Doctors’ updated ethics code targets bias in care, but for immigrant women, the test is in the delivery room

The organization that represents Canada's medical doctors has revised its national ethics code to address racism and discrimination.

The Code of Ethics and Professionalism was developed as part of its reconciliation commitments following an apology to Indigenous Peoples, but it doesn't specifically include immigrant patients and whether it will address the discrimination they experience.

The Canadian Medical Association (CMA) released the revised code Sept. 18. It outlines expectations for physicians to provide “culturally safe, trauma-informed and equitable care to all, including historically underserved and excluded populations,” and says patients should not be treated differently because of life circumstances that can cause stigma.

It also directs physicians to make “reasonable efforts to ensure that the patient understands their rights in making informed decisions throughout the course of their care, including their right to decline care or treatment.” 

A CMA document explaining the updated code states that discrimination can include treating a patient’s “knowledge and experiences as less important,” and that racism can include “hidden acts of discrimination that are masked by a polite, friendly or professional attitude.”

Immigrant women in Canada report they often feel dismissed, judged or pressured during childbirth and reproductive care, according to doctors, nurses, researchers and community workers interviewed by New Canadian Media. They say language barriers, unfamiliarity with the health care system and racial stereotypes can also make it harder for them to be heard.

Anna (NCM is using only her first name, as requested) remembers the sense of alienation she felt after giving birth to her daughter four years ago. She was struggling to recover in a Montreal hospital and she wanted to take her daughter home.

The doctor on duty wanted her to remain in the hospital so her daughter could undergo checks for jaundice. When Anna insisted on leaving, she said the doctor threatened her.

“If you don’t show up tomorrow and do the next blood test, we will take your baby away from you. I can get a court order,” she recalled the doctor saying.

Anna had immigrated to Canada in 2018 and her husband followed a year later. When their daughter was born in 2022, they were navigating parenthood and an unfamiliar health-care system. 

The strain of coping with their new home’s health system began during pregnancy. Concerned about the baby’s small size, one doctor recommended inducing labour. 

When Anna asked whether her own small stature and South Asian background might explain the measurements — the other prenatal checks were normal — she said her concerns were brushed off. After her daughter was born, Anna questioned the repeated blood tests on her newborn: Eight in two days, she said. 

A doctor later told her that the device used to read skin tones for jaundice “doesn’t work for tan skin.”

Looking back, Anna questions whether the medical system had tried hard enough to secure their informed consent at every stage.

“It’s the immigrant experience,” she said. “because we didn’t have the information, we didn’t know we could say no.”

Andrea Willett, a nurse and PhD candidate at the University of Ottawa, studied mistreatment during hospital births through interviews with health-care providers and 15 women who delivered their babies in Montreal. Nearly half of the study participants were immigrants.

She said the women described feeling alienated and dismissed, though Willett cautioned that specific sources of discrimination were difficult to disentangle. Accounts included uncomfortable comments about food and, among uninsured immigrant women, suspicion about whether they could pay for their care. 

Health-care providers described colleagues making derogatory remarks about the smell of women of certain ethnicities, Willett said. She also heard accounts of dire warnings about babies’ well-being used to pressure women into accepting medical recommendations.

Insisting on a choice can come at a cost. One immigrant participant in Willett’s research asked her doctor to stop administering oxytocin, a drug used to induce labour, to see whether her baby’s heart rate improved. After a disagreement with the doctor, a nurse adjusted the equipment and left without explanation. 

The woman said she rang for help, but waited an hour and a half before another nurse explained that the medication had been stopped.

“Which is what she had asked for,” Willett said. “But the price she paid was the lack of communication around it, which seemed like a sort of a passive-aggressive response.”

CMA president Dr. Bolu Ogunyemi said it was unacceptable for patients to feel dismissed, judged or excluded from decisions. 

“Patients should be able to ask questions, be taken seriously, and have a say in their care – including immigrant patients,” Ogunyemi said.

The revised code sets clearer expectations for culturally safe care that takes patients’ histories into account and involves them in the decisions, he said.

