I welcome everybody to meeting 131 of the Standing Committee on Health. We will go until about 5:10 and then go in camera for a little bit of committee business.
First of all, I want to thank our witnesses today for coming to help us with this new study.
From the Department of Heath, we have Abby Hoffman, Assistant Deputy Minister, back again after several visits.
We have from the Department for Women and Gender Equality, Lisa Smylie, Director, Research and Evaluation, Results and Delivery Unit.
From the Department of Indigenous Services Canada, we have Valerie Gideon for another return engagement. Thank you very much. She is Senior Assistant Deputy Minister, First Nations and Inuit Health Branch. We also have Dr. Tom Wong, Executive Director and Chief Medical Officer of Public Health.
We're going to have two opening statements, one by Ms. Hoffman and one by Ms. Gideon.
Ms. Hoffman, if you would like to open with a 10-minute statement, we'll start our meeting.
Good afternoon. Thank you for the opportunity to appear in front of you on this important issue.
I want to begin by acknowledging that the land we are meeting on today is the traditional and unceded territory of the Algonquin nation.
I, like everyone else, have been very concerned about the reports we've all heard of indigenous women being coerced into undergoing sterilization procedures. It is unacceptable that this could happen to any woman anywhere in Canada's health care system. Forced or coerced sterilization is a serious violation of human rights and medical ethics. It's a form of gender-based violence and evidence of a broader need to eliminate racism and discriminatory practices that may exist within our health system.
Unfortunately, there is a documented history of compulsory sterilization in Canada linked to a broader eugenics movement in the 1900s. Institutionalization, regulation of marriage and sterilization were social controls in place in some parts of the country. While these practices were codified in law in some provinces, we know that sterilization without appropriate consent occurred in other parts of the country as well. Women with intellectual disabilities and marginalized, racialized and indigenous women were often the victims. Several well-known academics, including Dr. Karen Stote and Dr. Erika Dyck, have documented this history in detail.
Recent media reports of indigenous women undergoing coerced sterilization procedures suggest that these injustices may have occurred long after laws allowing forced sterilization were repealed. The scope of the issue has not been documented comprehensively, aside from the work of now Senator Boyer and Dr. Judith Bartlett.
It's the responsibility of all players in the health system to ensure that patients have access to health services that are free from bias and discrimination. The Government of Canada takes this obligation seriously. We know that indigenous women, along with other vulnerable women impacted by poverty, mental health, addiction issues and so on, also struggle with bias and safety in the system.
Just as an example, in 2016 Women's College Hospital, following a period of study of over six years, released a report entitled “A Thousand Voices for Women's Health”. It documented how women from diverse communities feel they were treated, and expressed their expectation for services that are responsive to and respectful of individual identities, cultures, and social circumstances, and that are non-judgmental.
We know that in Canada no one level of government has exclusive jurisdiction over health care. It's a complex system of shared jurisdiction, where both the federal government and the provinces and territories have important responsibilities. The federal government, for its part, has important roles to play in ensuring the health and safety of Canadians, making financial contributions to the Canadian health care system through the CHT and setting national standards for health care through the Canada Health Act. Provincial and territorial governments have the primary responsibility, of course, for day-to-day management, organization and delivery of health care services. Each jurisdiction has created its own health care system, but based on common principles.
As part of their responsibilities to administer and deliver health care services, each province and territory has laid out, through statute, its frameworks for oversight of health care professionals by self-regulating bodies. These bodies are responsible for reviewing and responding to complaints against health care professionals under their authority, and for disciplinary action when warranted.
Provinces and territories also have the authority to regulate matters related to a patient's consent for medical treatment. The concept of informed consent has evolved over time. It's complex. The processes for making decisions on treatments that were once almost entirely the domain of providers have shifted over time to greater consideration of the views of patients. Informed consent today is about ensuring that the patient has the information and the capacity to make an informed decision based on the advice and counsel of their health practitioner.
Informed consent means that a patient has received information about the nature of the treatment that's proposed, the expected benefits, risks and side effects, alternative courses of action, and the likely consequences of not receiving treatment. But the consent also has to be valid. For the consent to be valid, the consenting individual must have the capacity to make an informed judgment and to provide their consent voluntarily.
