Hon. Marilou McPhedran: Honourable senators, I note that this item is at day 15, and I’m not ready to speak at this time. With leave of the Senate and notwithstanding rule 4-15(3), I move the adjournment of the debate for the balance of time.

Hon. Marilou McPhedran: Honourable senators, thank you for the courtesy of allowing me to adjourn for the balance of my time on Tuesday evening.

In continuing, with great appreciation of his acumen as a sponsor, I wish to address briefly two assertions made by Senator Cotter in his speech.

First, he stated that:

. . . a vast majority of the disability community — I have counted — is comfortable with the structure of the bill before us and strongly supports its passage in its present form.

Perhaps we are speaking to different disability rights experts?

Second, Senator Cotter encouraged trust in the cabinet process and trust in Minister Qualtrough to deliver far more than is required or even mentioned in this bill.

As much as I respect Senator Cotter and Minister Qualtrough and know that they speak from their lived experiences with disability and deep commitment as champions to better the lives of people with disability, I must question the wisdom of such a leap of trust as the rationale for this bill.

The disability rights experts with whom I have consulted understand that a perfect bill, or a perfect benefit, cannot be achieved this time around. They all agree that this initiative by Minister Qualtrough must be seen through, with the best possible version of this bill finalized and enacted in this session of Parliament, and this bill must not die.

But their political pragmatism — born of necessity — does not excuse us from our duty to give this bill our full consideration and to make achievable critical improvements.

Yes, this is a framework bill. But it’s not a rights-based framework as much as it is aspirational.

Briefly, the glaring omissions and shortcomings in this bill include the following: The bill may never lift anyone out of poverty; there is no minimum standard in the benefit; there is no requirement for the regulations — which are core to any positive change — to be done by the time the act is operational; there is no deadline for payments to be dispersed; the benefit disqualifies thousands of disabled people by their age — clearly discriminatory; the bill lacks transparency and therefore it lacks accountability because it puts decision-making processes behind closed doors; the bill makes an ultimatum, not a real choice.

Given the stakes at hand, it is troubling that this bill does not build more on Canada’s international human rights commitments, principally Article 28 in the Convention on the Rights of Persons with Disabilities, addressing, “Adequate standard of living and social protection.”

Strengthening this bill from a rights-based approach will yield a stronger legislative framework, and, as we saw in the other place, this can be done without stalling the legislative process if the government wills it so.

Dr. Nancy Hansen, Director of the Interdisciplinary Master’s Program in Disability Studies at the University of Manitoba, summarized this approach as a:

. . . charity ethic to support disabled Canadians . . . an overarching colonial aspect of service provision for disabled people . . . that maintains people in marginalized positions. It is residual legislation. It’s better than nothing, but a “once in a generation” fix should be done better than this.

Similarly, Senator Seidman, in her excellent analysis of the bill, raised important questions of moral and ethical compulsion versus mere legal obligation to persons with disabilities.

As noted in the Convention on the Rights of Persons with Disabilities, people with disabilities who also identify as members of minority groups are subject to “multiple or aggravated forms of discrimination.”

There are numerous relevant human rights commitments which Canada has made that should influence our review, but I will list just two more. First, the UN Universal Declaration of Human Rights, Article 25.1, states, “Everyone has the right to a standard of living adequate for the health and well-being . . . .” Second, in the UN Sustainable Development Goals, Goal 10 is to “reduce inequality within and among countries.” Under that goal, target 10.2 is:

By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status. Entrenched within the Canadian Constitution, the Canadian Charter of Rights and Freedoms unequivocally underlines the concept of substantive equality, to which I note direct reference is made in the preamble to Bill C-22.

In R. v. Kapp, the Supreme Court reiterated that this concept of substantive equality is grounded in the idea that:

“The promotion of equality entails the promotion of a society in which all are secure in the knowledge that they are recognized at law as human beings equally deserving of concern, respect and consideration” . . .

There is an additional sense of urgency in protecting the fundamental human rights of persons with disabilities in this bill. Applications and requests for MAID as a response to struggles with poverty increase. Bill C-22 does not guarantee that any persons with disabilities will be brought out of poverty. It does not guarantee that any dollar amount will be dispersed in a timely manner, and put bluntly, it doesn’t guarantee the existence of the Canada disability benefit at all.

Life-reducing poverty among persons with disabilities has always been with us, but there is now an additional sense of urgency. Since March 2021, Canada has expanded MAID to be available to people who are not at the end of life to die due to their disability-related suffering and who meet other eligibility criteria. Widespread social and economic deprivation has created conditions in which dying appears to be the only answer for some persons with disabilities to escape poverty.

The Parliamentary Secretary to the Minister of Employment, Workforce Development and Disability Inclusion, Irek Kusmierczyk, acknowledged this reality. He said:

Living with dignity is a far-off hope for many in these circumstances, and some persons with disabilities have, unfortunately and tragically, chosen to apply for MAID in the past year, with poverty being the key driver. The sad fact is that eligibility for MAID has expanded faster than have the social supports that would lift persons with disabilities out of poverty and allow them to live with dignity.

