Globe editorial: Quebec injects politics into its health care system

In Quebec, language is political. It was that way before the province enacted the Charter of the French Language, a.k.a. Bill 101, in 1977, and it has stayed that way in the nearly five decades since.

But through two referendums and all the fractious debates about the use of English on signs, the right to an education in English, over whether pasta can be called “pasta” in an Italian restaurant and so on, the Quebec government has never inserted overt language politics into the place where people are most vulnerable and most in need of support – the health care system.

Until now, that is.

Last month, the Quebec health ministry released a directive outlining the permissible exemptions to an expansion of Bill 101 that requires that all written and oral communications in any health care setting – doctor’s office, emergency room, delivery room, therapist’s couch – be in French only.

French Language Minister Jean-François Roberge insisted this week that people will still be able to receive care in English and other languages when they need it, but the mere existence of a directive that reinforces the requirement to use French only by listing a narrow range of exceptions sends a different message.

It also doesn’t help that the list is weirdly specific and focuses on episodes where a refusal to provide care in a person’s mother tongue would be inhumane – and possibly constitute medical malpractice.

They included: a father who can’t speak French who brings his gravely ill 10-year-old son to the emergency room can be asked in English for consent to treat the child in order to prevent any delay; an emergency hotline operator who gets a call from an English-speaking adolescent in a state of psychosis may answer the person in English; the Ukrainian spouse of a convalescing patient who needs a catheter can take home printed instructions on changing the catheter in their language.

Just to put these things down on paper seems at once patronizing and menacing. Why is it even necessary to state that an ER doctor may choose to get consent for a lifesaving treatment in English from a desperate, unilingual parent? Why is it even necessary to say that a hotline operator can choose to respond to a desperate caller in their language?

Those things should be done as a matter of course, as they would be in any other place. It is the responsibility of every jurisdiction in which multiple languages are spoken to do their best to provide emergency services and health care in a range of languages, to the best of their ability.

The implication in the health ministry’s directive is that Quebec is doing its long-time anglophone population and its growing immigrant population a reluctant favour.

The same document takes pain to remind health care workers that they can only provide immigrants with care in their language for the first six months after they arrive in Quebec. And it says English-speaking Quebeckers who’ve lived their whole lives there can only deal in English with the system if they are in possession of a certificate from the education ministry stating they were entitled to attend English-language schools – a humiliating carding system.

Otherwise, the directive says that the health care system must work “systematically” in French, and all first contact must be made in that language. This applies to hospitals that have been granted bilingual status because they serve specific communities, such as the Jewish General Hospital and Santa Cabrini Hospital, where Italian is spoken.

There is no doubt that doctors, nurses and other frontline health workers in Quebec won’t stop for a single second to doublecheck which language they are permitted to use in what emergency; they will always try to do what’s best for patients, in spite of bureaucrats from the Office québécois de la langue française watching over their shoulder.

But the government doesn’t want patients’ needs coming first, no matter the risk. Its injection of language politics into the health care system could, in spite of workers’ best intentions, slow down or stall a treatment needed to save someone’s life, and result in tragedy.

That’s unacceptable. Hospitals and doctors should be left alone to decide how to care for patients, and patients have the right to expect that the language they happen to have been born speaking won’t affect their care. The only directive that should come from any government is, Do the right thing.