The Canadian Medical Association (CMA) last week apologized to Indigenous Peoples in Canada—First Nations, Inuit, and Métis Peoples—for the role it played in contributing to medical racism and research misconduct since its founding in 1867.
“As the national voice of the medical profession, we are sorry for the actions and inactions of physicians, residents, and medical students that have harmed Indigenous Peoples,” said the group’s statement, which acknowledged the “ripple effects on future generations.”
The apology, presented at an emotional ceremony that included Indigenous practices of song, dance, and saging, comes as organizations in Canada, including the federal government, are working to reconcile with Indigenous Peoples in the country.
An accompanying 47-page report documents specific cases of unethical research, including forced sterilization and withholding nutrition from children conducted by Canadian doctors and researchers.
The Canadian medical establishment’s long history of abuse and neglect of Indigenous people has left a legacy of racist stereotypes, barriers to care, and disparities in health outcomes. Indigenous Peoples have markedly shorter life expectancies than the general population, with the largest gap being 64 years for Inuit men compared with 80 years among Canadian men overall. They also have a higher prevalence of diabetes, hypertension, and mental health challenges compared with non-Indigenous groups.
Even now, unconscious—and sometimes even conscious—bias among health care providers means that identifying as an Indigenous person “could bring on poor service or even negative consequences to a person’s health,” says Esther Tailfeathers, an Indigenous family physician at Blood Tribe Clinic in Standoff, Alberta. Mistrust of the medical system has in turn deterred Indigenous Peoples from participating in research, she adds. “We need to get as much data on Indigenous health as we can in order to understand the full picture of it,” said Tailfeathers, who works with scientists to develop research plans that require the inclusion of Indigenous groups.
The CMA’s formal apology was the final step in a 3-year process during which the group attempted to confront its contribution to Canada’s history of cultural genocide. To improve the medical community’s relationship with Indigenous Peoples, the CMA brought together several groups of Indigenous leaders, including community elders, who served as a guide for the apology project. The project involved a deep dive into 156 years of historical archives, a review of social media accounts, parliamentary debates, committee records, and broad consultations with Indigenous communities.
“We can’t make whole” those who have been permanently harmed, disfigured, or lost their lives as a result of medical or scientific maltreatment, says Alika Lafontaine, an anesthesiologist and a past president of the CMA and the first Indigenous person to hold the post. Lafontaine, who also helped to deliver the apology, says this moment offers an opportunity for people to share their stories and feel less alone.
Notably, in a section titled “Medical experimentation on Indigenous children and adults,” the report outlines case after case of unethical research on Indigenous children, some of whom were deprived of dental care and subjected to nutritional experiments led by Lionel Pett, a doctor who wrote guidelines that became the foundation of Canada’s nutritional guidelines. As part of Pett’s research, Indigenous children were fed experimental flour, fortified with bone meal and other ingredients. Researchers found that children who were given the flour developed higher rates of anemia. In another case of unethical research, one group of Indigenous children was intentionally given less than the daily recommended amount of milk while others were given three times the allowance.
Indigenous adults were similarly subjected to unethical research, often without their consent, the report says. Some were forcibly sterilized at hospitals and residential schools, a practice that continued after it was repealed in the 1970s and has been reported as recently as 2019. Others were subjected to experimental tuberculosis vaccines and treatments, including lung removal, while being denied antibiotics that were standard care for the infection. One person described in the report, Sonny McDonald, was incarcerated at a tuberculosis sanatorium as a child. His legs were forcibly restrained with casts that were also tied with a bar to prevent him from moving around in the hospital and infecting others.
The report acknowledges the organization’s failure to make any public comment when, in 2019, Prime Minister Justin Trudeau apologized for the government’s management of tuberculosis between the 1940s and 1960s as well as a range of research misconduct and medical experimentation.
The report also described how, for a decade starting in the early 1940s, Indigenous adults in northern Manitoba communities became a “living laboratory,” the report said. Government-led scientists and researchers recruited Indigenous adults to study a range of nutritional interventions using “newly developed medical procedures” such as x-rays, blood draws, and physical exams without their informed knowledge or consent. In the Canadian Arctic, Inuit men were used for experimentation of skin grafts, exposed to bitter cold to understand their reaction to extreme temperatures, and poked with instruments to assess pain tolerance—all without their consent.
Such abuses are not unique to Canada. In the now-infamous Tuskegee Syphilis Study in the United States, researchers working to understand syphilis beginning in the 1930s recruited Black men with the disease and withheld effective treatment without their knowledge. Like the CMA, U.S.-based organizations, including the American Medical Association and The New England Journal of Medicine, have also taken a look at their own problematic past and role in perpetuating medical racism.
At last week’s ceremony, “I was in that room bearing witness to that apology, first and foremost, as Anishinaabe, as an Indigenous person … but at the same time, I was also part of their making the apology,” said Michael Dumont, a family physician and Medical Director at Lu’ma Medical Centre in British Columbia whose grandmother was among those who underwent forced sterilization. “I don't know how many cousins and uncles and aunties I didn't get to meet because that surgeon made that decision,” he said.
As part of the apology, the CMA outlined key steps for reconciliation, such as recruiting more Indigenous people into the medical profession and reviewing the Code of Ethics and Professionalism. “We kept on hearing over and over again, ‘Don't apologize unless you're actually ready to do things right,’” Lafontaine says. He is hopeful the CMA’s process has inspired other organizations to follow in their footsteps on their journey to advance reconciliation. “What's important is that it's now something that they see,” he said. “There's a clear path for them.”
