Bill 32 will fail to prevent more deaths like Joyce Echaquan

Universal health care does not mean universal quality of care – for Indigenous communities, Quebec's Bill 32 highlights a failed opportunity to address systemic racism in health care institutions.

Photo sourced from CBC News.

By Asha Sivarajah

September 30 was the National Day for Truth and Reconciliation, when communities honour the lives of Indigenous children lost to residential schools in Canada and reflect on the continued impact on survivors. 

In the spirit of reconciliation and justice, Canadians should also reflect on the three-year anniversary of Joyce Echaquan’s death on September 28 – and the Quebec government’s inadequate response through Bill 32 to systemic racism within its healthcare institutions. 

Echaquan, from the Manawan community and Atikamekw Nation, went to Quebec’s Joliette Hospital Center, complaining of severe heart palpitations. Despite her medical history of diabetes and cardiomyopathy, medical staff assumed she was undergoing withdrawal. Joyce Echaquan filmed hospital staff hurling racist comments and failing to give her the medical attention she needed. She passed away a day later of pulmonary edema. 

Were it not for Echaquan’s phone recordings, the circumstances leading up to her passing likely would have never seen the light of day. The coroner’s subsequent inquiry into the incident concluded that racism was a contributing factor in Joyce Echaquan’s death.

In response to the investigation’s findings, Atikamekw leaders drafted Joyce's Principle, a series of recommendations to codify anti-discriminatory measures into provincial law. The Quebec government, however, decided not to move forward with Joyce's Principle, thereby refusing to acknowledge systemic racism within its institutions.

Instead, Quebec’s Indigenous Affairs Minister, Ian Lafrenière, introduced Bill 32, which aims to implement a ‘cultural safety approach’ towards Indigenous Peoples. The cultural safety approach involves considering the cultural and historical realities of Indigenous Peoples while administering medical care. 

It seems that the government did not take Joyce’s Principle into account when drafting Bill 32. Instead, Bill 32 has nearly identical recommendations for a cultural safety approach detailed in the Viens commission, a public inquiry into Indigenous discrimination in Quebec’s public institutions dating back to 2019.

Joyce’s Principle goes further to address systemic racism than Bill 32 through more proactive measures to give Indigenous Peoples access to quality care. These measures include: establishing an Ombudsman office for Indigenous health, reducing barriers to entry for Indigenous Peoples seeking medical training, and most instrumentally, recognizing systemic racism in Quebec’s social and health services. 

Joyce’s Principle also empowers Indigenous Peoples to be actively involved in improving healthcare outcomes. The Principle calls for the Quebec government to work in tandem with Indigenous authorities, while Bill 32 merely advocates for the ‘promotion’ of partnerships with Indigenous Peoples.

The fight continues for the Atikamekw and other First Nations, who continue to bring attention to racist treatment in healthcare across Canada. At the second legislative committee hearing on Bill 32 last month, representatives of Joyce's Principle Office offered remarks on the shortcomings of the Bill and then proceeded to walk out in protest.

The past is precedent. The relationship between anti-Indigenous racism and healthcare is partially rooted in the Indian Act of 1876. The Act formed reserves,  pushing Indigenous Peoples onto lands that were often non-arable and limited the capacity of Indigenous Peoples’ to grow fresh food. The issue of food access was made worse by the Act’s ‘pass system,’ which prevented Indigenous Peoples from leaving their reserves without authorization from the Canadian government. 

These barriers to access continue to negatively impact the health outcomes of Indigenous Peoples. According to a cross-Canada participatory study of on-reserve First Nations Peoples from 2008 to 2018, almost 50% of households lacked food security.

While the federal government has made some efforts on reconciliation, the work they have done is simply not enough. For example, the government has tried to address the intergenerational health consequences resulting from the physical, sexual and emotional abuse survivors endured through the residential school system. Call 18 of the Truth and Reconciliation Commission’s recommendations asks all levels of government to “acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools.”

However, there is much work left to be done to tackle the myriad of health conditions that Indigenous communities experience. For example, according to a 2022 Statistics Canada report, the most commonly diagnosed conditions among First Nations, Métis and Inuit populations were mental health conditions, high blood pressure, arthritis, asthma and diabetes. 

Determining which level of government is accountable for improving health outcomes is complicated. While the federal government is responsible for funding many health care services for Indigenous Peoples living on reserves, health care generally falls under provincial jurisdiction. 

The consequences of unclear jurisdictional accountability can be detrimental. Joyce Echaquan lived on-reserve, with healthcare services funded by the federal government. However, she passed away off-reserve in a Quebec hospital. As she was receiving – or rather, failing to receive – care through Quebec’s healthcare system, her well-being fell under provincial jurisdiction. However, both governments should be held responsible – because neither government provided services that were sufficient to protect Joyce’s health.  

Public discourse on anti-Indigenous racism is an important first step to recognizing and eradicating discrimination within our public institutions. Premier François Legault has publicly denied the existence of systemic racism in Quebec. Quebec residents, on the other hand, disagree. In a 2020 survey of 1,002 non-Indigenous Quebecers, 92% said they felt Indigenous community members were subject to racism, with 70% believing that Indigenous Peoples were treated differently within public institutions. 

While Quebecers recognize that systemic racism is an issue, more public pressure on the government and institutions is needed so the Quebec legislature no longer introduces weak and ineffective legislation like Bill 32. The bottom-line is that Bill 32 fails to acknowledge the colonial context which necessitated its existence, and therefore it lacks the comprehensiveness to meaningfully serve Indigenous Peoples.

Racism should have no place in our healthcare system. But if we can collectively agree that Joyce’s health outcome would have been different if she were white, why can’t our laws?

Asha Sivarajah holds a Bachelor of Arts (Honours) in Media, Information, and Technoculture from Western University. Since completing her degree, Asha has worked at the Canadian International Council (CIC) and coordinated the relaunch of the award-winning foreign policy publication, Open Canada. Most recently, she worked at a Toronto-based asset management firm. Asha now seeks to leverage her research and advocacy experience to design policies that help advance human rights protections, particularly in the data & technology sector.