Evidence of meeting #131 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was witnesses.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Abby Hoffman  Assistant Deputy Minister, Strategic Policy Branch, Department of Health
Valerie Gideon  Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Indigenous Services Canada
Tom Wong  Executive Director and Chief Medical Officer of Public Health, Indigenous Services Canada
Robert-Falcon Ouellette  Winnipeg Centre, Lib.
Bob Benzen  Calgary Heritage, CPC
Clerk of the Committee  Mr. Alexandre Jacques
Marlisa Tiedemann  Committee Researcher

4:10 p.m.

Winnipeg Centre, Lib.

4:10 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Indigenous Services Canada

Valerie Gideon

It wouldn't have been done through the federal process; it would have been done through the provincial process. I would assume there would have been interviews in that context.

What we have done, though, is that we have been working with national health professional associations to advance cultural safety and humility. I referred to a few of those in my presentation, such as supporting the Royal College's work and identifying cultural safety as a mandatory requirement in post-medical education, and also working with them to develop and provide in a much more seamless way cultural safety materials for medical schools, medical professionals, both individually and across the system.

4:10 p.m.

Winnipeg Centre, Lib.

Robert-Falcon Ouellette

To return to the question about the calls to action 23 and 24, which look at health care professionals, will the working group of federal, provincial and territorial and indigenous organizations, which are hopefully part of it, include looking at the education programs for new nurses and new doctors?

4:10 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Indigenous Services Canada

Valerie Gideon

Yes, this is exactly part of the agenda.

4:10 p.m.

Winnipeg Centre, Lib.

Robert-Falcon Ouellette

Okay.

I have no more questions.

4:10 p.m.

Liberal

The Chair Liberal Bill Casey

All right.

That completes our first round of questions, and now we go to Mr. Lobb for five minutes.

4:10 p.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

Is this issue of forced sterilization just amongst the indigenous community, or is this a wider spread issue in Canada that we may not be aware of? Perhaps it's young women who could potentially be involved in drugs, maybe have had a tough life, or whatever the circumstances. Is this isolated to the indigenous community? Is there any information on that?

4:10 p.m.

Assistant Deputy Minister, Strategic Policy Branch, Department of Health

Abby Hoffman

I think it's hard to say categorically, but given the circumstances under which these kinds of incidents might occur, it wouldn't be impossible to imagine, as I was saying earlier, that a woman with mental health issues or addictions or someone who, for whatever reason, is not really capable, shall we say, of holding her own in an interaction with a health care provider, might have it proposed to her that she undergo a sterilization procedure. At the end of the day, what may have seemed to the provider as consent might not in reality have been consent as one would think consent should be managed. I think, without suggesting anything about the scale of what might be going on, it's not impossible to imagine that this is not an issue confined only to indigenous women.

4:15 p.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

Again, forgive me for not knowing—

4:15 p.m.

Liberal

The Chair Liberal Bill Casey

Dr. Wong would like to answer that.

4:15 p.m.

Executive Director and Chief Medical Officer of Public Health, Indigenous Services Canada

Dr. Tom Wong

If I may, in the past, historically, the provinces of Alberta and B.C. had legislation specifically regarding sterilization of individuals with, for example, mental illness. That was in the twenties, thirties and all the way up to the seventies. Those kinds of practices were very troubling, the fact that individuals with mental illnesses were targeted as a group to undergo tubal ligation and sterilization procedures. Those laws in those provinces have since been abolished.

4:15 p.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

Forgive me for not knowing this, but in the cases of these, I guess, mainly tubal ligations or other methods, how did this happen? Was it after one of the individuals had given birth to a child and their doctor or somebody had advised them? I'm just trying to understand how this even would have come to be. Maybe you can tell the committee a bit about what step in the process this occurred.

4:15 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Indigenous Services Canada

Valerie Gideon

The information in the external review is the information that we have. It's not by individual-by-individual circumstance. It was not a homogeneous situation, so it was at different stages. I also think there were lots of comments about how women felt there would potentially be an interaction with the child and family services system, which is why they felt coerced into sterilization. That says to me that they probably had just birthed, if they were concerned about an interaction with the child and family services system. We don't have all of the information about all of the individual circumstances, but we have some information through the external review report.

