Five Years After Joyce: What Progress Has Been Made to Eradicate Systemic Racism and Ensure the Cultural Safety of Indigenous Peoples in Quebec?

 

Karine Millaire, Lawyer and Professor, Faculty of Law, Université de Montréal*

Jennifer Petiquay-Dufresne, Executive Director, Office of Joyce's Principle

 

September 28, 2025, marks the fifth anniversary of the tragic death of Joyce Echaquan. This Atikamekw mother from Manawan filmed hospital staff making racist and degrading remarks as she sought treatment for severe pain.  The video posted on Facebook sparked widespread outrage. The coroner's office confirmed the link between the racism suffered and the death[1]. Five years later, what is the assessment of the progress made to eradicate systemic racism and ensure the cultural safety of Indigenous Peoples in Quebec?

 

Systemic Racism, Cultural Safety and Joyce's Principle 

 

Joyce’s death sparked a collective awakening to systemic racism. In response, the Atikamekw of Manawan and the Atikamekw Nation created Joyce’s Principle, which seeks to guarantee every Indigenous person the right to fair and discrimination-free access to all social and health services.

 

Sadly, Joyce’s case is not an isolated one. Situations continue to be documented where prejudice against Indigenous Peoples has led to errors or under diagnosis with potentially fatal consequences. This is particularly true when an Indigenous person’s pain or health condition is wrongly assumed to be the result of alcohol use rather than illness.

 

Systemic discrimination also leads to serious violations of consent. Consider the women subjected to forced sterilizations^[2] and the many Indigenous children who disappeared in Quebec hospitals and whose whereabouts are still being sought.[3] The toll is heavy. 

 

Cultural safety, which lies at the heart of Joyce’s Principle, is a science-based approach to addressing this discrimination. It requires that Indigenous patients feel safe and respected. Unlike Indigenous awareness training, which emphasizes differences and positions Indigenous Peoples as “other,” cultural safety calls for recognizing historic power imbalances to dismantle harmful dynamics and foster equitable, respectful relationships.

 

Rights to be Recognized and Practices to be Transformed: Between Action and Resistance

 

Over the past five years, professional bodies such as the Collège des médecins du Québec, the Ordre des infirmières et infirmiers du Québec, and the Ordre des sages-femmes du Québec have adopted measures to combat systemic discrimination.

 

Cultural safety training programs have been introduced for health care professionals. However, not all these programs are effective. Only those that encourage critical reflection on prejudices and unconscious bias have proven to be.

 

Progress has also been made toward greater recognition of Indigenous traditional and living knowledge in health as a complementary approach. This does not mean rejecting biomedical medicine but rather shifting toward respect for Indigenous values and spiritualities. For many years, the health care system has respected patients’ religious choices, including the refusal of treatment. There is no reason why the choices of Indigenous patients, grounded in millennia-old knowledge, should not be equally respected.

 

It is also worth highlighting the effort to train Indigenous professionals and to support research on best practices. A provincial program reserves 10 spots each year in Quebec’s medical schools for Indigenous students. A similar approach should be adopted for other health, education and rights advocacy professions.

 

Joyce’s Principle must be understood as a binding right, not merely a request. Article 24 of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) guarantees non-discrimination in health care, including respect for traditional knowledge and medicine. The Canadian and Quebec Charters also protect against discrimination and guarantee the rights to life and security, which must be interpreted considering Indigenous cultures.

 

Cultural safety also requires rejecting the paternalistic approach in which policies concerning Indigenous Peoples are adopted without their involvement. There can be no cultural safety without respect for consent. The recent adoption by Quebec of its Cultural Safety Act, widely criticized^[4], represents a contradictory step.

 

Jacques Viens, former commissioner of the Public Inquiry Commission on relations between Indigenous Peoples and certain public services in Quebec, recently observed that progress in the province has been slow. The Ombudsperson has also reported that systemic discrimination continues to significantly affect service delivery for Indigenous populations in Quebec. ^[5]

 

Quebec still refuses to recognize Joyce’s Principle and systemic racism. It also refuses to implement the UNDRIP, despite Ottawa’s commitment to doing so. This position is untenable from scientific, legal, and societal perspectives.

