canada a more just and equitable society.