‘Forced’ ster­il­iza­tions a sys­temic fail­ure

National Post (National Edition) - - ISSUES & IDEAS - COLBY COSH Na­tional Post

On Thurs­day, the Saska­toon Health Re­gion (SHR) re­leased the re­port of an in­de­pen­dent in­quiry into al­le­ga­tions that Abo­rig­i­nal women giv­ing birth in the city’s hos­pi­tals had been co­erced into be­ing ir­re­versibly ster­il­ized by means of tubal lig­a­tion. I am be­ing care­ful in my lan­guage here. All of the women who spoke with Boyer and Bartlett had signed con­sent forms agree­ing to a ster­il­iza­tion pro­ce­dure. In a court of law, this fact would give the doc­tors, nurses, so­cial work­ers, and other pro­fes­sion­als in­volved in the scan­dal plenty of cover.

That makes me a lit­tle re­luc­tant to talk of “forced” ster­il­iza­tion per se. But ev­ery­body qual­i­fied to do any of these jobs knows (and are all bound to agree if chal­lenged) that the soul of in­formed med­i­cal con­sent does not re­side in a sig­na­ture.

If you read the Boyer-Bartlett re­port, and con­sider the vul­ner­a­bil­ity of Abo­rig­i­nal women un­der­go­ing labour or hav­ing pre-natal care far from their own com­mu­ni­ties, you do not need re­course to a word like “forced.” Pick your own lan­guage: the wit­nesses who came for­ward tell — very be­liev­ably and with im­plied cor­rob­o­ra­tion from hospi­tal and so­cial-worker in­ter­vie­wees — of be­ing pres­sured, iso­lated, ig­nored, some­times bul­lied.

Some as­pects of their ex­pe­ri­ence will make per­fect sense to any­one who has ever been in a hospi­tal. Some will re­quire an act of imag­i­na­tion for a non-Abo­rig­i­nal reader.

The in­ves­ti­ga­tors — lawyer and nurs­ing ex­pert Yvonne Boyer and physi­cian Ju­dith Bartlett, who are both Métis — had phone calls with 16 women who had bad ex­pe­ri­ences with tubal lig­a­tion. In the end, they were able to in­ter­view seven. This may not sound im­pres­sive or no­table, and as a statis­tic it is not. But look at the creep­ing catas­tro­phe that is the on­go­ing fed­eral in­quiry into miss­ing and mur­dered Abo­rig­i­nal women. The SHR and the ex­perts it re­cruited were able to pro­duce a fairly clear and sen­si­ble re­port on a so­cial prob­lem that is just as dif­fi­cult. It con­tains the tes­ti­mony of only a hand­ful of wit­nesses, but it shouldn’t be over­looked just for that rea­son. The op­po­site might be true.

When you need health care in Canada, you are in­evitably en­ter­ing an im­per­sonal sys­tem, and you are bound to some­times feel that it is a pow­er­ful ad­ver­sary, a sort of chess op­po­nent. For Abo­rig­i­nal Cana­di­ans, this ef­fect is mul­ti­plied by a hun­dred; for Abo­rig­i­nal women who have rea­son to fear state seizure of their chil­dren, it is more like a mil­lion.

Saska­toon’s hos­pi­tals are full of so­cial work­ers. But as the re­port ex­plains, some of these are SHR so­cial work­ers, there to de­fend the pa­tient’s in­ter­ests and make them com­fort­able, and some of these are Child and Fam­ily Ser­vices Min­istry so­cial work­ers, en­dowed with child-snatch­ing pow­ers. They don’t wear uni­forms or badges to help a pa­tient tell them apart, and it wouldn’t help if they did. Although they have dis­tinct du­ties, they share in­for­ma­tion, and the white hats are pos­i­tively ob­li­gated to re­port sus­pi­cions of child abuse or ne­glect to the black hats.

It would be nat­u­ral for the most ded­i­cated Abo­rig­i­nal mother on earth to feel fear when in the clutches of such a sys­tem — even if we leave aside lit­er­ally ev­ery other fact in the his­tory of Abo­rig­i­nal-state re­la­tions in Canada. You could call the feel­ings para­noia if the ra­tio­nal jus­ti­fi­ca­tion for them were not so stun­ningly ob­vi­ous. And it is easy to see how this syn­drome can make a to­tal mess of an Abo­rig­i­nal pa­tient’s in­ter­ac­tions with so­cial work­ers, nurses and doc­tors. All are there to help and want to help — but what con­sti­tutes “help”?

Some­times, “help” might take the form of a doc­tor warn­ing a preg­nant woman, us­ing tech­ni­cal lan­guage, that she has vague health prob­lems that might af­fect fu­ture preg­nan­cies. Some­times, he might tell scary sto­ries of women who were killed or in­jured by a risky child­birth, per­haps as a wellintended way of avoid­ing the same tech­ni­cal lan­guage. Some­times, doc­tors and nurses — know­ing that a par­tic­u­lar woman is not likely to have or ob­tain a reg­u­lar fam­ily physi­cian — might go a lit­tle fur­ther than they ought in sell­ing tubal lig­a­tion as a con­tra­cep­tive so­lu­tion. It is mostly in­no­cent be­hav­iour — un­til you con­sider it from the other side.

One of the more heart­break­ing parts of the re­port is the part in which the wit­nesses talk about the af­ter-ef­fects of hav­ing to live with an un­wanted tubal lig­a­tion. Some of these ef­fects are strictly emo­tional. But some women found that their re­la­tion­ships with men suf­fered, or their chances of find­ing a re­la­tion­ship com­pro­mised, be­cause they were no longer fer­tile.

Most of us are trained by schools and me­dia to think of con­tra­cep­tion as a good thing, and I sup­pose most of us would en­cour­age these women to ac­cept that fem­i­nin­ity is sep­a­rate from fer­til­ity. But words will not solve their prac­ti­cal prob­lem, or re­verse the pro­ce­dure that has al­tered their lives in a neg­a­tive way. Nor is it re­ally an an­swer to pro­pose that they may sim­ply be suf­fer­ing buyer’s re­morse. Their con­sent to per­ma­nent ster­il­iza­tion was sup­posed to have been in­formed: that is a duty that per­tains to the doc­tor and the hospi­tal, not to the pa­tient.

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