The CMA says its revised Code of Ethics and Professionalism strengthens expectations around culturally safe, trauma-informed care and respect for Indigenous knowledge and healing.
The Canadian Medical Association (CMA) has released an updated Code of Ethics and Professionalism, introducing clearer expectations for physicians on racism, discrimination, cultural safety and the treatment of Indigenous patients.
The revised code was released on September 18, 2026, following a two-year review and consultation process involving Indigenous partners, physicians, patients and other communities across Canada. The CMA said the changes are intended to provide clearer standards for ethical medical practice and build on its commitment to reconciliation with First Nations, Inuit and Métis Peoples.
The updated code specifically strengthens guidance on culturally safe, trauma-informed and equitable care, while asking physicians to respect Indigenous worldviews, medicine and approaches to healing.
What Has Changed in the CMA Code?
According to the CMA, many of the fundamental principles in the code remain unchanged. These include respect for patients, fairness, patient well-being, integrity and professional excellence.
The major change is that expectations surrounding racism and discrimination are now more explicit.
The updated code says physicians are expected to actively address racist and discriminatory behaviour and reflect on their own biases. It also calls for continuing education concerning historical and contemporary issues affecting Indigenous Peoples and other communities that have experienced discrimination.
The CMA said physicians should also consider how their approach to care can better support groups that have historically experienced poorer access to health services or unfair treatment.
The organisation says this is intended to move the code beyond general ethical principles and provide more specific guidance about how those principles should be applied in medical practice.
Cultural Safety and Trauma-Informed Care
One of the most notable additions is the stronger emphasis on cultural safety and trauma-informed care.
The CMA says physicians should provide care that takes account of patients' experiences and circumstances while respecting their rights and informed decisions.
The updated guidance specifically addresses Indigenous patients and calls on physicians to respect Indigenous knowledge and healing approaches.
The changes are part of a wider reconciliation programme within the CMA.
The organisation apologised in September 2024 for its role, and the role of the medical profession, in past and ongoing harms experienced by Indigenous Peoples within Canada's health system. The CMA's review identified issues including Indian hospitals, forced medical experimentation, forced sterilisation, child apprehensions and systemic racism and discrimination.
The revised ethics code is one of the measures the association has subsequently introduced as part of its reconciliation work.
Indigenous Languages
The updated Code of Ethics and Professionalism has also been made available in several Indigenous languages.
The CMA says versions are available in Inuktitut, Southern Heritage Michif, Northern Michif-Cree and Anishinaabemowin, in addition to English and French.
The organisation said making the document available in these languages is part of its effort to make the standards more accessible and reflect the communities involved in Canada's health system.
Why the CMA Says the Changes Are Necessary
The CMA says racism and discrimination remain present within Canada's health-care system and can contribute to mistrust and barriers to treatment.
The association says patients have reported experiences including not being believed, harmful assumptions, delays in treatment and other forms of discriminatory treatment.
The CMA's Indigenous health programme cites a 2024 Statistics Canada survey in which one in five Indigenous respondents reported experiencing discrimination or racism in health care.
The association argues that improving Indigenous health outcomes requires partnerships with Indigenous communities and greater attention to culturally safe care.
Its reconciliation programme is guided in part by an Indigenous Guiding Circle made up of First Nations, Inuit and Métis leaders, Elders and Knowledge Keepers.
The Code Also Addresses Doctors' Relationships With Colleagues
The changes are not limited to interactions between doctors and patients.
The CMA said the revised code also strengthens expectations concerning how physicians treat colleagues and other health professionals.
It identifies unacceptable professional behaviour more clearly and places greater emphasis on accountability when concerns arise.
The CMA said the code is intended to provide standards not only for clinical decision-making but also for professional conduct and relationships within the medical profession.
The code has traditionally covered areas including consent, confidentiality, privacy, clinical decision-making, research and professional conduct.
Part of a Wider Reconciliation Programme
The revised ethics code follows several other measures introduced by the CMA since its 2024 apology.
The organisation established a Reconciliation Action Plan covering Indigenous health, support for Indigenous physicians and learners, engagement with Indigenous-led organisations and efforts to address anti-Indigenous racism in the health system.
The CMA has also said it wants to increase Indigenous representation within the organisation and create opportunities for Indigenous voices to influence its policies and work.
Its Indigenous health goal calls for a health system that is free from racism and discrimination, supports Indigenous self-determination and provides culturally safe care.
Debate Around the Updated Code
The changes have also generated debate about the role of social and cultural considerations in professional medical ethics.
Some commentary has focused on the code's language concerning systemic racism, social accountability, cultural safety and Indigenous knowledge. Juno News, for example, characterised the changes as incorporating social-justice obligations into physicians' professional responsibilities.
The CMA's own description is narrower: it says the revisions clarify ethical standards around racism and discrimination, improve culturally safe and trauma-informed care, respect Indigenous knowledge and healing, and strengthen professional accountability.
The updated code therefore represents both a professional-ethics revision and part of the CMA's broader reconciliation programme.
What the New Code Means for Physicians
The CMA Code of Ethics and Professionalism is influential in Canadian medicine. The association says it is used by physicians and medical learners to guide ethical decision-making and professional conduct, while medical regulatory authorities and colleges in many provinces and territories use it as part of expectations surrounding physician practice and licensure.
The practical effect of the new provisions will therefore depend on how physicians, medical schools, health organisations and regulatory bodies apply them.
The CMA says the updated code is intended to make expectations clearer rather than replace the fundamental principles that have guided medical ethics for decades.
At the centre of the revision are patient well-being, respect for persons, equity and justice, integrity, professional excellence and continued reflection.
For Indigenous patients, the CMA says the changes are specifically intended to support care that is respectful, culturally safe and free from racism and discrimination.
The association has described the revised code as one part of a longer process rather than the final step in its reconciliation efforts.
