Some Implications of Colonialism and Indigenous Cultural Genocide for Healthcare Ethics: Reflections from Northern Ontario, Canada

Questions of genocide and colonization are barely discussed in bioethics, yet they pose profound moral problems for healthcare ethics. Bioethicists and healthcare workers are accustomed to thinking of healthcare systems as generally beneficent, however much there might be specific flaws in specific institutions, units or individual behaviors. Similarly, theory in health ethics presupposes principalist or virtue-ethical approaches to health ethical issues, and all of them assign foundational roles to both law and dialogue in the resolution of complex moral issues. Colonialism, and the genocides which accompany it, challenge these beliefs. For Indigenous peoples, health systems as such are problematic and a priori, since these have been, and continue to be, violently imposed upon them. The law that is supposed to function as the final arbiter of moral disputes lies at the heart of the genocides and thus itself can lack legitimacy. That law is the foundation, and that its legitimacy is disputed means that dialogue is superficial rather than real, since any time an Indigenous person objects, and the conflict proves intractable, the means of resolution is violent. Further consequences are that resource allocation decisions become unjustly skewed, beneficence and maleficence shape to dominant settler populations, and health ethical decision-making promotes health inequities rather than eliminating them. In short, racism in health ethical decision-making becomes inescapable. Moreover, given that the destruction of Indigenous identity continues, un-self-critical bioethicists and health workers contribute to that genocide rather than opposing it. This paper describes the problem of genocide — above all that form Lemkin described as ‘ethnocide’ or ‘cultural genocide’ and explores some of the practical distortions in ethical decision-making and institutional formation that result.