In colonial societies such as Canada and Australia, the implications of colonialism and ethnocide (or ‘cultural genocide’) for ethical decision-making are ill-understood yet have profound implications in health ethics and other applied ethical spheres. They combine to shape racism in health care in ways that, sometimes obvious, more often subtle, are inadequately understood and often wholly unnoticed. Along with overt experiences of interpersonal racism, Indigenous people in health care are confronted by systemic racism in the shaping of institutional structures, hospital policies and in resource allocation decisions. Above all, racism is a function of state law – of the unilateral imposition of the settler society law on Indigenous communities. Indeed, the laws, including health laws, are social determinants of the ill-health of Indigenous peoples.  The ethnocide is current, not past, and a failure to recognize that it is ongoing means that ‘ethical’ decision-making in fact continues to contribute to the ethnocide. This talk will describe the ethnocide and discuss some of these ethical implications, including the unavoidable racism of decisions, behaviours, policies and laws that look, on the surface, as if they are morally legitimate.