Studies involving women consenting to gynecological procedures show that patients frequently describe feeling compelled to sign a consent form despite their preference not to undertake a procedure. ln a study by Hall, Prochazka and Fink, published in the Canadian Medical Association Journal in 2012, 30% of women consenting to surgery reported that they did not think they had a choice about signing the consent form, and 88% of the respondents perceived the form as strictly administrative. This suggests there are some significant shortcomings in practitioner communication with patients on matters of consent and that how and when consent is obtained from women is important.
All jurisdictions have a role in ensuring that health care services are delivered in a manner that is free from discrimination, no matter where those services are delivered, and no matter who provides the service. The federal government can and does play an important role as catalyst for health care system improvements and for supporting collaboration among multiple players and stakeholders on critical issues.
In just a minute, my colleague from lndigenous Services Canada will elaborate on a number of areas, but I want to speak briefly to our plans specific to improving cultural safety.
Our plan is consistent with the government's overall commitment to advancing reconciliation with indigenous peoples and implementing the Truth and Reconciliation Commission's calls to action. Specifically, calls to action 23 and 24 ask all orders of government to support “cultural competency training for all healthcare professionals” and the calls directed to medical and nursing schools ask them to require that all students have “training in intercultural competency, conflict resolution, human rights, and anti-racism”.
On December 11, 2018, the and the then wrote to provincial and territorial ministers and to health professional organizations, among others, seeking their collaboration on and participation in a federal-provincial-territorial working group. Health Canada is taking a leadership role and will partner with provinces, territories and health organizations to take actions that we hope will lead to a significant cultural shift in the Canadian health system; that is, a shift to a system that supports efforts to prevent discriminatory practices and increases access to culturally safe health services for indigenous peoples.
This March, Health Canada will convene provincial and territorial partners to begin discussing areas for collaboration on measures to increase cultural safety in the health care system. This group will work closely with indigenous partners, women and health professional organizations. We expect the federal-provincial-territorial group to build on the good work already under way across the country and to identify opportunities for action in areas such as awareness raising and training.
By way of example, in British Columbia, which is among the most advanced jurisdictions in the country, extensive cultural safety training has already been delivered to providers, administrators and policy-makers throughout the province. Health authorities, institutions, provider organizations and so on in other parts of the country have other initiatives under way as well.
We will collaborate with indigenous partners and governments at the national and regional level and with professional colleges and health organizations. Fortunately, there are opportunities to learn from the experiences of groups who've championed the objective of non-discrimination for some time, such as, for example, the First Nations Health Authority in British Columbia, which has a vision of hard-wiring the concepts of cultural safety and cultural humility into the delivery of health care services.
We know that improving health outcomes, increasing access to culturally appropriate health services and programs and addressing the social determinants of health are high priorities for indigenous leaders and communities across the country.
I believe that the work we are undertaking will increase the level of cultural safety within the health care system, lead to improvements in the quality of service and contribute to reconciliation.
I thank you for the opportunity to make these short remarks. Following my colleague's remarks, I would be pleased to attempt to answer your questions. Thank you.
Good afternoon. Thank you for inviting me to also appear before this committee on the critical issue of forced or coerced sterilization.
I would also like to begin by acknowledging that we are on the unceded traditional territory of the Algonquin people this afternoon.
We're here today because we're all disturbed by reports of forced and coerced sterilization of indigenous women in Canada. I want to acknowledge these women and recognize their bravery. I speak as a First Nation woman, member of the Mik'maq Nation of Gesgapegiag in Quebec, and mother of two young indigenous girls, and as someone who has dedicated her entire career to advocating for the health of indigenous peoples, both outside and inside the public service.
