Nation

Three years after the death of Atikamekw mother Joyce Echaquan, First Nations groups are critical of Quebec’s Bill 32, which aims to respond to Indigenous inequality by creating a “cultural safety approach” in the province’s health network.  

Developed shortly after Echaquan died in a Joliette hospital amid racist insults from staff, Joyce’s Principle provides measures aimed at ensuring Indigenous people receive the highest standard of care, free from discrimination, along with the right to traditional medicines and health practices. 

Quebec has yet to adopt Joyce’s Principle or recognize the existence of systemic racism. The Joyce’s Principle Office delegation walked out of a public hearing in Quebec City September 13 after its executive director Jennifer Petiquay-Dufresne condemned the government’s “colonial practices” even as it expressed a willingness to “do things differently, respectfully.” 

“We don’t share the Quebec government’s definition of cultural safety,” Petiquay-Dufresne told the Nation. “The government is still ignoring our recommendations and showing its inconsistency by drawing inspiration from Joyce’s Principle while still refusing to adopt it, like it was decoration. We need to be fully participative in our process for wellbeing.” 

Petiquay-Dufresne believes the bill cannot be effective without recognizing the health and social services network has been designed without consideration of Indigenous realities and unique health determinants. She’s disappointed with how Bill 32 was drafted and said the government should change how it works alongside Indigenous people. 

Quebec Indigenous Affairs Minister Ian Lafrenière disputed allegations about a lack of consultation, arguing he can’t share a proposed bill before it’s tabled in the National Assembly. “Before sitting here today, I toured all 55 communities and met with 13 groups before even thinking about drafting legislation,” he said at the public hearing. 

“Consulting is not enough,” responded Petiquay-Dufresne. “I was in my community when he came for consultations and most of the time it was only his voice we heard, so I don’t know how people can really express their concerns or ideas. I think we must go into a relationship based on co-construction, respect and equality.”

She was “shocked” by the way Lafrenière referred to Echaquan in his opening remarks, “objectifying her cause for his political agenda” without taking sufficient steps to change the system. Petiquay-Dufresne denounced the proposed law as “too light” with a focus on healthcare practitioners undergoing sensitivity training without measures that ensure a new approach.

While certain initiatives have been introduced since Echaquan’s death, the Office stated results are too often superficial with power imbalances remaining and traditional knowledge trivialized. Quebec’s College of Physicians also criticized the government’s approach as “paternalistic” and said the bill should be broadened to include all vulnerable groups.

“Our brief contains 13 recommendations on how the bill can go further than this first step,” said Mauril Gaudreault, the college’s president. “First, the future law must be drafted with the First Nations, not in their place. Otherwise it’s colonialism.”

Joyce’s Principle Office submitted 12 recommendations related to Bill 32 based on concerns from practitioners and community members. The draft states that many Atikamekw are still hesitant to request provincial healthcare services, with distrust exacerbated by the reemployment of an employee involved in the Echaquan incident. 

“One of our recommendations was the need for an ombudsman for Indigenous rights,” said Petiquay-Dufresne. “Right now, Indigenous people don’t use the process of complaints because they don’t trust them. If they make a complaint, they never feel like they’re listened to [or they’re told] ’We’ll try to do better next time’.”

With widespread public support, Joyce’s Principle Office has been amplifying its message as it helps community health departments to implement their vision of cultural safety. Petiquay-Dufresne said they have “more faith and hope in the population of Quebec than its government.”

At the hearing, Innu surgeon Dr. Stanley Vollant spoke about his experiences with racism in his studies and work, noting that healthcare inequalities haven’t improved over the years. While suggesting the bill was a step in the right direction, he observed it is too focused on individuals and not the institutions in which they operate. 

“There are people in Pessamit, from Uashat, from Manawan, who are afraid of going to the hospital because they don’t feel understood, respected – they feel like they’re teated differently,” Vollant explained. “They’re even afraid to die.”