Joyce’s Principle | Cultural security and the broken promises of the CAQ

As caregivers and caregivers who advocate for dignified and equitable care, we are flabbergasted by the decision of the Legault government to abandon its promise to include the principle of cultural safety in the Act respecting health services and social services.

This decision – denounced among others by the Atikamekw Council of Manawan, the Atikamekw Nation Council and the Assembly of First Nations Quebec-Labrador – was announced when the Minister of Health and Social Services had just presented with great fanfare its reform of the health system. Although Christian Dubé promises us a “more humane” system, there is no mention of cultural security.

Is ending systemic anti-Indigenous racism not even a footnote in the overhaul of our healthcare system?

However, Minister Dubé affirmed that we were done with “the reports” and that we had to “take action”. What about the 34 calls to action aimed at the health and social services network in the final report of the Commission of Inquiry into Relations between Aboriginal Peoples and Certain Public Services (Viens Commission), tabled more than two years ago?

Recommendation No.^oh 74 specifically calls for changing the Act respecting health services and social services “to embed the notion of cultural security, in collaboration with Indigenous authorities”.

Since the tragic death of Joyce Echaquan in September 2020, several Indigenous people who were victims of racism within the health care system have courageously testified about their experiences, calling for the implementation of cultural safety measures. This is what Joyce’s Principle claims, which states that “the Government of Quebec must recognize the systemic racism faced by Aboriginal people, particularly in connection with a right of equitable access, without any discrimination, to all social services. and health, as well as the right to the enjoyment of the highest attainable standard of physical, mental, emotional and spiritual health”.

In her report following the public inquiry into the death of Joyce Echaquan, coroner Géhane Kamel recommended that the Government of Quebec “recognize the existence of systemic racism within our institutions and make a commitment to contribute to its elimination.

Added to this are the voices of the thousands of people who marched in cities across Quebec to show their solidarity with Joyce Echaquan’s family, her community and her nation, and the hundreds of health care workers who signed the open letter “Systemic racism killed Joyce Echaquan”¹.

Disappointing training

Several healthcare establishments, faculties, professional orders and unions have taken action by adopting the Joyce Principle, while the Ministry of Health and Social Services (MSSS), in addition to refusing to do the same, strives to promote its “Aboriginal Awareness” training to caregivers.

This training was designed for public service employees. Lasting one hour and forty-five minutes, the mandatory component of the training addresses in a superficial and historically incomplete manner the impacts of colonization on Indigenous Peoples in Quebec. In fact, it just doesn’t address aboriginal health issues. In this context, it is not regrettable that only 30% of employees in the health network have completed it.

Having taken this mandatory training, we were disappointed not to find any mention of medical colonialism or systemic anti-Indigenous racism in health care in Quebec. Neither the Joyce Principle nor the death of Joyce Echaquan is mentioned there. Ditto for cultural security, also absent from the content, while the Minister responsible for Indigenous Affairs, Ian Lafrenière, would have insisted recently that it was “extremely important”.

It should be remembered that the notion of cultural security, developed in the 1980s by Maori nurses and educators, is part of an analysis of structural inequalities and colonial power relations between health professionals and Indigenous peoples.²and goes beyond the lens of “interculturalism” favored in MSSS training.

Without relevant content or an appropriate framework for analysis, how can we claim to make healthcare personnel aware of “Aboriginal realities” in today’s Quebec? Clearly, this training must be reviewed from top to bottom.

Ultimately, it will take much more than a mandatory training capsule to eradicate the racism that is structurally embedded in our health and social services system. We must adopt a decolonial approach in order to improve the health care provided to the entire population of Quebec. To do this, we must begin by listening to the calls of the indigenous communities and demonstrating an authentic and supportive commitment while respecting their self-determination and their autonomy.

From a restorative perspective, the CAQ government has an obligation to respect its promise to include cultural security in the Act respecting health services and social services during this mandate. More so, Joyce’s Principle must be an integral part of any overhaul of the healthcare system.

For “more humane” care, we expect nothing less.

* Nazila Bettache is an internist, assistant professor at the Faculty of Medicine of the University of Montreal; Samir Shaheen-Hussain is a pediatric emergency physician, assistant professor in the Faculty of Medicine and Health Sciences at McGill University, author of No More Indigenous Children Uprooted: Ending Canadian Medical Colonialism