Forced or coerced sterilization is a serious violation of human rights and medical ethics. All Canadians have a responsibility to ensure that these practices never happen again. As noted by my colleague, Abby Hoffman, there is evidence of the broader need to eliminate racism and discriminatory practices and to eliminate forced or coerced sterilization as a form of gender-based violence. Its practice, among others, compels us to seek to ensure there is cultural safety and humility in health systems across Canada, to improve culturally competent informed consent, and to remove barriers facing indigenous women when accessing health services. As cited by the Truth and Reconciliation Commission, addressing racism in health systems is a matter of reconciliation.
ln addition to the progress that Abby noted to advance cultural safety and humility within health systems, I would also like to highlight the work that Indigenous Services Canada has been undertaking on this issue. For the sake of time, I will outline some of the more recent actions.
ln early December of 2018, we held a teleconference with indigenous partners and national health organizations. We discussed ways to advance collaboration and to identify actions that would ensure free, prior and informed consent, along with culturally informed and safe services for indigenous women across Canada.
The Inter-American Commission on Human Rights recommended that Canada produce an information brochure for health care providers and patients on free, prior and informed consent in the context of indigenous women's health services. To make this happen, we've been in discussions with national indigenous women's organizations on how to proceed.
We're also establishing a new advisory committee on indigenous women's well-being made up of representatives from national indigenous organizations, national indigenous women’s organizations, the National Aboriginal Council of Midwives, the National Aboriginal Circle Against Family Violence, and the Society of Obstetricians and Gynaecologists of Canada. This committee will inform the department on current and emerging issues, including sexual and reproductive health. The inaugural meeting will be held on February 14, 2019.
In addition, we'll be hosting a national forum in the spring to mobilize indigenous and professional organizations to take collaborative actions on indigenous women's reproductive health, and to develop guidance on free, prior and informed consent regarding sterilization procedures.
ln addition to responding to recommendations made at the lnter-American Commission on Human Rights, lndigenous Services Canada endeavours to more broadly support indigenous women's reproductive health through its programs and policies. The first nations and Inuit health branch's maternal and child health program offers community-based home visiting services by nurses and family visitors to over 8,100 pregnant women and families with young children in over 309 first nations communities. This is not counting British Columbia, which is under the direct control of the First Nations Health Authority mentioned by Abby. Through the program, expectant mothers receive case management, screening, assessment and referral services as well as health promotion strategies to identify risks and improve maternal and child health. Budget 2017 increased the existing program funding of approximately $25 million annually by $21.1 million over five years.
ln addition, budget 2017 invested $6 million over five years for indigenous midwifery, the first-ever federal investment in this area. Midwifery care to indigenous communities has been identified as a pathway to helping improve the health and well-being of women, their children and the entire community. lndigenous midwifery is a way to bring birthing back to communities where it had previously been a longstanding traditional practice embedded with ceremony as well as traditional medical practices. Furthermore, informed choice is recognized as a central tenet of midwifery care in Canada. It could help ensure that indigenous women play a central role in their own health care and in their experience of giving birth.
Senator Yvonne Boyer and Dr. Judith Bartlett, who conducted an external review into reports of forced and coerced sterilizations in Saskatoon, found that previous custodial loss, or the threat of custodial loss, has played a role in the forced and coerced sterilization of indigenous women in Saskatchewan.
There's some evidence that midwives not only support women in their reproductive health planning, which may prevent further cases of forced or coerced sterilization, but that they also provide support to women in preventing custodial loss of their children. Further work is required in this area, and we're looking to indigenous midwives' leadership to better understand the issues. To that end, we're pleased that the National Aboriginal Council of Midwives has agreed to sit on the indigenous women's well-being advisory committee.
Budget 2017 also included new investments that will strengthen maternal supports by ensuring that all first nations and Inuit women are entitled to an escort when they have to leave their community for childbirth. We know that the presence of a support person offers many benefits to a labouring woman, including assisting her with making decisions and advocating for her wishes. lndigenous Services Canada's non-insured health benefits program now provides coverage for an escort for expecting mothers, regardless of their age or medical condition. This recognizes that no woman should have to birth alone.
The Government of Canada has committed to implementing the Truth and Reconciliation Commission's calls to action, including calls 22, 23 and 24, which were mentioned by my colleague. These calls pertain to using and recognizing the value of Aboriginal healing practices, retaining and increasing the number of Aboriginal health care professionals, and providing anti-racism and cultural competency training for all medical and nursing students.
