St. Mary’s Hospital of Montreal | You do not need to know…

The public release of doctors and other professionals from St. Mary’s Hospital⁠1who denounce the condemnation of the health establishment on its management of the last moments of Andrée Simard, inspired this reflection.


In response to the unveiling of a poignant situation, the professionals and governors of a hospital have just opened a fascinating window on the cult of administrative opacity.

Their remonstrance deserves to be heard and even preserved, because, well beyond this particular case, it develops such an exemplary defense of institutional opacity that it could serve as a standard model for all managers: that we deals with mines, schools, forests or passports, just fill in the blanks to adapt it to any situation. Even if it means forcing the line a little, let’s summarize the main rules, for the use of hierarchies under pressure.

– Take refuge behind his first line. Organizations rely on people, usually very dedicated, who must apply their tortuous rules and may suffer from being associated with dysfunctions that are not really their responsibility. They thus constitute perfect human shields for administrative cogs that are less so.

– Challenge exaggerated or imaginary accusations (eg “that we are opposed to adequate palliative care”). This will divert the debate to much safer ground.

– To deplore the promptness of the media and of unnamed “various individuals” (in this case, it seems, the two ministers concerned) is even more defensible, since haste can indeed cause errors of assessment which will have to then be rectified.

We will therefore prefer the wise slowness of processes long enough for all collective attention to have disappeared.

– Extend the obligation of confidentiality as much as possible. It is so legitimate in its real object that it would be a shame not to extend it indefinitely. Very effective, the method is increasingly used: for example, a patient will be invoked to reject any general question. In other cases, we will evoke business secrecy or any legal proceedings in order to wall ourselves in too complete a silence to be seriously justifiable. With a little imagination, anything can become a pretext: the Ottawa police, particularly gifted, have just added the reason “not to comment on the ongoing investigation” to give no details about an impressive robbery. Previously, “respect for the victims” had allowed him to reveal nothing of a catastrophic bus accident.

– Never let “the trust of our people” be disturbed, and more generally protect them from any information likely to worry them.

If necessary, we can denounce the irresponsibility of the media since only an organization can judge what it is appropriate to teach its constituents: they do not need to know the rest.

– Boldly delegitimize the sphere of public debate. Whatever the Enlightenment may have thought of them, problems of public interest can only be properly examined according to specific, regulated and more or less opaque procedures. The ideal could be to return to ancient times, provided you do not go back to the Athenian agora.

Even if we obviously caricature all this, the last rule is the mother of all the others, the one that reigns over the world behind the scenes. The one that makes it possible to judge “inappropriate[é] by nature any media lighting, even factual. The one that devastates forests and public finances, while enriching lobbyists and consultants.

One cannot want the good of the population without wanting what preserves it. Year after year, from child protection to that of the gendarmerie radios, a good hundred major administrative dysfunctions (probably more than double, they should be counted…) are revealed in the public square. The chosen ones discover, are taken aback and often end up correcting. One shudders to think of the society we would live in without this constant process.

Conversely, organizations whose administrative superstructure escapes the scrutiny of the media, or even that of their own governing bodies, often end badly. To stick to the example that I know best, it is the case of universities where, as in the cinema, you never change a proven recipe. The first scene is still bathed in darkness and silence. Did you like “The Voyageur Island Disaster” then “The Laurentian University Disaster”? You will love the very next episodes, even more spectacular…

Even well-meaning – and most probably are – managers easily tend to see the world from the top down, the bottom being made up of the “administered” who, as their name suggests, should be administered in their own interest. Why would they need to know the details, let alone discuss them? Perhaps, but the other end of the scale, at the very top, is constituted by another abstraction, the “citizens”, of whom any person in charge is only a delegate. And those, whether they realize it or not, really need to know.


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