“She's only good for sex.” These were some of the last words Joyce Echaquan an Atikamekw woman, heard as she lay dying in a Quebec hospital this past September. While pleading for help from her hospital bed, Echaquan, began to livestream the vitriol spewed at her. Nurses ridiculed her pain, called her “stupid as hell” and sneered her children would be ashamed of her.
Echaquan died soon after and, in her wake, left us with gut-wrenching and heart-breaking proof of the deep-seated systemic racism that Indigenous people face when seeking medical care. We cannot ignore the words used to denigrate Echaquan's dignity were not only connected to her Indigeneity, but also to her womanhood and her motherhood.
Like the missing and murdered Indigenous women and girls who were particularly vulnerable to violence and government inaction because of their interconnected ancestral and sex identities, Echaquan was disparaged because of her multifaceted personhood. The Ontario Human Rights Commission (OHRC) has long recognized that discrimination is intersectional, and the discrimination people with intersecting identities face cannot be compartmentalized or viewed through the lens of any one identity in isolation.
There is no doubt the nurses hurled insults at Echaquan because she embodied multiple identities: her ancestry, race, gender and family status. Only people with similar concurrent identities as Echaquan would have had their intelligence openly demeaned, been reduced to their sexualities and criticized as bad mothers in what must have felt like the same noxious breath.
Notably, there was one other intersecting characteristic that also rendered Echaquan a victim of the mistreatment – she was seeking healthcare in Canada. Echaquan reportedly had a stomach ailment and heart condition. In human rights law, that means she had another intersecting and protected characteristic: disability.
In Canada, people with disabilities routinely report being dismissed and disrespected in health services. The largest proportion of human rights complaints across the country are because of disability. In 2018, the World Health Organization reported that people with disabilities were “four times more likely to report being treated badly and nearly three times more likely to report being denied care.”
While the toxic words Echaquan heard on her deathbed targeted her motherhood, womanhood and Indigeneity en masse, it was her poor health that exposed her to mistreatment – and she was not alone in this experience. A recent Canadian Journal of Public Health article noted that urban Indigenous peoples report high prevalence of “discrimination through negative behaviours such as insults and unfair treatment, including in healthcare settings.”
In 2008, Brian Sinclair, an Indigenous man who used a wheelchair, died while waiting 34 hours for care in a Winnipeg emergency room. An inquest found that hospital staff assumed he was homeless coming in from the cold, or was drunk and “sleeping it off.” Subsequently, in 2017, a report entitled “Ignored to death,” found racism caused Sinclair's death and concluded the inquest failed to consider larger social patterns.
Though Indigenous persons have made complaints at human rights tribunals about discriminatory health services, few cases have gone very far to deliver justice.
For example, in Marchand v St. Michael's Hospital, a 2015 Ontario case, an Indigenous woman alleged mistreatment while at the hospital, including stereotypical assumptions about drinking. She said that bed side rails trapped her, which forced her to defecate in her bed, and, instead of allowing her to clean herself, staff cleaned her without her consent. These allegations, though serious, were dismissed at the tribunal for procedural reasons due to delay.
In Boyer v Sault Area Hospital, another 2015 Ontario case, it was alleged the hospital lfailed to provide the claimant with “appropriate medical care because of her identity as a First Nations woman.” This complaint was ultimately dismissed as abandoned because the woman died, and no one filed the needed materials to pursue further action.
In Cole and Joseph v Northern Health Authority, a 2014 British Columbia case, the claim was that the Wrinch Memorial Hospital, which served Indigenous communities, was underfunded and palpably unequal to hospitals serving other populations. In Naziel-Wilson v Providence Health Care, another 2014 British Columbia case, an Indigenous woman alleged that she was “denigrated by racial stereotypes, turned out of a hospital, and denied important medical treatment because of stereotypical considerations based on who she was and how she looked.” Similarly, in A v Y and X Association, again in British Columbia, a woman alleged her medical practitioner made a stereotypical remark about alcohol abuse in connection to her Indigeneity.
The previous human rights cases were positioned to move forward, but there is no record of full hearings taking place or final rulings. Sometimes legal cases are resolved through mediation, the caveat being that matters of public importance might be settled privately and not create precedents or lasting change.
It is clear that when their Indigeneity intersects with health, Indigenous peoples are experience compounding mistreatment. Echaquan used her last moments to show us graphically and tragically what this looks like for one ailing Indigenous woman and mother. It is not enough for us to acknowledge Indigenous people frequently face systemic discrimination in Canada. We must also recognize that when an Indigenous person holds an intersecting identity, like gender or disability, our systems attack them even more. Not only that, but when complaints are raised in our human rights systems, they are seldom carried through to justice.
What needs to change so that Indigenous people can, as women and mothers, or as men with disabilities, become sick without being vulnerable to more harm? What does it say about our society that Indigenous people cannot seek healthcare without being exposed to increased risks of verbal abuse and neglect? Should Canadian human rights tribunals do something different to ensure that cases like Echaquan's are fully heard?
Recognizing the public importance of cases concerning Indigenous people in healthcare and systemic barriers for Indigenous communities when pursuing legal rights is an essential first step. Another key step is requiring human rights tribunals to acknowledge that the magnitude of the harm and discrimination can only be understood when compounding identities are looked at together rather than separately.
Two important systemic cases seeking to protect Indigenous rights in healthcare are currently moving forward in the nation's largest human rights jurisdictions. In February 2019, the OHRC filed a complaint alleging discrimination by public service providers due to their treatment of Joey Knapaysweet and Agnes Sutherland, who died in Timmins in 2018 after travelling there from Fort Albany First Nation, more than 400 kms away, to access health services unavailable in their community.
In July 2020, the Union of British Columbia Indian Chiefs launched a complaint on behalf of Indigenous communities against the Ministry of Health, asserting that the province's liver transplant policy discriminatorily restricts “access to vital and necessary healthcare.” In permitting the claim to advance as a representative case, the tribunal noted that Indigenous people are “disproportionately under-represented” in seeking human rights redress.
While Echaquan's death triggered dismissals, apologies, and consideration of anti-racism training, it is doubtful these steps will lead to long term change. Efforts need to extend beyond one-off reactions. We should be outraged about what happened to Echaquan. But we must also be outraged by what was happening long before her death, and by what will inevitably happen again unless we mobilize our outrage with action. Society and our legal systems must recognize that what is happening is deeply systemic, highly intersectional and that dignity, human rights and lives are at stake.
Ena Chadha is Chief Commissioner of the Ontario Human Rights Commission