Thank you to the chair of the committee and to all the members for the invitation to present today.
I'm Dr. Don Wilson. I am an obstetrician-gynecologist, and I've been in practice as a generalist OB/GYN for almost 20 years. I completed my residency training in 2006, and along with Dr. Robin Johnson, I was one of the first two first nation obstetrician-gynecologists to graduate in Canada. I'm a member of the Heiltsuk Nation from Bella Bella, B.C.
I've been asked by the Survivors Circle for Reproductive Justice to share my perspective with you on the issue of forced and coerced sterilization and the need for Bill S-228 to pass into law without further amendments.
As a member of the expert panel for the Survivors Circle for Reproductive Justice, I have been tasked with reviewing the applications for membership to the survivors circle. Membership in the circle ensures access to a number of supportive resources that become available for survivors of forced or coerced sterilization, including psychological support and counselling, cultural supports to promote healing, connection with other survivors, and even access to assisted reproductive technologies in selected cases.
The most striking issue I have noticed when I have reviewed applicants' files has been the issue of inadequate informed consent for the procedures that have resulted in sterilization. It has been a near-universal theme in all of the applications where the medical care provided was often founded on solid medical decision-making, but patients were not adequately informed or educated regarding the procedures they underwent. Only in retrospect did patients come to understand that they had lost their reproductive capacity and had been sterilized.
As an OB/GYN with nearly 20 years of experience, I am very familiar with the spectrum of clinical situations that can make informed choice or informed refusal difficult. I am very cognizant of the fact that some clinical situations can make valid informed choice nearly impossible, such as life-threatening hemorrhage in an unstable patient. There is even ongoing debate within the profession as to whether or not the consent discussions we have with patients who ultimately need Caesarean delivery, for example, are valid, since these discussions are often held when the patient is in pain, exhausted, or under great physiological stress.
I am here to try to centre the experience of survivors who have been sterilized without the benefit of a thorough consent process. We know in medicine that consent is not simply a signature on an official form. In medical training, we are taught that consent is an ongoing process and that it can be withdrawn at any time by the patient prior to completion of a proposed procedure. We are taught that elements of valid consent depend upon building a trusting rapport with our patients and that information must be shared in ways and means that are accessible to the patient. We must ensure full comprehension of our consent discussions by seeking feedback from patients that they understand our discussions. We need to review certain critical elements of our proposed treatments, such as the description of the procedure or the treatment itself; its associated risks, including the common, uncommon, and rare but catastrophic risks; any alternative options to the proposed intervention; and any possible complications. We are responsible as clinicians to guide patients through the consent process while ensuring adequate understanding and ongoing agreement with the proposed treatments or procedures.
There is a great deal of room for improvement in the profession of medicine for achieving these goals. In the case of forced or coerced sterilization, I believe there has been an evolution over time from the paternalistic, eugenics-based, physician-driven implementation of non-consensual sterilization to the current situation, with the main issue, as I see it, being the failure to ensure adequate consent. There is also the interplay of bias and racism that may influence the judgment of physicians undertaking sterilization procedures.
We, as clinicians, need to shift our focus from checking boxes to a level of true engagement with this process. There are realities in the practice of medicine that make it difficult to pursue fully informed consent, but those realities do not erase our responsibility to strive to achieve the goal of fully informed consent.
In the area of reproductive care, this is of utmost importance because the implications are vast and failure can lead to lifelong suffering and distress for our patients. The results of non-consensual sterilization extend beyond the patient to their families, communities and, in the case of indigenous people, their entire nations.
Bill S-228 places a clear legal backstop on the issue of informed consent for sterilization. This has not existed in the past and addresses a legal gap in Canadian law.
I acknowledge the concerns of many of my colleagues, who worry about a chilling effect on reproductive care, the politicization of reproductive care and the potential for unintended consequences; however, I support the passage of Bill S-228 without further amendments. It is my hope that the bill will be a strong catalyst for the medical profession to strengthen our processes around informed consent for sterilization procedures, especially for those most vulnerable to the failures of the informed consent process, such as first nations, Inuit and Métis people.