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

4:20 p.m.

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

Valerie Gideon

Yes, definitely. That's why a working group will focus specifically on this issue.

4:20 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Okay.

By requesting a more specific study and obtaining the facts to determine the scope of the situation, we'll be able to build on something real. Right now, we can make things up. The principle itself is completely indefensible. However, I'm bothered about the fact that we're once again faced with a tangled web of responsibilities. We're wondering what we'll do, who will take responsibility, how the action plan will be implemented and how the funds will be spent. Funds are needed to implement an action plan and solutions.

In the meantime, if the situation is real and ongoing, other women will experience what I call mutilation. There are many issues at stake. These include the legal aspect, the notion of consent, and other issues. I'm not blaming you, but you don't have the information. In my opinion, you're unable to reassure us that a plan exists and that all the provinces, clinics and doctors are moving in the same direction. Unfortunately, there's a lack of clarity.

Does this issue concern only Saskatchewan? Is the rest of Canada also affected? You've already been asked this question, but you don't really have an answer.

In addition, there has been a great deal of advocacy for women's bodies in this case. However, I'm wondering whether men have also been subjected to this practice in specific communities. Has there been any forced or voluntary sterilization of men?

4:25 p.m.

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

Valerie Gideon

Good question. The statistics on what's happening in hospitals aren't the only source that will provide the answer. That data shows only how many sterilizations have taken place, and not whether the sterilizations were forced.

When the government was asked in the 1970s about the hospitals in the territories still under its responsibility, it looked at the statistics and it didn't necessarily conclude that there was an issue. This doesn't mean that Inuit women weren't affected by the issue during this period. The government then implemented measures to improve the consent process. For example, two doctors would need to recommend the procedure and the woman's spouse would also need to sign the consent form. In short, measures to address this ethical issue were implemented at the time.

A qualitative research project must be carried out, and indigenous organizations must be involved in the project. During the external review conducted in Saskatoon, a number of women stated that they wanted to participate. However, when they realized that the study had been ordered by the regional board, they withdrew from the project. They were afraid.

4:25 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Maybe they were ashamed.

4:25 p.m.

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

Valerie Gideon

Possibly, but they feared the repercussions. The health care system involves a power imbalance between the doctor and the patient. Most people feel this imbalance, in a way. The phenomenon is even more pronounced when it concerns an Indigenous, marginalized or vulnerable woman.

The research project will take a few months to complete. We must verify with the Indigenous organizations how the project will proceed. This process is important for the success of the project.

4:25 p.m.

Liberal

The Chair Liberal Bill Casey

Your time is up.

4:25 p.m.

Liberal

Ramez Ayoub Liberal Thérèse-De Blainville, QC

Thank you.

4:25 p.m.

Liberal

The Chair Liberal Bill Casey

Mr. Benzen.

4:25 p.m.

Bob Benzen Calgary Heritage, CPC

Thank you, Mr. Chair.

Thank you, witnesses.

I guess I want to look at it from the medical side and try to find the breakdown in this consent. The medical profession's model is “Do no harm”. I find that doctors are very, very cautious. They are very afraid of making a mistake. If you've ever had surgery, you know all of the steps you've got to go through before they actually perform a surgery. They do not want to look at losing their licence; there's insurance, there are lawsuits, there are all kinds of things. They're very concerned about doing the right thing. So consent is extremely important.

Here we have a case of a female who's pregnant for nine months. Now normally there is a relationship built up between the mother-to-be and her family doctor or a doctor of some sort. During the nine months of pregnancy, there are sonograms and testing done. There are all kinds of things that have to be done. Usually that's a period where a relationship is built, and in that relationship the pregnancy is talked about: how's it going; do we have to be careful about this; what's your nutrition? They talk about how the pregnancy is going to go. They talk about the period after the pregnancy. So there's a lot of communication going on.

I'm wondering what's going on in that process where a fair number of women are making a decision that they either feel they're forced to make or that they don't want to make, when they've had this long period of time to have these discussions to build trust with their doctor, to get informed consent, to talk it through with other people in their family. What's going on? Why isn't the consent breaking down? There seems to be enough time. This is not a rushed thing. This is not like, okay, you've just been in a car accident, you're rushed to the doctor and you've got to do this thing. You've got 10 seconds to make a decision because it's life and death. This is a long process.