Our department has been exploring, with the Royal College of Physicians and Surgeons of Canada and indigenous organizations, project ideas for an online knowledge hub of cultural competency learning tools. Last year, the Royal College embarked on making indigenous health and cultural safety a mandatory component of postgraduate medical education and certification.
As also mentioned by Abby, the B.C. First Nations Health Authority has done remarkable work with the province and its regional health authorities in finalizing a declaration on cultural safety and humility, as well as informing cultural safety and humility training across the provincial health system. It is presently developing the first-ever cultural safety and humility standard in partnership with the Health Standards Organization, which is affiliated with Accreditation Canada. We're hopeful that other provinces and territories will look to this work as a promising practice.
We can't undertake this work unilaterally. The Native Women’s Association of Canada and Pauktuutit Inuit Women of Canada have been providing leadership on indigenous women's health. As our relationship with these women's organizations grows and expands to include Les Femmes Michif Otipemisiwak, or Women of the Métis Nation, we're encouraged by their good work and guidance. Their collaboration is essential to getting this right.
It will take the efforts of many to ensure that structural racism and the effects of colonization do not interfere with the health of indigenous women. I want to assure you that we are taking this matter very seriously and will continue to work in the spirit of collaboration and partnership towards culturally informed and safe health services for indigenous women throughout Canada.
I would now be pleased to take your questions.
I would say that pretty well universally in medical education there are units or modules that are a mandatory part of training on informed consent. That training covers the ethical, legal and clinical dimensions of the issue of informed and valid consent.
Beyond what happens in formal medical education settings, there are organizations like the Canadian Medical Protective Association, which obviously is the liability insurer, if you like, for the medical profession in Canada. It has a very strong interest in making sure that providers fully understand their responsibilities around informed consent legally, ethically and clinically as well. They have a lot of resources available.
In hospitals and other institutions, beyond the realm of formal undergraduate or graduate training, issues of consent are very complicated. It is the case that within hospitals on any given day hundreds of informed consent situations are encountered in the interactions between providers and patients. So in hospitals there are people whose responsibility it is to engage with providers who are in the course of making decisions informing patients about treatment options and wanting to be assured that they in fact have secured appropriate consent from patients.
I'm just recounting this, not that I'm an expert on the legal aspects of informed consent. I'm not and I don't purport to be or wish to be interpreted as such. I just want to make the point that there is both the formal training that medical students receive and also an ongoing dialogue about consent issues throughout a practitioner's career.
With respect to a particular discipline—and again I want to underscore that I'm not an expert on this—inasmuch as certain specialists are permitted to do some procedures, or to propose those procedures and to implement them in their areas of specialization, there is some consideration of how consent would apply to those particular procedures. In the obstetrics and gynecological world, because of the kinds of procedures those individual specialists are permitted to pursue, they would need to consider how they would discuss treatment or interventions and what would constitute appropriate advice and, therefore, an appropriate determination of whether or not a patient has actually given consent relative to the procedures they are authorized to pursue.
There is a specialist-specific dimension to the issue of informed consent. This all assumes that the process is working well. It assumes that due consideration is given to the circumstances of the individual patient who is discussing a treatment procedure with the provider. This is where issues around cultural safety and sensitivity and awareness of cultural difference and the circumstances of patients come into play. What may be a completely appropriate conversation with one patient may not be taken appropriately into account in the circumstances of another patient. While it may look like informed consent had been achieved, it may not have been, given the circumstances of an individual patient.
I want to just put this into some context as I understand it.
In 2015, women in Saskatchewan reported suffering unwanted tubal ligations and told stories of being pressured by health professionals and social workers to undergo the procedure. Often, as they were in delivery, sometimes on the table as epidurals were being administered, literally under anaesthetic, the topic of whether or not tubal ligation would be appropriate came up with pressure from the physicians to undergo it then, and to have an answer then.