[caption id="attachment_43384" align="aligncenter" width="699"] Title page of the Canadian Medical Association's Code of Ethics and Professional Conduct. Photo: Screenshot[/caption]

Anna’s questions about fetal growth and jaundice screening also point to the importance of clear clinical explanations. 

Dr. John Kingdom is a maternal-fetal medicine specialist at Toronto’s Mount Sinai Hospital and co-author of Canada’s 2023 fetal growth restriction guideline. He said patients like Anna could be given a placental growth factor test that can help distinguish a naturally small baby from one with restricted growth, potentially avoiding unnecessarily inducing early labour and delivery.

Dr. Eugene Ng, a neonatologist at Toronto’s Sunnybrook Hospital and a member of the Canadian Paediatric Society’s board of directors, said jaundice-screening devices compensate imperfectly for skin pigmentation despite being designed to make the effect on readings negligible. In these instances, blood tests can confirm readings high enough to warrant treatment, he said.

When language limits access

Before a patient even reaches the examination room, the language barrier can get in the way of the revised code’s call for equitable care for “historically underserved and excluded populations.” 

Karen Pontious supports refugee claimants and asylum seekers at Options Community Services in B.C., accompanying women to medical appointments and advocating for their care. She said she's had many encounters with family practices unwilling to accept patients unless they speak the doctor’s language, or asked to bring someone to interpret for them.

“There’s an expectation that family members or friends will go, or I myself will go with clients, but I’m not always available,” Pontious said.

Without a family doctor, women can also struggle to obtain referrals for reproductive care, Pontious said. She connects them with clinics that accept patients without those referrals — an option that newcomers may not know exist.

The College of Physicians and Surgeons of BC endorses the revised CMA code as “the common ethical framework to which all physicians and surgeons are bound in B.C.” 

It states that physicians should have access to phone interpretation through the Provincial Language Services program. Denying care solely because of a potential language barrier “may be deemed unprofessional and unethical,” the BC College said.

But even when interpretation services exist, patients may not get them when they're needed. 

Dr. Susan Bartels, emergency-room physician and researcher at Queen’s University in Kingston, Ont., said waiting for an interpreter can leave families choosing to interpret themselves.

“It’s not always that there isn’t an interpreter available; it’s that it creates a delay,” she said.

Accounts of feeling dismissed also extend beyond reproductive care. In a study of emergency department experiences in Kingston, Ont., Bartels and her colleagues found that visible-minority participants more often reported feeling judged, ignored and uninformed. They were also more likely to say their identity or culture had negatively affected their care.

The study did not specifically examine immigrants; visible minority participants could also be Canadian-born. 

Bartels said a negative encounter did not necessarily establish discrimination, but she found it notable that some participants linked their treatment to race, ethnicity, appearance or perceived immigration status.

For Anna and her husband, questions about their care lingered long after they left the hospital. The couple didn’t pursue a formal complaint, partly because they did not know their options. The deadline for the redress route they considered has now passed. 

The CMA code is enforced in provinces and territories where regulators require it, and patients with concerns may contact their provincial regulatory college.

Laura Track, director of the Vancouver-based BC Human Rights Clinic, said uncertainty about where to turn is a familiar refrain. 

“I think many people, particularly newcomers, aren’t aware of their rights under the Human Rights Code,” Track said. “They may not know that the law protects them from discrimination, or how it works.”

People with insecure immigration status may also fear starting proceedings against an institution or the government, she said.

The CMA’s background document on the updated code acknowledges that “limited resources, system pressures and broader social conditions” can limit what individual physicians are able to address.

For Bartels, the code’s promises rest on what happens in practice: Whether a small hospital can find an interpreter in the middle of the night; whether explanations are clear and respectful; and whether patients have a meaningful say in their care.

“I think the harder question is how to operationalize it,” she said. 

“How do you more meaningfully involve patients in participating in decision-making in an authentic way?”

Copyright 2026, New Canadian Media. All rights reserved.

Mubin S. Khan, Local Journalism Initiative Reporter, New Canadian Media.