Can you give us some background? When you've got all this time and all this stuff available, why are these decisions happening this way? It's not just one doctor; it seems that it's a bigger thing than this. It's happening in multiple cities. It's across Canada. Can you give us some background on why it's not happening the way we would normally think it would happen, with a good decision being made?

4:30 p.m.

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

Valerie Gideon

Do you want to start that off?

4:30 p.m.

Assistant Deputy Minister, Strategic Policy Branch, Department of Health

Abby Hoffman

Sure. I can start it.

First of all, let's acknowledge that I think we are speaking to a degree in hypotheticals here. But I doubt that the kind of situations you are speaking of—situations where a women has had an ongoing interaction with one or several health care providers over the course of a pregnancy and has either a planned date for delivery or at least a time frame in which the birth will take place—are the cases where women are being induced into a sterilization procedure that they subsequently either deny agreeing to or feeling was the right decision.

I think the cases we're talking about are more likely instances where, if you can imagine, a person for all practical purposes is homeless, and maybe they've had an interaction with a public health professional wherever they are spending their days and nights in whatever somewhat indigent kind of living situation they have. I think it's more likely that it's that kind of person who has no established relationship with the health care system, and certainly is not dealing on any kind of equal footing with the provider. I think just speaking to these issues of consent, there's a huge difference when there's even a certain amount of cultural awareness or sensitivity to the fact that someone is of very modest economic means or really almost destitute. One can understand that.

We also need to understand that any conversation between a health care professional and a person in those circumstances is such a power imbalance that one can't take at absolute normal face value the exchange that occurs between those two people.

Again, one has to use some imagination, but you can sort of see how a circumstance could evolve in the kind of situation that I'm describing. It's further compounded by mental illness or an addiction—and I want to be clear I'm not making an accusation against health care providers, but it wouldn't be shocking to imagine that some providers without adequate training who encounter a person who's got a whole array of social and economic and psychological circumstances might well be more inclined to ask that person, if it's at the time of delivery, if they'd like to avoid this situation in future, and to have a conversation that is not adequately taking account of the real circumstances of that individual, and therefore what the exchange between the patient and the provider really means and how it should be managed properly.

4:30 p.m.

Liberal

The Chair Liberal Bill Casey

I'm sorry, but the time is up.

Ms. Sidhu.

January 31st, 2019 / 4:30 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

Thank you, to all of the panel, for being here.

Forced sterilization of indigenous women is a serious violation of human rights, which is unacceptable.

We heard that the indigenous population speaks 60 languages, or maybe more than that. We heard that health care professionals were getting training and when there is a sterilization procedure, of course the doctors performing that procedure, the social workers or the nurses have to get consent.

What steps have been taken to reduce language and cultural barriers? For that 60 languages are they providing any translators? With 60 different languages, doctors, nurses, and maybe social workers don't know what type of language is being spoken, so are there any translators provided to them so they can understand better?

4:30 p.m.

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

Valerie Gideon

I can speak to that from an indigenous individual's context.

There are many hospitals across Canada that do have indigenous navigators or interpreters, particularly in areas where a significant amount of the population are indigenous patients. There are also community workers that are there as health representatives who can help interpret and support women.

If women have to leave their community and travel a far distance to access hospital-based services, and if they have linguistic or cultural distinctions that are important in terms of them being able to understand the information, they will receive support, not just in terms of their own individual transportation but also for transportation of that individual to escort them. That's what we mean when we say an escort.

An escort can be for interpretive services as well, if they require those.

I don't think it is perfect yet. I think there is a lot of awareness now within provincial and territorial systems, and there has been a great increase in those services compared with what there were 10 years ago, but I think that will be part of what the group will be looking at.

Are there still hospital areas where indigenous women are accessing sterilization procedures, or other specialized procedures that carry risks, especially in terms of informed consent, where we need to invest in better interpretive services?

4:35 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

As Dr. Wong said, especially with mental illness, the population is going to be targeted.

4:35 p.m.

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

Valerie Gideon

Absolutely.

