Indigenous Patient Information Toolkit: Access Healthcare

Scroll to the bottom for tips and tricks on exercising your informed consent rights!

Safer Access to Healthcare

Indigenous communities have experienced harm in accessing healthcare; this toolkit will support safer access to these services. The Canada Health Act’s purpose is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers. Some waitlists are outliving people, but they’re not often faced with rolling the dice on whether racist attitudes will seriously impact their healthcare.

Let’s use the Criminal Code’s definition for a medical practitioner as it captures a wider net of healthcare experiences:

A medical practitioner is a person who is entitled to practise medicine under the laws of a province.

Racist (un)conscious biases shade a medical practitioner’s opinion of their patient, affecting their access to healthcare, let alone the quality of care. These racist views seem to be at odds with the altruistic nature of the profession itself. Medical practitioners are supposed to help people, right?  

Well, it’s a bit more complicated than that.

When it comes to the “Indigenous” experience of accessing healthcare, racism tends to play a big role. Some medical practitioners justified these procedures as necessary because they didn’t want the Indigenous person “back here again having kid after kid.”  This is combined with evacuation policies that require the expecting Indigenous person to leave their community to give birth in a hospital. Medical practitioners have isolated Indigenous women and gender-diverse peoples from their community network when they’ve come into medical facilities to give birth and have coerced or forcefully sterilized them.

It's a layered experience: racist policies exist in place that disconnect Indigenous peoples from practicing birthing ceremonies in their communities, and racist biases result in violence against Indigenous peoples. Controlling Indigenous bodies has been linked to controlling Land and resources themselves. Maintaining the status quo works in the state’s favour as it allows them to preserve power over unceded Lands and resources.

Joyce was a member of the Atikamekw Nation in Manawan and died as a result of healthcare’s systemic racism, which created the space for and welcomed racist biases of medical practitioners. Joyce live-streamed the hateful, violent, and racist comments of the medical practitioners who specifically ignored her pleas and her attempts to communicate her medical history. These same medical practitioners denied these allegations despite the publicly available video proving otherwise.

Right to Autonomy and Self-Determination

The Council of the Atikamekw of Manawan and the Council de la Nation Atikamekw prepared a brief for the Government of Canada and the Government of Quebec to advocate for the assertion of Indigenous people relative to healthcare and social services.

Joyce’s Principle guarantees all Indigenous people the right of equitable access, without discrimination, to all social and health services and the right to enjoy the best possible physical, mental, emotional and spiritual health. The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) affirms in Article 24 the right to use traditional medicines and maintain health practices and access, without discrimination, to all social and health services. Article 24 further specifies the right to enjoy the highest attainable physical and mental health standard, requiring the state to take steps to realize this right.

Safe Care

Joyce’s Principle links healthcare services for Indigenous peoples with access to safe care. Kinship is emphasized as essential to providing culturally safe care and requires that culturally safe care anchor medical practitioners’ standard of healthcare services. Culturally safe care also includes culturally safe space. Article 23 of UNDRIP affirms the right to determine and develop priorities and strategies to develop and determine health through their own institutions. The government is co-developing in partnership with Indigenous nations across Turtle Island a healthcare framework similar to Bill C-92, which shifted child, family, and youth services under the jurisdiction of Indigenous nations.

Medical practitioners do not define safe care – Indigenous peoples define it. Article 29 of UNDRIP affirms that the government is required to take effective measures to ensure programmes monitor, maintain, and restore the health of Indigenous peoples and develop these programmes in partnership with Indigenous peoples. Safe care cannot happen without anchoring it in the voices of Indigenous peoples.  

Indigenous Harm Reduction

The Native Women’s Association of Canada (NWAC) developed Indigenous harm reduction principles in relation to access to sexual and reproductive health. NWAC focuses on reconnecting individuals to culture and creating supportive spaces honouring cultural identities. These same harm reduction principles mirror those recognized in culturally safe care. Joyce's Principle requires recognizing and respecting Indigenous people’s traditional and living knowledge in all aspects of health. Article 21 of UNDRIP also affirms the right to improve their economic and social conditions, including health and social security.

Canadian law needs to meet the standard of UNDRIP, thanks to the adoption of the United Nations Declaration on the Rights of Peoples Act (UNDRIP). These UNDRIP articles become key markers to guide current access to healthcare and the ongoing and future development of this legislative framework.

But wait, there’s more – the government will argue who picks up the bill. The Canadian Human Rights Tribunal slapped the government on its wrist when it made Jordan Anderson, a child born to the Norway House of Cree, spend his entire life in a hospital while they bickered over who would cover his hospital and foster care costs. Jordan’s Principle was soon implemented to ensure that First Nations children have access to public health services. Find out more here. This page also covers how to access funding related to Jordan’s Principle.

Informed Consent

Patient autonomy was affirmed as a fundamental right by the Supreme Court of Canada in 1993. Article 2 of UNDRIP affirms that Indigenous peoples have the right to be free from any discrimination in exercising their rights. Accessing healthcare services without discrimination is within reach, especially with the hopeful co-development of a legislative framework that shifts health jurisdiction to Indigenous nations.

But for now, here are some tips & tricks to navigate accessing healthcare.

Disclosure of information

– Before consenting to treatment, the medical practitioner must communicate significant risks that threaten your life, health, and comfort.

This can include:

• If the treatment would pose even a small chance of serious injury or death

• If there is a significant chance of slight injury, and

• Any unusual or special risks with an uncommon occurrence

This does not include:

• Common everyday risks

• Minor discomforts that may follow the treatment (think of a scar that may follow surgery)

It gets tricky – the medical practitioner is not obligated to provide you with information about treatments they do not think are necessary. Yikes. But what if their (un)conscious bias may shade their opinion on what treatments they think are necessary?

Don’t be afraid to ask questions – Medical practitioners are required to provide you with an answer regarding obtaining your permission for treatment. They have the responsibility to take reasonable steps to make sure you understand. Sometimes, it’s easy to swallow these questions up, especially when the environment can feel unwelcoming. Remember, this is your body and your choice. Take as much time as you need to get the information to feel comfortable proceeding with the treatment.

Bring a friend

– It’s easier to harm one person when there aren’t many witnesses. Quick caveat: if harm befalls you in healthcare, it’s not “okay” because you brought a friend – the actions of others are not your responsibility.

Indigenous doulas have been recognized as a “middleman” between the medical practitioner and the patient. They’re great anchors for building advocacy skills, too. Plus, it’s a bit easier to advocate for yourself when you know someone’s got your back.

Practically, retaining information regarding your health is much easier when you have another person there who can take notes. You can always have someone on speakerphone, too!