Bill on cultural safety in health coming, Quebec says, following forced sterilizations study

Update: This story has been updated following a ministry spokesperson's assertion the bill would be introduced in early 2023, not during the current session as Indigenous Affairs Minister Ian Lafrenière said.

Nearly a year after the Quebec government's self-imposed deadline passed to enshrine cultural safety into its health-care law, the province's Indigenous affairs minister says it will finally introduce a bill to do so in the winter parliamentary session.

Ian Lafrenière renewed his government's promise Friday, just days after the release of a report that found at least 22 Indigenous women in Quebec had been forced or coerced into sterilization between 1980 and 2019, a practice that has been tied to colonialism and genocide. 

The report is the latest among several to scrutinize the treatment of Indigenous peoples by health-care services in Quebec.

Lafrenière said the bill to include the principle of cultural safety into the law wasn't passed earlier this year, as promised, because the Coalition Avenir Québec government wanted to address the issue in a separate bill. It had initially planned to include it in another bill.

"I'm sorry it wasn't done last spring," he said in an interview on Quebec AM Friday. "We want to send a strong message, so we decided to postpone it. It's going to be done in the next weeks and months. So at the beginning of this session, it's going to be done."

A spokesperson for the provincial Indigenous Affairs Ministry contacted CBC News Wednesday, following publication, saying the bill will, in fact, be introduced in the National Assembly session that begins in February, not in the coming weeks as Lafrenière said in the interview.

Though a Radio-Canada investigation last September unveiled cases of forced sterilization among Black and Indigenous women in Quebec, the issue had not been formally studied in the province. Quebec refused to be a part of a federal initiative in 2019 to examine the practice of forced sterilization across the country. 

The report, by researchers based at the Université du Québec en Abitibi-Témiscamingue (UQAT), detailed the stories of women from four First Nations, as well as Inuit women, who were pressured, coerced or misled into sterilization procedures. They were between aged 17 to 46 at the time of the procedures.

This summer, the Senate committee on Human Rights called for the criminalization of forced sterilization, after it heard emotional testimony from nine people who had lived through procedures without their consent. 

Senator Yvonne Boyer, who is a member of the Métis Nation of Ontario and a member of the committee who has advocated on the issue of forced sterilization, said she believes the UQAT study will result in more women in Quebec coming forward with their experiences. 

"It had previously been difficult to get in and to be able to talk to women [in Quebec] that were wanting to come forward," Boyer said, also in an interview with CBC's Quebec AM this week, referring to the province declining to be part of the national effort looking into the practice. 

"When women hear about other women who have been sterilized, they, for various reasons, feel a little more empowered because the whole act of sterilization is so traumatic on people," she added.

Tensions and broken promises

Tensions between the provincial government and Indigenous leadership in the province have mounted over the course of the more than four years the Coalition Avenir Québec government has been in power.

Among the points of contention are François Legault's reversal of a 2018 electoral promise to adopt the United Nations Declaration on the Rights of Indigenous Peoples, as well as his government's refusal to adopt Joyce's Principle — a call to guarantee Indigenous people the right to equitable access to social and health services, following the death of Joyce Echaquan at Joliette Hospital. 

Legault and his government have also refused to acknowledge the existence of systemic racism in Quebec, despite several reports and studies identifying its presence as a recurring issue within institutions.

In September, CBC News reported that the Indigenous sensitivity training devised after Echaquan's death was deemed "superficial" and "cringe-worthy" by Indigenous health professionals. The Health Ministry later promised to address the issues they pointed out.

In 2019, Legault's government challenged C-92, a federal law that gives First Nations, Métis and the Inuit autonomy over the treatment of their children in the foster care system. The government said it was simply refusing to submit to federal power over the province. For Indigenous leaders, it was another blow to their right to sovereignty and autonomy.

Just months before that, in an apology to First Nations and Inuit people following the Viens commission's three-year inquiry into the treatment of Indigenous people by Quebec's public service and its scathing final report, Legault once again stopped short of acknowledging the existence of systemic discrimination and racism in the province.

When Quebec resisted calls to create an exemption for Indigenous communities to its overhaul of the French-language law, Chief Ghislain Picard of the Assembly of First Nations Quebec-Labrador announced that First Nations in Quebec would be creating a "self-determination office," pointing to the difficulty they have had working with the CAQ government with its "paternalistic" attitude toward Indigenous communities.

Ahead of the Oct. 3 provincial election when Legault was re-elected, Picard said, "I cannot say today that there's a sound and positive political relationship with the province."

Encouraging women to file complaints

Friday, Lafrenière said he'd been shocked by last week's report and congratulated Suzy Basile, its lead author and the Canada Research Chair in Indigenous women's issues at UQAT. He also commended the Quebec College of Physicians, the professional order representing physicians in the province, for its response. 

Dr. Mauril Gaudreault, the college's president, wrote a letter to members earlier this week, reiterating the importance of obtaining clear and informed consent from patients before going ahead with a procedure. 

"Doctors must treat and not judge. Attempting to obtain consent for sterilization while someone is in labour, as was reported, is absolutely odious," Gaudreault wrote, inviting victims to make formal complaints to the order. 

"We have to be able to say: NEVER AGAIN!" he concluded the letter in all caps.

Gaudreault said in an interview with CBC News that he was meeting this weekend with Basile and Dr. Stanley Vollant, an Innu surgeon at Montreal's Notre-Dame Hospital, who has been outspoken about racism in Quebec health care following Joyce Echaquan's death. 

Gaudreault said he wanted to devise a process that would make Indigenous women feel safer and more comfortable to submit complaints to the college, one of the few means available to hold medical practitioners accountable for actions that go against their code of ethics and which can ultimately lead to criminal charges.