4:35 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

We are giving training to the health care professionals.

Are we giving training to the indigenous population?

4:35 p.m.

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

Valerie Gideon

This is what we are also committed to doing. It was something that even the Inter-American Commission on Human Rights recommended that Canada do, which was to provide specific public awareness materials for indigenous women with respect to forced sterilization.

We will be working with the indigenous women's organizations to develop those materials, taking into consideration the distinctions among indigenous nations so that they are very relevant to their local reality.

4:35 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

Thank you.

What other provinces have sterilization legislation? I know British Columbia and Alberta have it. Are there any other provinces working on that?

4:35 p.m.

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

Valerie Gideon

They had it. They've repealed it because it was for individuals who had mental incapacity as it was discussed at that time.

It doesn't exist at this time.

4:35 p.m.

Liberal

Sonia Sidhu Liberal Brampton South, ON

Thank you.

4:35 p.m.

Liberal

The Chair Liberal Bill Casey

Mr. Davies.

4:35 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

I have to say that I'm quite concerned with what I'm hearing. I believe the testimony is well-meaning, but the description that we've been asked to imagine is that of a homeless person who is poor, with no established relationship with a medical professional, a very vulnerable woman who's coming into a hospital at the most vulnerable point in their existence: at the point of delivery. An extremely profound question is put to her at a moment where she's either pre-labour or in labour, asking her whether or not she will consent to being sterilized. I'm hearing the suggestion that this is a question of maybe a communication issue.

This situation should never arise, and I'll tell you what: If that woman were a middle-class white woman, there is no way a doctor would even put the question to her the first time while she's going into labour. There is obviously a stereotyping, racist....

I don't think there's a cultural problem here; there's no cultural issue on the side of the women. What I'm hearing is a systemic racist, post-colonial, paternalistic, sexist, classist approach in Canada's health care system as a G7 country.

I'm also going to tell you that I'm hearing a very weak and tepid response from the federal government, which has known about this for four years now. We don't know how widespread this is. We don't know what provinces it's occurring in. We don't know who it's really been affecting; we don't know who they are. There's been no attempt to reach out to the women. That's what I'm hearing.

I'm not blaming any of the officials here, by the way—I know you're here to give answers—but I have to tell you that I'm extremely concerned by what I'm hearing: a very, very weak response to something that has been internationally called torture. I can't think of a worse violation of human rights than to take away someone's reproductive choice—the choice to have a child or not—at a time when someone's in labour.

By the way, that decision should never be made at that point in time—ever. The question should never even be put. It's not a question of whether or not the person is misunderstanding the consent. I want to know the health care professional who has the gall to put that question to a woman, based on some stereotypical assumptions, at that point in time with no established relationship. That's where the problem is. It's not with anybody's culture, language or ability to understand.

I'm going to move a motion right now:

That, pursuant to Standing Order 108(2), the Committee invite representatives from Maurice Law Barristers and Solicitors, the DisAbled Women's Network of Canada, the Native Women's Association of Canada, Amnesty International, the BC First Nations Health Authority, and the Minister of Justice, to appear before the Committee at the earliest opportunity to provide evidence with respect to the forced sterilization of women in Canada.

Colleagues, I think we're all on the same page on this. I think we all are horrified by what we've heard. I thank my colleagues for supporting my motion to have you come here today, but I think we can all understand that we don't have the right people in the room here who are placed to give us the information that we need. I would ask that all of my colleagues support this motion so that we can get to the bottom of it.

I'm going to add that we have obligations, internationally, to investigate, to put a stop to this. We've heard very honest evidence, so we don't even know if it's going on today—it could well be. We, as parliamentarians, have been apprised with knowledge that assaults are being made on the most vulnerable Canadians, whom I think we have the greatest duty to protect, assaults that constitute torture. We have a duty to investigate, to prevent this, to ensure that restitution and support are provided, and to hold those responsible accountable. I'm hearing that the witnesses before us are unable to provide any of that information, so I would ask that my colleagues support this motion.

4:40 p.m.

Liberal

The Chair Liberal Bill Casey

Could you clarify the parties that you're asking us to invite—

4:40 p.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Sure, I....

Pass this around.