The Canadian Medical Association (CMA) recently updated its Code of Ethics and Professionalism to strengthen the standards for physicians in Canada and clarify how doctors are expected to address racism and discrimination in healthcare. The association had committed to updating its code as part of its Reconciliation Action Plan.

Last year, the CMA apologized for its role, and the role of the medical profession, in past and ongoing harms to Indigenous peoples. These harms include the impacts of Indian hospitals, forced medical experimentation and sterilization, child apprehensions, and systemic racism, discrimination, neglect, and abuse within the healthcare system. The Reconciliation Action Plan was developed as part of the CMA’s apology.

Medscape News Canada spoke with CMA President Bolu Ogunyemi, MD, about the development and rollout of the revised Code of Ethics and Professionalism.

What is the main driver behind the update to the CMA’s Code of Ethics and Professionalism?

The [CMA] apology and the update to the code are both driven by a need to confront anti-Indigenous racism in Canada and take concrete steps toward reconciliation. I see the policy update as contributing to that apology rather than the apology leading to this update.

For example, the previous version of the code said that a doctor must treat all patients with the dignity and respect that they deserve, which is obviously good. But the updated code says that we must specifically not discriminate on the basis of a patient’s Indigenous background, race, ethnicity, sexual orientation, sexual identification, etc. It’s more explicit, which is important. It also says that not only must we not engage in this behavior, but we must not condone this behavior. So it really sets a high bar.

What process was used to develop the update?

A big part of the process was making sure that we had perspectives from a broad group of individuals. We intentionally reached out to patient advocacy groups — such as those who support patients and those with lived experiences of disease — as well as people in rural and remote areas, Indigenous peoples and Indigenous physicians, women, gender-diverse people in the LGBTQ community, Black physicians, medical learners, elderly physicians, and disabled physicians. We wanted to make sure that all those perspectives were included in this update.

What will this update mean for how clinicians in Canada practice medicine?

The Colleges of Physicians and Surgeons are different in each province and territory, but most of them use a version of the [CMA] code as part of their licensing requirements. So during licensing, doctors working in those provinces and territories need to affirm that they abide by the code. More broadly, [the Code of Ethics and Professionalism] serves as a guide and as a standing document because there are some [medical] cases where tensions arise or principles conflict.

How will the update affect medical education in Canada?

It’s important to address [racism and discrimination in healthcare] early at the level of medical students and residents. It is also important to address it among practicing physicians because medicine now is very different than in previous generations.

In addition, one thing that is also included in the update is that physicians have a duty to discuss medical information in light of current acceptable medical practices. The code now explicitly says that if a physician has a position that does not reflect current acceptable medical practices, this must be clearly discussed with patients. This has shown up with conflicting or minority views about COVID and the vaccine and more broadly with misinformation.

This specific part of the update is important because the world has changed since the code was originally developed. We didn’t have social media or influencers back then, so we need to keep updating the code to make sure that doctors today and in the future can best serve our patients.

Is this update tied to other CMA efforts?

In my role as spokesperson for all doctors and medical learners in this country, I am involved in the implementation [of the code], and I travel all over the country. It’s important for me to be there on the ground, speaking to people in person, whether it’s a small group setting or a formal presentation.

This might specifically include talking about the Code of Ethics or, what might be more likely, discussing it in the context of broader health priorities, expectations of physicians, or future directions for physicians.

Overall, the code is something that we want to make real. We want to make sure that it can shape how doctors approach their work, interact with other colleagues, and interact with their patients. This is the most recognized policy of the CMA and certainly one of our oldest policies as well.

It’s exciting to be involved in these changes, where we’re modernizing [the code] in many ways. I’m also proud of the fact that we’ve had so much broad engagement and that the Truth and Reconciliation Commission’s Calls to Action that are relevant to healthcare are reflected in this new code.

Ogunyemi reported no relevant financial relationships.