In 2017, an external review by the Saskatoon regional health authority highlighted the exposure of indigenous women being coerced into tubal ligations. I believe that has now been acknowledged by the Saskatoon health authority. This has happened, so we're not talking about any doubt. There is no question that coerced or forced sterilization has occurred.
In 2017, a class action representing, at that time, some 60 indigenous women was filed against the Province of Saskatchewan, regional health authorities, individual physicians, and the federal government regarding forced sterilization. We also know that as Canada is a state signatory to the UN Convention against Torture, our record on preventing and addressing torture and other forms of ill treatment was reviewed by the UN Committee Against Torture. The most recent review took place in November in Geneva. In its final report, the committee officially recognized that the extensive forced or coerced sterilization of indigenous women in Canada is a form of torture. They also provided Canada with a number of recommendations, and in a rare occurrence, requested that Canada provide information on the implementation of the recommendations within one year, as opposed to the typical five or six years.
Within that context, I have some questions.
First, has the federal government, to your knowledge, instructed any federal prosecutors in Canada to investigate whether criminal charges ought to be pursued? Does anyone have any information on that?
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?
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?
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.
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?
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.
There are a few issues. One is related to the justice department. If there is a lawsuit, would they be allowed to come to testify? I'm not sure if they'd be able to answer questions. It doesn't mean you can't ask the questions, but I think there are other departments that might be more appropriate, because we're talking about an investigation. In this case, that would probably be the RCMP, because they're the ones who would probably have to conduct that investigation.
I'm not sure, but I also agree that maybe we need to take our time on this. It's good to debate it now. I think everyone is in agreement that we want to move forward in some way—I haven't heard anyone say no—but we do need to take our time to make sure that we're doing it in an appropriate way, so that we have success at the end of the day. What we've been talking about is ensuring, one, that justice is done for the women, but also that we respect the conventions and the separation of powers between the judiciary and ourselves. We have considerable powers if we wish to force people to testify, but we do have to be very careful. I think we need to take a bit more of our time.
I'm not sure if we need to specify all of the witnesses. I'm not convinced about that because there is, I believe, the subcommittee that runs the affairs of this committee that could set the witness list with everyone's suggestions. I don't think people would have their suggested witnesses denied.
I think, as well, this might be at a much higher level. I know we have some very capable assistant deputy ministers who have come to committee, but at the same time maybe someone at a more deputy minister level, even higher up in the food chain, might need to come and respond to questions. Not trying to make it overly political is also one of the issues. This goes to basic human rights in Canada, and it's something we have to deal with here.
One final thing: I know we want to move on to the next speaker, but the witnesses are sitting here. I'm not sure if we're going to get back to the witnesses to hear any more testimony. I know there was another round of questions to be asked of them. The issue is, should they continue to sit here for the next 35 minutes and listen to us? Will we get to go back to the questions, or are we done with that portion? I believe a lot of people do wish to speak and debate this issue and think out the best ways forward.
I'm just wondering if there are additional questions that people have for the witnesses. I know that the analysts have prepared a number of questions, which might also shed light on this. If they don't have it on the record.... I know it was the final round.
There are a number of questions.
As I said earlier, I think that we're all very concerned and that we want answers, but that we want to make sure that we do things properly.
I have a great deal of respect for my colleague, Mr. Davies. However, sometimes certain motions seem to be introduced quickly in response to presentations, as is the case today.
Until now, the Standing Committee on Health has always been very collegial. It has always worked for the best interests of Canadians and in a non-partisan manner.
In my first comment, I said that we would be able to study and improve the motion later. We mustn't make decisions on the spur of the moment. We can't say that we want to study this issue and obtain information immediately without even having a game plan.
We could go all over the place to try to obtain all kinds of information. In the end, we must avoid having the analysts base their report on something improvised. I'm calling into question this aspect. I'm not against the motion. We may adopt exactly the same motion later, once we've established a framework.
I want the committee to conduct a proper study of the issue. The study would be much more extensive than if we were simply to hear the presentations of certain people, regardless of whether the presentations are relevant.
I also think that we're wasting time. We have four witnesses before us who likely have answers. The issue isn't whether the answers are good. They could provide an overview of the current situation and tell us where the Department of Health stands on the matter.