Former Chief Human Rights Commissioner for Ontario, Professor Emeritus Catherine Frazee, described this alarming aspect of MAID:

We dial 911, we pull you back from the ledge, and yes, we restrain you in your moment of crisis. Autonomy be damned. We will get to the heart of the problem that drove you out into the woods and we will beckon you back toward a life that is bearable. Unless your suffering is medical or disability related, then and only then there will be a special pathway to assisted death.

Death on demand, essentially.

As we heard from Senator Miville-Dechêne today, there is a troubling connection between MAID and surprising numbers of people living with disabilities saying clearly that they are now choosing MAID because they cannot live their lives with dignity and adequacy because they are kept poor.

This is why high and welcome aspirations in Bill C-22, unmatched by required resource adequacy, have disability advocates telling us that the focus needs to be placed on strengthening the insufficient framework of this bill. It is not an either/or proposition. Advocates are not suggesting that all details must be worked into the bill. There is no need. Nor are they calling for overly prescriptive legislation here.

Professor Hansen, Professor Frazee, lawyers David Lepofsky and Roberto Lattanzio and their many colleagues are experts. They are seasoned advocates in our democracy. They have to be. They well know that the majority of all legislation is fine-tuned and developed via regulation. They are not being naive in their assessment of essential changes that are needed for this framework to truly bring positive changes to the lived reality in the nitty-gritty of daily lives.

Put bluntly, Bill C-22 is too hollow, too void of direction and there is barely any scaffolding upon which a strong, durable framework can be built.

Here are four clear, practical improvements that the committee could consider: Bring a rights-based lens to the right to an adequate standard of living and social protection, consistent with the Convention on the Rights of Persons with Disabilities. Article 28 provides that “States Parties recognize the right —

Hon. Marilou McPhedran: Honourable senators, this item is adjourned in the name of Senator Dean. I ask for leave of the Senate that, following my intervention, the balance of his time to speak to this item be reserved.

Tansi. As a senator from Manitoba, I have previously made my land acknowledgement, as in speaking today, so I would like to proceed with my remarks on Motion No. 11.

Allow me to begin by emphasizing our responsibility as senators to represent the voices of minorities in this country. Minorities can mean many different things, depending on the context, but, in the context of this motion, I want to suggest that “minority” pertains specifically to members of BIPOC populations: Black, Indigenous and people of colour living in Canada.

Senator McCallum’s Motion No. 11 asks us to recommend the adoption of anti-racism as the sixth pillar of the Canada Health Act, to strengthen the intersectionality of the existing pillars of universality, comprehensiveness, portability, accessibility and public administration.

What an indictment it is that such an amendment is even necessary. I support this motion because it is a crucial step in recognizing and responding more effectively to the indisputable fact that there is systemic racism in our health care system in this country.

People living in Canada should not have to fear racial discrimination when trying to access health care services, whether that be at a doctor’s office or in a hospital. Although we understand this basic right and we recognize it in the equality clauses of the Canadian Charter of Rights and Freedoms, as well as the Canada Health Act, we continue to ignore aspects of systemic racism that seep into Canada’s health care system at the cost of people’s well-being and dignity, sometimes taking their lives.

As a White woman raised with privilege, my chances of receiving the health care that I need, without being challenged about my honesty or my needs based on my skin colour or socio‑economic status, are better than average. I do not have to wonder whether I will be unknowingly sterilized when I’m in surgery. It is highly unlikely that I will be ignored or that health care providers will give up on finding a diagnosis that I need. It is unlikely that it will be implied that my health problem is my fault. I do not need to wonder at or fear these things, but others do. We cannot deny that. It is our job to establish a higher standard of care that is consistent and is available everywhere in Canada so that every person in Canada can access health care without discrimination.

Indigenous people experience a high level of racism across Canada. Depending on the geographic location, between 39% and 78% of Indigenous people have reported experiencing unfair treatment as a result of racism. In particular, one study highlighted that Indigenous patients strategize how to manage racism before going to the emergency room. Can you imagine that? To have to weigh whether seeking medical aid is worth it, even when you are in great pain or sick enough that you know you need to go to a hospital?

One of the most obvious examples of racism in Canada is the deplorable treatment of Indigenous women who were sterilized without their knowledge, without their consent.

With credit to Senator Yvonne Boyer for her leadership, the harrowing report of the Standing Senate Committee on Human Rights on forced sterilization is compelling in honouring witnesses who bravely shared the violence of their experience of health care.

These patients — women — were vulnerable, laid open following birth and entrusted into the care of doctors, nurses and other health care providers who essentially coerced them into permanent procedures that robbed them of their agency, robbed them of their liberty and denied them the choice of their fertility.

In addition, this assault on their bodies was compounded by the added humiliation they reported because they were subjected to medical staff making irrelevant, inappropriate comments about their lives and their culture.

Across the country — not just in Manitoba — people were horrified when Indigenous patient Brian Sinclair died after waiting over 34 hours in a Winnipeg emergency room in 2008 while medical staff took care of others who came much later than he did to care.

