The author is a pediatric emergency physician and associate professor in the Faculty of Medicine and Health Sciences at McGill University. He is involved in the Soignons la justice sociale collective and wrote the award-winning book No more aboriginal children torn away. To end Canadian medical colonialism (Lux editor).
On June 9, the Minister responsible for Relations with the First Nations and the Inuit, Ian Lafrenière, tabled Bill 32 (Act establishing the cultural safety approach within the health and social services network). Even if Aboriginal authorities and groups have welcomed certain elements of PL32, several shortcomings have been raised, both in terms of the process, its development and its content.
In a press release, we learn that the chiefs of the Assembly of First Nations Quebec-Labrador “reiterated many times to Minister Lafrenière that it was not up to the Quebec government to move forward with this approach because it is up to the First Nations to define and ensure respect for their cultural safety”. For their part, the Office of the Joyce Principle and Quebec Native Women point out that “Indigenous organizations do not seem to maintain the same definition of cultural safety as the Quebec government”.
Indeed, the Coalition avenir Québec (CAQ) seems to be frozen in a framework of “cultural sensitivity” or “cultural competence” favoring an “intercultural” approach, but clumsily tries to pass it off as “cultural security”. The wording of Bill 32 stipulates that institutions in the health and social services network must “adopt an approach of cultural reassurance towards Aboriginal people” and must “adopt reassuring practices” which would consist of “considering the values and cultural realities and histories of Aboriginal people”, to “foster partnership with Aboriginal people and effective communication with them”, to “be welcoming and inclusive of Aboriginal people” and to “adapt, when possible, the offer of health and social services”.
However, there is no mention of colonization by Europeans, the consequences of colonialism or the interwoven discriminations within the health system, notably through medical colonialism. Yet naming these structural elements—historical, political, economic, social—is a cornerstone of cultural safety.
The concept of cultural safety (translated by many as “cultural safety” rather than “cultural safety”) was developed in the late 1980s by Maori nurse and educator Irihapeti Ramsden, and then spread and took hold at many levels in New Zealand throughout the 1990s. Ramsden explains in her doctoral dissertation in nursing (submitted in 2002, the year before her death), that the ideas of cultural safety respond to the fact that “issues of resource deprivation economic, land, people and identity, i.e. colonization, have major health and disease consequences that have remained largely unrecognized and unaddressed in the education of nurses and midwives “.
According to Ramsden, “cultural safety always seeks to situate its action in the belief systems and behaviors of the caregiver rather than in those of the patient” by using a pedagogical framework of analysis of power relations, “whether according to the sex, sexuality, social class, professional group, age, ethnicity or a large combination of variables”, but it is the user who ultimately decides whether he feels safe in the context of this care.
Drawing on a cultural safety and trauma-informed care approach (trauma-informed care), the Canadian Medical Association (CMA) recently announced the start of a process to issue a formal apology for the harm done to Indigenous peoples. The CAQ should take note.
Alika Lafontaine, physician and the CMA’s first Indigenous president, said, “The history of the profession [médicale] is also the story of Canada. This history is marked in particular by the devastating effects of hospitals for “Indians”, forced medical experiments on Aboriginal people and disparities linked to investments in infrastructures, but also by systemic racism, neglect and mistreatment. It is a “past” that remains very present in the daily experiences of indigenous peoples throughout our common territory. Lafontaine also stressed that “for reconciliation to be possible, there must be trust.”
One way to establish this confidence in our health and social services network is to adopt Joyce’s Principle to ensure that the Quebec government recognizes the autonomy and self-determination of Aboriginal peoples, in particular by respecting the “knowledge and knowledge traditional and living Aboriginal health practices”. Jennifer Petiquay-Dufresne, Executive Director of the Office of Joyce’s Principle, rightly recalled that “the latest mobilizations by Aboriginal organizations and experts have shown us that the bond of trust between the government [québécois] and Indigenous peoples unquestionably requires the adoption of Joyce’s Principle and the recognition of systemic racism and discrimination”, but that, “for the moment, the government and its bill do not meet our expectations”.
By removing from PL32 the colonial context that underpins relations between the Government of Quebec and the Indigenous peoples residing in that province, and by referring to Joyce’s Principle without adopting it on the pretext that, according to her, systemic racism does not exist, the CAQ tries to depoliticize a tool of self-determination — cultural security — which is fundamentally political. Faced with such a colonial approach, we should not be surprised that trust is sorely lacking.