Abstract
Ethical health data use in Canada is often reduced to compliance with privacy requirements, limiting its role in governance and decision-making. This article reframes ethical data use as a relational practice that supports trust, transparency, participation, and shared accountability across institutions, patients, and communities. Grounded in Principle 7 of the Pan-Canadian Health Data Charter, it examines tensions between risk-averse data protection and the need to enable responsible data use for care, research, and system improvement, arguing that this divide constrains both innovation and public benefit. Trust and social licence are positioned as foundational to participation, data quality, and legitimacy, underscoring the need to redistribute decision-making power to patients and communities. Relational governance offers a practical pathway to move beyond compliance and support ethical, effective, and publicly trusted health data use in Canada.
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