The Canadian Medical Association released its revised Code of Ethics on Sept. 18 after two years of consultation with more than 50 groups and organizations.Jeff McIntosh/The Canadian Press
Jamaica Cass and Sarah Funnell are physicians and academic leaders in Indigenous health.
For many physicians in Canada, cultural safety education looks the same as in other professions: “soft skills” gained from a module, a lecture or suggested reading. The Canadian Medical Association’s newly revised Code of Ethics and Professionalism thankfully makes it much more central to medical practice. Cultural safety, anti-racism and respect for Indigenous world views now sit at the core of the profession’s ethical framework.
On Sept. 18, the CMA released its revised Code of Ethics after two years of consultation with more than 50 groups and organizations. It now contains stronger language on racism, discrimination, and culturally safe and trauma-informed care. There are explicit references to the Truth and Reconciliation Commission’s Calls to Action on Indigenous approaches to health and access to traditional healing. And the new Code places these obligations at the centre of ethical expectations for physicians. The Code cannot drive change on its own – but it influences regulators, educators, institutions and physicians.
We are already seeing a shift in medical education, with cultural safety increasingly incorporated into competency frameworks and more recently required for accreditation of medical residency programs. Ethical obligations work differently. Confidentiality and consent are central to ethical medical practice, with harsh, often legal consequences when they are not adhered to. The CMA’s Code of Ethics frames cultural safety as a core component of these obligations, and of good medical care itself. That marks a clear shift in the professional baseline.
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“I treat everyone the same” can no longer stand as evidence of equitable care. Treating everyone identically may sound fair, but ignores the different histories, barriers, risks and experiences that patients carry with them into the health system – including experiences that impact trust. In the revised Code of Ethics, the expectation shifts from the passivity of “I am not a racist” to actively disrupting racism when witnessed and modelling this to trainees.
Racism kills people. For every Indigenous patient whose experience of racism in health care becomes national news, countless others experience similar harms outside of public view. Ethical neutrality is not the same thing as ethical responsibility.
In our practices, Indigenous patients have told us of being dismissed in the emergency department as pain medication-seeking, or of their pain not being believed, only to later be diagnosed with conditions that required emergent surgery. These are not abstract failures of cultural awareness.
When stereotypes influence whose symptoms are believed, they alter clinical decisions. Cultural safety is, therefore, a patient-safety issue. Family medicine’s own College has committed, alongside the Indigenous Physicians Association of Canada, to provide cultural safety in care. The CMA’s Code now sets that expectation for the whole profession.
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Canadian medicine has long treated the Western biomedical model as the dominant, and often only legitimate, authority on health and healing. By explicitly recognizing Indigenous world views and approaches to health, the new Code creates space for something medicine has not always practised well: intellectual humility and respect for Indigenous self-determination. That does not require physicians to abandon evidence or treat different knowledge systems as interchangeable.
Recognizing that Western medicine is not the only system through which people understand health, illness and healing is an important condition for building trust with Indigenous patients. For a profession whose institutions suppressed Indigenous systems of healing and participated in harms against Indigenous peoples, that carries significant weight.
On its own, a Code of Ethics cannot change who is believed in an emergency department, reform a complaints process, redesign medical curricula or eliminate anti-Indigenous racism. That consequential work begins with implementation.
Will regulators integrate the Code into professional standards? Will medical schools integrate anti-racism into core professional identity formation? Will hospitals examine the policies and practices that determine whose pain is believed and whose concerns are dismissed?
The new Code matters because of what is now clearly expected of Canadian physicians and what it makes harder to excuse. The measure of success will be whether Indigenous patients experience safer care, less stereotyping, better access and greater respect for their knowledge and ways of understanding health.
Medicine has spent a decade grappling with how to teach physicians cultural safety, and even today that education varies widely from coast to coast to coast. The revised Code asks a larger question: What does a physician owe a patient in a country where racism and colonialism continue to shape health? The profession’s answer is becoming clearer: Cultural safety belongs within the practice of ethical medicine itself.