We can continue to debate the motion or we can introduce a friendly amendment. Ultimately, I find that we don't have a plan. Our committee is reacting on the spur of the moment to a very serious situation. Three additional witnesses won't change the committee's current recommendation. Our committee is much more serious than this.
I want us to establish and approve a plan, as we've done for our other well-documented studies. We should have a list of witnesses from across the country, since all regions will be affected. Our analysts must propose a game plan that will enable us to submit a report to the , if necessary.
If my colleague so desires, we can always listen to two or three more witnesses. However, I would like to do more than this.
Do we have copies of the motion so that I read it? I'm not a very aural person; I like to read a lot of stuff. I'd like to get a copy of the motion to be able to know what I'm actually voting on, to be honest, because it is very important to me. I'm very interested in doing this. I don't remember all of the witnesses who were potentially going to be called. I would like to make sure that we would have the provincial authorities from Saskatoon, from all of Saskatchewan, who might be involved in this or might have information to share with us. I'd also be interested in hearing from the College of Medicine.
The question we also need to debate is how large we wish to make this study. This could go on for a very long time and look at a lot of issues. I think we need a bit more time to think about this. We can debate this publicly and how many days we wish to debate this issue, whether it's another two, three, four, or eight sessions. There is a lot of information that's missing and things we don't know about, which is rather unfortunate. We have innuendo in the media. I'm interested in whether there is an investigation and what has occurred potentially in that investigation. I'm not sure what the RCMP could share, I'm not sure what the justice department could share, and I'm not sure how that relates to the civil case.
There are an awful lot of questions where, if I had a couple more days, or a week.... I don't think it's going to change the course of history if we wait just one more week to lay out a bit of a working plan for us. We could have a discussion amongst the people who really run the committee, who I'm sure are Ms. McLeod, Mr. Casey, as well as Mr. Davies, to lay out a good working plan for us. Obviously, there are the questions of where are we going to end, and how much work can we get done efficiently to ensure that we offer justice to the women?
I suspect there won't be people doing any more sterilizations in Canada in this way. There are probably people who are actually quite nervous within the health care system, I'm certain, and who are worried about lawsuits. Nonetheless, there are some potential witnesses we could call.
I'm concerned that if we set the list now.... I know there was an amendment and we could add more witnesses. How many people were on that witness list so far?
I'm going to read the motion again. To give the benefit of the doubt to my colleagues, this could be a result of my not passing around the motion—which, by the way, I do have in writing. It might have been easier. Listen to the motion. It reads:
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.
It does not call for a study. It does not call for a report. It's no different from the motion that provided for these witnesses here. It's simply to hold another meeting with some more witnesses who could provide us with information.
What happened, then, is that as people started describing all of the difficulties of whether we should have a report and other witnesses and those sorts of things, we got off on a tangent. I was trying to be collegial to Ms. McLeod, recognizing that we could add some further witnesses to the ones I suggested, but the motion does not obligate us to do this immediately. It does not obligate us to have a report. It's not a study that we'd be undertaking; we'd just be hearing from some more witnesses.
While I have the floor, that's the most charitable interpretation of what I've heard. If I'm less charitable, I want to go on the record to note that I'm a little offended by the comments or any notion by Mr. Ayoub about this not being collegial, or of it being partisan or of it being done on a whim. I had the motion drafted in writing prior to the meeting; it was not done on a whim.
Number two, there's nothing uncollegial or partisan about this. It was based on testimony. When this issue came up, we had discussion and we put motions forward to hear from the minister. The Liberals shot that down; we can't hear from the minister. We discussed having a multi-committee panel, because this issue involves Status of Women, Indigenous Relations, and Health, as we recognize. That was shot down; the Liberals didn't want that. We proposed having a subcommittee of our Standing Committee on Health to look at this. That was shot down. Finally what we had was a briefing from ministerial officials who were hand-picked by the Liberals. These are the people here. This wasn't a decision of the committee. This was a decision by the Liberals to put these people in front of us.