 

It took the death of Joyce Echaquan to put a human face on the devastating consequences of systemic racism experienced by Indigenous Peoples. Five years later, the time has come not only to take stock, but above all, to act.

 

*This letter was signed by Carol Dubé, father and spouse of Joyce Echaquan, along with more than 60 health professionals, experts, advocates, and organizations working with Indigenous populations, including:

Constant Awashish, Grand Chef de la Nation Atikamekw / Président du Conseil de la Nation Atikamekw

Chef Sipi Flamand, Conseil des Atikamekw de Manawan

Commission de la santé et des services sociaux des Premières Nations du Québec et du Labrador (CSSSPNQL) 

Honorable Michèle Audette, sénatrice et conseillère principale en matière de réconciliation et d’éducation autochtone, Université Laval

Femmes Autochtones du Québec 

Julie Pelletier, SF, DESS DPS (elle/she), Présidente, Ordre des Sages-Femmes du Québec

D^r Mauril Gaudreault, Président du Collège des médecins du Québec

France-Isabelle Langlois, directrice générale, Amnistie internationale Canada francophone

Stacy Boucher-Anthony, directrice générale, Projets Autochtones du Québec

Mikonis Awashish, Inf. B. Sc.

Naïma Hamrouni, professeure, Université du Québec à Trois-Rivières

Sylvie Roy, psychologue

Marie-Claude Tremblay, professeure titulaire, Faculté de médecine, Université Laval

Comité Droit Autochtone de l’Université de Montréal

Fannie Lafontaine, professeure titulaire, Faculté de droit, Université Laval

Amandine Catala, Professeure, UQAM

Samuel Rainville, Directeur, Relations et engagement auprès des Premiers Peuples, Rectorat, Université du Québec à Trois-Rivières

Ryoa Chung, professeure titulaire, Université de Montréal

Eugénie Godin, étudiante en droit, Université de Montréal

Alex Alexis, chargé de cours et doctorant, Faculté de droit, Université de Montréal

Caecilia Alexandre, chargée de cours et chercheuse postdoctorale, Faculté de droit, Université de Montréal

Marina Boulos Winton, directrice générale désignée, Jeunesse au Soleil / Sun Youth

Benjamin Gingras, professeur, Université du Québec en Abitibi-Témiscamingue

D^r Stéphanie Marsan, Médecin Cheffe du service de médecine des toxicomanies, CHUM

Tealey Ka'senni:saks

Joannie Gill Inf. B. Sc - Utapi Consultants

Jasmine Châtelain, Registered Midwife (Inactive), Planning, Programming and Research Officer, Eeyou Istchee Pimaatisiiwin Chiskutimaachawin, Utinaausuwin (Midwifery) Education Program, Cree Board of Health and Social Services of James Bay

Amélie Blanchet Garneau, professeure, Université de Montréal 

Suzy Basile, professeure, Université du Québec en Abitibi-Témiscamingue

Sylvie Carignan, sage-femme, Services de sage-femme, Conseil Cri de la Santé et des Services Sociaux de la Baie-James, Chisasibi

Sylvie Lévesque, Professeure, UQAM

Benoit Ethier, Professeur, École d'études autochtones, Université du Québec en Abitibi-Temiscamingue

Annie DesRochers, professeure, Université du Québec en Abitibi-Témiscamingue

Marie-Hélène Poulin Ph.D. ps. éd., Université du Québec en Abitibi-Témiscamingue

Yvette Mollen, Professeure agrégée en langue innue - Innu-aimun, Université de Montréal

Corina Borri-Anadon, professeure titulaire, Université du Québec à Trois-Rivières.

Mireille De La Sablonnière-Griffin, professeure, Institut national de la recherche scientifique

Myriam Kaszap, IPSPL, PhD

Infirmière praticienne spécialisée en première ligne

Clinique de Proximité en santé autochtone PAQ-MdM

Louis-Christophe Juteau