Recently, in 2020, we have been made well aware in this chamber of Inuit Indigenous woman Joyce Echaquan who managed to record the vicious treatment that preceded her death in a Quebec hospital while strapped to her bed suffering in agony. She recorded the staff insulting her, ignoring her pleas for help.

Again, we were shocked. But have we been shocked enough to act? How many of these well-documented cases of racism-driven health emergencies do we need to know about before we start to analyze this as systemic, before we start to address these individual cases as inextricably connected to each other and connected to failures in our health care system because of racism?

These are not all isolated cases but, rather, it is that racism is built into many aspects of our health care system. And racism can kill. How are Indigenous and other BIPOC people expected to trust the health care system when it continues to fail them in this way?

It is not only Indigenous people that experience the consequences of systemic racism. According to research published in the Canadian Medical Association Journal, Black people experience risk factors that purely biological disparities cannot explain. In large measure, these risk factors can be attributed to systemic racism.

Specifically, experiences of anti-Black racism in Canada’s health care system can be found in stereotyping and provider bias. Provider bias is when a health care provider embodies a particular attitude and restricts client access and choice. As a result, health care providers can rely on assumptions and stereotypes when making decisions about that patient’s health.

Time does not allow for many more examples.

However, I do want to speak very personally now about one of my very dearest friends, a Black woman — I will not name her — who is highly educated in the medical profession. A Black woman who is almost never ill, is physically fit and lives in a high-income household.

Last summer, she overdid it moving bricks in her garden and ended up in a paralyzing, crippling pain that forced her to go to the emergency. We almost lost her. Although she is among the most highly qualified people I know, she is a Black woman. It was that Black woman that triggered decisions by the doctor who ignored her initially, repeatedly in terms of even asking for certain aspects of her condition to be attended to.

That doctor prescribed completely inappropriate medicine that almost killed her — I am not exaggerating — to the point where the medical doctors who then treated her and saved her life have joined in a complaint to the medical association. It was so obvious that this was based on her skin colour. There was no other rational explanation for what happened to her.

In 2021, The Commonwealth Fund ranked the health care systems from 11 different countries on a variety of factors, including equity. Canada ranked second last in equity. Although Canada ranked significantly higher than the United States, it was far below the average. Australia, Germany and Switzerland placed in the top three. Canada was also in the bottom three in 2017. It is important to note that The Commonwealth Fund’s 2017 report only included income-related inequities.

However, in recognizing intersectionality, BIPOC groups are more likely to earn a lower income. The accumulation of advantage among primarily White people due to our society’s cultural and political framework creates and perpetuates structural racism.

Issues of structural racism have been linked with negative health outcomes in BIPOC populations, such as higher infant mortality and myocardial infarctions — which are a lack of blood flow to the heart.

While Canada has made improvements, we clearly have much further to go.

Adding anti-racism as the sixth pillar of the Canada Health Act would be influential in a number of ways. First, it would shine a light on systemic racism at the forefront of health care by explicitly showing that they are intertwined. Acknowledgement of its existence is the first step in addressing this.

I am reminded of the appalling, ignoring, head-in-the-sand refusal to acknowledge what happened to Joyce Echaquan as exemplified by the top political leader in Quebec, who condemned Ms. Echaquan’s death but denied the existence of systemic racism as a contributing factor. This was despite the damning fact that a comprehensive 488-page study of the issue in Quebec, released only a year before, found pervasive evidence of systemic racist practices throughout provincial public services.

We know that systemic racism has many forms. There are fewer BIPOC health care providers in management. There is less knowledge regarding conditions or diseases that are more prevalent among members of a particular racial group.

BIPOC patients receive a lower quality of health care based on stereotypes, as I have demonstrated with the story of what happened to my friend last year.

BIPOC people know that health care in its current form is tied to racism. It is time that Canada acknowledge this truth and change the Canada Health Act. Adopting anti-racism as a pillar will not only shine a light, but it will force health care providers and institutions to evaluate the ways in which they make decisions regarding a patient’s health.

Currently, Canadian provinces generally apply a more Eurocentric perspective when making decisions regarding priorities for hiring in health care. Applying a one-size-fits-all approach contributes further to the discrimination faced by marginalized groups. Historically, this has created better health outcomes among White communities compared to Black or Indigenous communities.

An anti-racism pillar can open the door to new perspectives and create better outcomes for all. It can make accountability measures clearer and more targeted. We know well that what is measured gets done.

I also support this motion because it would give a voice to BIPOC members, both patients and health care workers alike. BIPOC people are those who will benefit most from this motion, and they should have the opportunity to share their experiences and recommendations. It is obvious that Band-Aid solutions like anti-racism training or diversity training are not going far enough to facilitate real, structural change, and BIPOC people have to be part of this process.

Fourth, anti-racism as the sixth pillar of the Canada Health Act would also address equality rights promised in the Charter. If everyone has the right to equal protection, then why do we continue to see the deaths of Brian and Joyce and others as isolated incidents? Why do BIPOC individuals feel that they must strategize to get the health care they deserve? Why are Indigenous women the targets of forced sterilization? Failing to adequately take steps to reduce and eliminate systemic racism in health care is unconstitutional. I will conclude by indicating my support. Thank you.