Now we know from the testimony we heard today—and again, I have enormous respect for all of the people here; this is not a comment on them—that they just don't have the information we need. We're here looking at this to get a briefing, and so far I've heard Ms. Hoffman say that one could just “imagine” the situation that's there.
By the way, I received a message while we were talking. The lawyer from Maurice Law Barristers & Solicitors said she would be happy not to come, but knows dozens of women who said they would be happy to come if it were the only way to give voice to victims. I'd like to have some people come before this committee who can tell us what happened. I don't want to have to imagine a homeless person who has no.... No, I want to hear what went on.
I think it's a little disingenuous. I keep hearing that everybody wants to get to the bottom of it, but there's always a reason, from the Liberal side, for us not to get people before this committee who might actually know. If the Liberals on this committee really believe this is a serious issue that we should get to the bottom of, then let's have one more meeting, or two, and hear from some other witnesses who might be able to give us more information. That's all the motion is calling for.
I want to make a few comments, Mr. Chair.
I want to choose my words carefully and I'll speak in French, even though the motion is only in English.
I've stated my support from the start, as long as the debate is orderly and sensible and the committee goes beyond the simple choice of two or three witnesses. Moreover, I never said that the study requires a report at this time. I'm fully aware that the study doesn't require a report. However, I said that the motion was introduced quickly. So much the better if you say that you prepared the motion and that you didn't submit it on the spur of the moment. That said, I'll make my first comment. If the motion had been prepared, it could have been translated into French.
I'll move on to my second comment. If the motion had been prepared and we had been able to discuss it, I could have been ready to submit suggestions for additional witnesses. We're being called upon, if I may say so, to vote on a well-intentioned but hurried motion.
I've always worked well with you, Mr. Davies. I don't see why we're at this point today. We're saying the same thing and we have very similar intentions. However, we're ultimately proposing different ways to achieve the same result.
Sometimes, we want to move faster, but we end up moving slower by going too fast. In the effort to move things forward, intentions are attributed to colleagues who have absolutely no desire to stand in your way. I'm as horrified as you are to have heard what was said and to not have obtained the answers that I would have wanted. Therefore, don't attribute intentions to me and don't put words in my mouth. I'm fully aware of what I said. We can check the preliminary transcripts.
I don't want to argue with you, because we get along well. I want us to work together to find a way to do better, because we can do much better. The important thing isn't us, here at the table, but the women who are currently waiting and being mutilated or tortured, as you were saying.
Unfortunately, we have only partial answers. I want to hear from the proper witnesses. There are more than three witnesses. Rest assured that we'll need more than three or four additional witnesses to really carry out work that does credit to the current Standing Committee on Health.
I'll stop here.
They're getting used to it.
Mr. Davies, why not actually do a study and call it a study, with a report and some recommendations? If we're going to hold information sessions and are planning to put out some information, I don't understand why we wouldn't put out recommendations as well. Let's do something that might make a bit of a difference in this whole situation.
The reason I'm interested in a study is that if we look at the Truth and Reconciliation Commission, we see there haven't been a lot of charges to come from that. We had thousands of hours of testimony from thousands of witnesses, and much of it was public. Yet I haven't seen many charges come out of it. It's one of the sad things concerning how the justice system has allowed that to be swept under the rug. It reminds me of this. There are positions of power, which we have heard from testimony, and we know this in anthropology, about people's relationships and who has the power—the certificate, the degree—when people are vulnerable, as you mentioned, Mr. Davies.
I'm concerned. I really want to do this in a good way. To be honest, I'm not sure.... We're having an information session right now, a briefing, as per the agenda: “Pursuant to standing order 108(2), briefing on Briefing on the Forced Sterilization of Women in Canada”. So it's a briefing on briefing. I'm not interested in that.
I'm interested in putting out concrete recommendations saying that if we find, after hearing witnesses...to tell the executive branch of government, whether it's in the RCMP or the Justice Department, to go out and actively hold people to account for the serious violations of human rights that have occurred in Canada. I'm not sure if a briefing on a briefing would do that. I'm not sure if we're going to have recommendations after that.
Maybe the chair can inform me.