In response to a 2022 report by two researchers from the University of Quebec in Abitibi-Témiscamingue which revealed sterilizations and terminations of pregnancies imposed on First Nations and Inuit women, the College of Physicians of Quebec (CMQ) is equipped with an action plan to tackle these issues in order to intervene preventively.
The research report highlighted gynecological or obstetrical interventions carried out without the patients’ knowledge as well as “the pressures experienced by young patients to accept permanent sterilization, despite their age and without other contraceptive options be offered to them.” These events occurred between 1980 to 2019.
Entitled “Free and Informed Consent and Forced Sterilizations of First Nations and Inuit Women in Quebec,” the report was co-written by researchers Suzy Basile and Patricia Bouchard of the University of Quebec in Abitibi-Témiscamingue. As part of their research, 35 women agreed to share their experiences.
The publication of the research report had reignited the indignation of Quebecers following the tragic death of Joyce Echaquan which had occurred approximately two years earlier.
The publication in November 2022 and the death of Mme Echaquan “opened our eyes to what racism experienced in a healthcare context could look like. However, violence does not always result in such obvious acts of denigration. It can be more subtle, insidious,” wrote in its report the think tank set up by the CMQ on terminations of pregnancies and sterilizations imposed on First Nations and Inuit women in Quebec.
The president of the College of Physicians, Dr. Mauril Gaudreault, remembers very well the day the research report was published. “I denounced these situations and I was angry that morning when I learned of such tragedies for these women,” he recalled.
“The first reaction was: it’s not true that this will continue to happen in Quebec. We are going to look at that, what we did with this working group,” he continued.
A preamble to the Code of Ethics and training
The think tank, formed in February 2023, is made up of two administrators of the CMQ and its president, but also of actors working with indigenous communities and the co-author of the report, Suzy Basile. “We did this consensually, together, to regain the confidence of the Indigenous community in the Quebec health system,” Dr. Gaudreault said in an interview.
“Because the reason why Indigenous patients have not communicated this to the College is because they do not trust us,” recognizes Dr. Gaudreault. We have to be part of the solution and quite humbly I don’t think this will solve everything, but it’s a step forward. »
The think tank made seven recommendations, including making basic training in cultural security of health care mandatory for professionals in the CMQ’s investigation and professional inspection departments. This training should also be promoted among doctors, but it will not be compulsory.
Dr Gaudreault does not exclude that it will become compulsory for doctors, but for the moment it will be optional in the fall.
Mme Basile believes that training in cultural safety would be welcome for all health professions. For doctors, she said she was confident “that things will be corrected if necessary” by the College.
The CMQ will also add a preamble to the Code of Ethics for Physicians to prohibit any discrimination based on culture and identity.
Initially, the research report recommended the modification of one of the articles of the Code of Ethics. “What the College of Physicians preferred to do for pragmatic reasons was to formulate a preamble which would color all the articles of the Code of Ethics. In my opinion, it is even stronger and the message sent to Quebec doctors by this means says that we must take into consideration the origin of patients and respect their rights,” said Ms. Basile.
One of the main issues raised in her research was that women often found out months or years later that they had had a tubal ligation.
Improve communication
Mme Basile emphasized the importance of communication between doctors and Indigenous patients who are often in a second language or even third language context. She also argued that prejudice often accompanies patients when they set foot in a health network establishment. “I dare to hope that the step forward that the College is taking, or at least the message it is sending to its troops, will be well heard,” she declared.
The researcher seems to be hopeful that the courses of action will improve the situation. “We can at least ensure that the attention and education of today’s doctors and those of tomorrow will ensure that this never happens again and that we respect the patients’ choice,” said -she affirmed.
The courses of action recommended by the think tank can be implemented this year. They do not only concern Indigenous communities, but all marginalized groups, including racialized and gender diverse clientele.
Furthermore, the research team from the University of Quebec in Abitibi-Témiscamingue is continuing phase two of its work. “We have heard a good number of new testimonies from First Nations women who have suffered either imposed sterilization or obstetric violence,” said Ms.me Basil. A second report is expected to be published this fall.