Saddle Lake Cree Nation Invokes Treaty 6 to Shelter Gender-Affirming Care

On September 9, at a Treaty 6 gathering at Fort Pitt, Saskatchewan, the Saddle Lake Cree Nation said something I had not heard a government say before: that its lands will be a haven for gender-affirming care, open to Indigenous and non-Indigenous people alike — and that the authority to say so comes from a treaty signed in 1876.

The declaration lands in the middle of Alberta’s fight over transgender health care, from a direction almost nobody was watching. If you have followed how these arguments have shifted over the decades, you know the venue usually changes before the outcome does.

What Saddle Lake Cree Nation announced

Chief Dale Steinhauer framed it as a treaty obligation rather than a political statement. As a sovereign nation and treaty rights holder, he said, Saddle Lake must “protect the health, dignity, and life of every person who comes to our territory.” The legal hook is Treaty No. 6’s medicine chest clause, which promised that “a medicine chest shall be kept at the house of each Indian Agent for the use and benefit of the Indians.” The nation reads that 150-year-old sentence as a standing guarantee of health care broad enough to cover hormone therapy.

The practical work is underway, according to Lauren Collins’s report for Black Press Media. Saddle Lake has passed a band council resolution affirming and protecting two-spirit people and is drafting its own health law. Dr. James Makokis, a Nehiyo two-spirit family physician from the nation, described a virtual care hub so clinicians working under that law could practice from anywhere in Canada — a hedge against the nation’s federal health funding being swamped by demand. Makokis, who has spoken about the shame he carried as a gender-diverse young person, called it a public health emergency. A legal defense fund had passed $80,000 by Friday afternoon. Nobody involved expects this to go unchallenged.

Why the argument moved to treaty ground

To see why the claim is jurisdictional rather than constitutional, look at the constitutional route. Alberta passed three laws under Premier Danielle Smith: one restricting puberty blockers, hormone therapy and gender-related surgery for minors; one requiring parental notification when a student under 16 wants to change their name or pronouns at school; and one limiting female sports categories by sex assigned at birth.

A judge blocked the health law with an injunction. Then, in November 2025, the province passed Bill 9, invoking the Charter’s notwithstanding clause to shield all three laws from constitutional challenge. The injunction fell away. Such declarations expire after five years unless renewed.

Smith defended the move, saying litigation takes years. “These delays are not acceptable to this government when children are in harm’s way,” she said; her government’s position is that the restrictions protect minors from interventions it considers irreversible. Egale Canada’s legal director, Bennett Jensen, called that argument “laughable” and “deeply offensive,” noting a judge had already sided with the challengers before the clause was invoked.

That is the impasse. With Charter review largely off the table for now, a treaty argument is one of the few doors left — and it is a door the province did not build. It echoes what shield laws elsewhere attempt, and what the fights over public coverage keep circling: when one government closes a door, people look for another that can open one.

The part nobody can answer yet.

Whether it works is far from settled. The College of Physicians and Surgeons of Alberta issued a statement respecting First Nations rights and treaty obligations while noting that its authority to regulate physicians comes from provincial legislation, and that “our authority does not extend to opposing or commenting on duly enacted legislation.” That is a regulator declining to pick a side while making clear it cannot step aside. A doctor practicing on Saddle Lake land still holds a provincial license, and no court has ruled whether a First Nation’s health law displaces that. Alberta’s government was not quoted in the reporting; the defense fund suggests the nation expects to learn the hard way.

I keep returning to that phrase — a medicine chest kept at the house of each Indian Agent. Its authors could not have imagined what it would be asked to carry. That is not a weakness of old promises; it is what makes them worth keeping. Somewhere in Alberta a family is reading this news and doing arithmetic about distance and money. Whatever the courts say, someone decided they should not have to do it alone.