Evidence of meeting #154 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was sterilization.
A recording is available from Parliament.
4:50 p.m.
Liberal
Doug Eyolfson Liberal Charleswood—St. James—Assiniboia—Headingley, MB
Thank you. I had some other questions, but they more or less got answered during the testimony so I'll stop a little prematurely.
Thanks very much to all of you.
4:50 p.m.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Thank you, Chair, and thank you to all the witnesses.
I'm going to start with you, Dr. Blake. Is it only obstetricians and gynecologists in Canada who can perform a tubal ligation?
4:50 p.m.
Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada
No. Depending on where you are, family physicians may well be the ones who are able to perform a tubal.
4:50 p.m.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Is there a complaint process such that if somebody felt they had a procedure without their informed consent they could complain about an OB/GYN?
4:50 p.m.
Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada
Yes. It starts at the local hospital level. I think almost every hospital now has an ombudsperson or someone in a quality office you would be able to speak to. Beyond that, there is the college in your province or territory. Also, at any time, you could speak with a lawyer, if you felt that it was for your lawyer. There's also your own care provider. You could go to your family doctor, who could help you push a complaint forward.
4:50 p.m.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
The reason I'm asking you this is that we've heard testimony that people could be charged today under existing law—so I'm not sure another law will help—but we've heard that people are too intimidated to speak to police or to even go through that whole criminal process.
I'm trying to figure out how we eliminate these forced sterilizations. If there was a complaint brought forward professionally, what would the SOGC do if somebody received one or multiple complaints that they were doing sterilizations without consent?
4:50 p.m.
Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada
The SOGC does not have any regulatory authority, so we would refer that to the local provincial college, and it would be up to the college. You'd really need to talk to the college about how they handle complaints that have a criminal element to them, but a forced sterilization would be illegal under current Canadian law.
4:55 p.m.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Let's talk to the college.
Dr. Richardson, what do you think the college would do if it received complaints like that?
4:55 p.m.
Chair, Indigenous Health Committee, Royal College of Physicians and Surgeons of Canada
You're speaking about the regulatory authority and the provincial colleges, which I'm not a part of, but I actually did speak to the chief medical officer of our college, the CPSO, about this.
As soon as they do a very thorough investigation, and as soon as there's any possibility that it is falling into the criminal realm, then it gets moved along. We have, unfortunately, many cases of that with regard to sexual assaults and sexual violence, so there is a precedent there and they are quite experienced. What she did say is that she wants to hear about all of this, and they're not hearing any of this.
You're speaking about the reporting, and it is a major issue because patients in general don't want to report. The literature suggests that only 20% of patient safety incidents that lead to mortality, increase morbidity or increase hospital stays get reported.
That's heightened completely for indigenous patients. When we speak to our people, they're worried about reporting. They're worried about the repercussions. If they make an anonymous report, the institution will not act because it's anonymous. If they make a report and they attach their name to it, they're suddenly the whistle-blower in a hostile environment, etc.
I think the crux of one of the things that needs to be worked on is what reporting that is safe looks like. Maybe it's to a third party who doesn't have to disclose the full background and identity and ideally is someone who is indigenous or understands the indigenous experience. Then, do a more robust investigation. I think that reporting piece is critical when we look at the way.... We have a lot of experience in the patient safety world and in our health care institutions.
4:55 p.m.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Perfect.
I have a question now for you, Dr. Abbas. We're talking about people who are disabled. There are some disabled people who wouldn't be mentally competent to give consent and may be under parental care. I was listening to your comments about the parents taking the decision for them.
What is the right thing to do in a circumstance where someone is not mentally competent to decide whether or not to have a procedure and they have people who maybe have their power of attorney or are their parents or their caregivers? What do you recommend should be done in that circumstance?
4:55 p.m.
Researcher, DisAbled Women's Network of Canada
I think that's a big question. There are procedures around guardianship and things like that. I think one of the concerns, as we're hearing anecdotally from people, is that those formal things that would give somebody power of attorney or whatnot oftentimes aren't happening. It's happening informally with parents and caregivers. That's a real concern there as well, especially with women with disabilities.
I don't know, Sonia, if you want to add to that.
4:55 p.m.
Research Coordinator, DisAbled Women's Network of Canada
Yes. I want to clarify what we also mean when we talk about individuals not giving their informed consent.
For example, people with intellectual disabilities who are members of the People First movement consider that they can provide their informed consent.
Who can decide what individuals can or cannot give their informed consent? That is a more social question and the answer is very broad, but I think that we should focus more on that aspect.
4:55 p.m.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Also, Ms. Alimi, you talked about intersex people and the number of times they're being sterilized. How many intersex people are there in total in Canada?
4:55 p.m.
Research Coordinator, DisAbled Women's Network of Canada
I don't have the exact number. In my presentation, I mentioned the statements of Morgan Holmes, who represents the Egale Canada group. I don't have the exact figure; I cannot answer that question.
4:55 p.m.
Conservative
Marilyn Gladu Conservative Sarnia—Lambton, ON
Okay.
I want to talk a bit more about the cultural safety training.
Dr. Richardson, I think you were talking about the training that's needed and what should be put in place. Does the federal government have a role to support that?
4:55 p.m.
Chair, Indigenous Health Committee, Royal College of Physicians and Surgeons of Canada
It's great that you're asking.
We've worked with the Métis National Council, the AFN and ITK. I'm a member of the Indigenous Physicians Association of Canada and the Canadian Indigenous Nurses Association. We've actually put together a request for the creation of a large online knowledge hub for cultural safety material, so that one can go to this online hub at any point and learn and expand one's knowledge. We've put that forward to Health Canada, and we're waiting to hear back from Dr. Gideon.
5 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you, Mr. Chair.
Dr. Blake, the Inter-American Court of Human Rights and the European Court of Human Rights have both recognized that informed consent can never be given during and immediately after labour and delivery. Is that the position of the society?
5 p.m.
Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada
We avoid, at all costs, trying to obtain consent at the time of labour and delivery. There are many reasons for that. That is the hardest time, so you always try to make sure that the request and the intention to seek sterilization have been expressed previously.
5 p.m.
NDP
5 p.m.
Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada
We don't have a hard and fast rule on that, but I can tell you there is a universal understanding that this is not the time to be obtaining consent.
5 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
The International Federation of Gynecology and Obstetrics has emphasized that “sterilisation for prevention of future pregnancy cannot be ethically justified on grounds of medical emergency.... [She] must be given the time and support she needs to consider her choice.” Is that also consistent with your society's understanding?
5 p.m.
Chief Executive Officer, Society of Obstetricians and Gynaecologists of Canada
Yes.
5 p.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Of course, at this committee's last meeting we learned that tubal ligations are being performed on indigenous women in Canada. We heard a story as recently as December 2018. These are being performed while women are in labour or immediately postpartum, when these women are physically and emotionally exhausted, often still under the influence of anaesthetic and unable to give informed consent.
Given that it seems to be well established within your profession that it's not possible to give informed consent for tubal ligation immediately before, during or after labour, why do you think health professionals continue to seek it from indigenous women?
