Irelie Riggle, MS in Bioethics student, Specialization: Policy
In 2016, Indigenous people in Canada made up only 4.9% of the population, yet they have and continue to experience disproportionate rates of disease and infection. Indigenous people in Canada have been 26.4 times more likely to be diagnosed with tuberculosis than Canadian-born non-Indigenous individuals, and they account for 10% of all Canadians living with HIV. These statistics indicate a stark need for Indigenous people in Canada to have access to, along with trust in, the Canadian health care system. The relationship between Indigenous people in Canada and access to health care may best be understood though the words of Justice Murray Sinclair, “Indigenous people often avoid the medical system, which has historically been a tool of their oppressors.”
Daniel Wikler and Jeremiah Barondess published an article discussing bioethics during World War II, in which they highlight the ethical wrongs within medicine perpetuated by the Nazis and argue for the need to learn from such tragedies. Even though Wikler and Barondess focus on the reign of the Third Reich, there are some important similarities to the history of and current relationship between Indigenous people of Canada and the Canadian health care system.
In the late 1800’s, the Canadian federal government created an institution which delegated the education of Indigenous children to the churches. This ultimately began the initiation of Indian Residential Schools (IRS). IRSs functioned as a system that stripped Indigenous people of their native languages, cultural and spiritual beliefs, and traditional rituals. Essentially these schools functioned to erase the Indian. (Thomas King reports that the term Indian must be claimed by Indigenous people, due to the terms used in past treaties with The Queen, in order to receive their compensation from the Canadian government for attending Residential Schools.)
This system pushed for the compulsory attendance of all First Nations, Metis, and Inuit children. In 1920, Duncan Campbell Scott, a high-level Indian Affairs agent, defended the introduction of legislation this way, “I want to get rid of the Indian problem. I do not think as a matter of fact, that this country ought to continually protect a class of people who are able to stand alone. That is my whole point. Our object is to continue until there is not a single Indian in Canada that has not been absorbed into the body politic, and there is no Indian question, and no Indian department, that is the whole object of this Bill.” Wikler and Barondess describe a similar process used by Nazi medicine referred to as a “healing mission.” “[Eugenics] provided a lens through which the Nazi program, not just regarding the sick and the disabled but in its entire ambition, could be portrayed as a healing mission.” Both nations, Nazi Germany and Canada sought to “heal” their government of a “problem” they saw linked to a single people group. Their “healing mission” came about by systematically washing out the culture of a specific group of people.
The Bryce Report
As early as 1907, the first intimations of trouble within the IRSs were made known to the Canadian government and Canadian public. That year, Dr. Peter Henderson Bryce, the Chief Medical Officer for the Canadian federal government, was hired by the Canadian government to be the Medical Inspector to the Department of the Interior and Indian Affairs. Dr. Bryce “documented and released evidence of the rate of Aboriginal children who were dying in Residential Schools”; Dr. Bryce became a “whistleblower”, leading him to speak against the government and their schools.
Dr. Bryce reported that most of the deaths that occurred were due to poor ventilation, poor sanitation, and overcrowded schools, along with the overall mistreatment of students. Dr. Bryce noted that such conditions were the leading cause of tuberculosis.
Dr. Bryce issued his findings to the Members of Parliament and even caught the eye of numerous newspapers. Duncan Campbell Scott, also a member of Parliament at the time, responded to the Bryce Report by stating, “They were housed in buildings not carefully designed for school purposes, and these buildings became infected and dangerous to the inmates. It is quite within the mark to say that fifty percent of the children who passed through these schools did not live to benefit from the education which they had received therein”. Even with Scott’s public recognition of the impact that IRSs had on their students/inmates, no changes were made.
As Mosby notes, on top of the poor conditions, the Canadian government used the IRSs as an additional opportunity to conduct “nutritional studies of Aboriginal communities and residential schools.” These studies were pushed forward by the Department of Indian Affairs. Parents of minors were not informed nor was consent from subjects given; the Canadian government seemed to view “Aboriginal bodies as ‘experimental materials’ and residential schools and Aboriginal communities as kinds of ‘laboratories’ that they could use to pursue a number of different political and professional interests.”
By others, Mosby is quoted as putting it this way: “even as children died the experiments continued. Even after recommendations from the Nuremberg Trials, experiments continued.” Wikler and Barondess describe Nazi medicine similarly, “thousands of unconsenting subjects were subjected to scientific or pseudo-scientific investigations and experiments which routinely led to suffering and death.” Again, both Nazi medicine and the Canadian government saw a single group of people as disposable and a means to their end. Both used their “different political and professional interest” to pursue their own scientific agenda and at the same time erase the influence of Jewish and indigenous cultures on their respective landscapes.
The Canadian government, though slow to realize the error of their ways, closed the last Indian Residential School in 1996. Unfortunately, over twenty years later, the systemic oppression by the Canadian government through the Canadian Healthcare System continues to negatively impact Indigenous people in Canada. Most studies examining the impact of attending IRSs reveal that mental health, specifically emotional-wellbeing, was negatively affected. In 2003, Corrado and Cohen examined 127 residential school Survivors and found that 125 out of 127 suffered from mental health issues such as PTSD, major depression, dysthymic disorder and substance abuse disorder. Furthermore, forty-three studies done between 1999 and 2017 found that IRS attendance was related to “mental health issues”, including suicidal behaviors. The traumatic events that occurred within the Residential Schools have had effects that cross generational boundaries. Today, children whose parents attended a Residential School are 6.2 times more likely to commit suicide than their white counterparts. Young Inuit people, a group of Indigenous people specifically targeted by the Canadian government in the Residential School system, are 23.9 times more likely to commit suicide.
So how does the Canadian government address this oppressive history?
The Canadian government is attempting to fix their wrong doings through financial compensation. Even with initial payouts starting over a decade ago, many Indigenous people are still waiting on their compensation. With slow payout, the socio-economic harms and related effects continue to hit Indigenous people. Wikler and Barondess published their text to reveal not only the past unethical missteps in medicine, but also to guide us in future medical endeavors. To quote Wikler and Barondess,“we must learn how to discern and apply the lessons of this history in a responsible way.” When Germany atoned for their sins, their efforts were not limited to money; this is a model that Canada ought to follow. To pay what’s due, in addition to financial compensation, efforts to repair the relationships and rebuild the trust in the Canadian health care system are also required.