4:15 p.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

Another thing you talked about was birthing alone. Has this practice been changed now? I'm guessing that people who are having to fly or travel to a hospital now are not going by themselves. Is this true?

4:15 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Indigenous Services Canada

Valerie Gideon

Prior to budget 2017, our policy was that unless women were minors or had a medical recommendation, such as a prescription from a physician to have an escort to accompany them at birth, they would not get paid for the escort's travel. It doesn't mean that they couldn't have an escort. It's just that it wouldn't be paid directly through our program. Now that has been changed through budget 2017.

4:15 p.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

Is there a chance that these forced sterilizations are still occurring?

4:15 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Indigenous Services Canada

Valerie Gideon

There's a chance, because we don't have information about the magnitude of the problem at this stage. We are trying to raise public awareness and work with indigenous women's organizations and communities to put the information up front in communities.

We have maternal child health programs and other programs in which there are community-based workers who would be able to provide that information more proactively and discuss the possibility or the issue proactively. We have general information that is published and funded around birthing and all sorts of general public health information, but it doesn't necessarily speak specifically to coerced or forced sterilization.

4:15 p.m.

Conservative

Ben Lobb Conservative Huron—Bruce, ON

I have one quick question. My time is coming to an end.

Is there now a system whereby public help, anybody who is in the advocacy area, or a doctor or a nurse can say, “Okay, I have explained this to somebody. They know now. I have proof they have consented to something.” Is there an official mechanism now whereby a health practitioner can feel confident about this or a young woman could possibly feel she has been properly notified?

I'm wondering if there is a system. We know there's an issue and we know it's widespread. Is there now a way such that we can actually say that this situation is fixed and we know going forward that here's how we would demonstrate or prove that consent has been granted?

4:20 p.m.

Assistant Deputy Minister, Strategic Policy Branch, Department of Health

Abby Hoffman

I don't think we could say with absolute conviction in every single case. As I was mentioning before, in hospitals, in terms of the issues of what constitutes valid consent, what is truly voluntary consent, and when is the person giving the consent really truly capable of giving this consent, these are very complicated issues.

Where there are difficult cases, they are often the subject of discussion by a provider with authorities in a health care institution, but that's not the same thing as what you're alluding to, which is some sort of system where every problematic consent case is somehow or other logged somewhere, and somebody could look at all of those consent situations. But there is, for reasons of legal liability, a lot of interest on the part of providers in being certain that what they believe has been freely given and informed consent is in fact the circumstance.

4:20 p.m.

Liberal

The Chair Liberal Bill Casey

We have to go on to Mr. Ayoub now.

4:20 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Thank you, Mr. Chair.

I want to thank the witnesses for their presentations. The information provided is extremely important and also very disturbing.

Ms. Hoffman, in your opening statement, you painted a very bleak picture of what minorities, people in difficulty, and indigenous people, particularly women, are experiencing. It seems that the situation is ongoing.

You mentioned the dual responsibilities for health. The federal and provincial governments have responsibilities. An action plan was implemented a few years ago. Who was responsible for the plan at the time? Who took the lead to change the things where they were happening at the time?

4:20 p.m.

Assistant Deputy Minister, Strategic Policy Branch, Department of Health

Abby Hoffman

It will depend on what the circumstances are and what the particular issue is. In these cases or the kinds of circumstances we're talking about here, we're speaking about practices that, unfortunately, have been perpetrated by health care providers.

In hospitals, generally speaking, the behaviours and standards of practice of physicians or the providers themselves are governed by health professional bodies that are subject to provincial regulatory regimes. The oversight of those individuals—

4:20 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Since I don't have much speaking time, I must interrupt you.

My question was mainly about who was taking the lead at the time. Things aren't quite the same now, but measures must still be taken.

I don't know whether you can answer my question, but I want to know whether you feel comfortable enough and whether you have enough evidence from across the country to make a preliminary diagnosis and, if so, to establish an action plan to fight this practice.

4:20 p.m.

Senior Assistant Deputy Minister, First Nations and Inuit Health Branch, Indigenous Services Canada

Valerie Gideon

We definitely need the co-operation of the provinces and territories. They have access to more detailed information on what's happening in the hospitals, which all fall under provincial and territorial jurisdiction.

4:20 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Are the provinces and territories aware of the issue?