We are writing as residents of Quebec and researchers representing Concordia University’s Critical Disability Studies working group. We are a group of interdisciplinary scholars advocating for the rights of people with disabilities and making visible the systemic ways that society ‘dis-ables’ such individuals.
The legislation proposed under Bill 20 is case it point. It harms people with disabilities and undermines their rights and access to care.
The Quebec Health Minister’s Bill 20 legislation proposes to put strict minimum patient quotas on family physicians, to dramatically reduce support services and consolidate health agencies, cutting budgets and staffing in an already overburdened system. It is proposed under a mask of economic reform, however the cuts are not simply a question of dollars and cents, but rather a result of government misspending, lack of procedural transparency and hasty decision-making without prudent consultation, including the vital participation of people with disabilities.
Bill 20 has been denounced by the Quebec Federation of Family Physicians (La fédération des médecins omnipraticiens du Québec (FMOQ)) for instituting quotas and turnstile medicine over quality patient care. People with disabilities often have more complex care requirements and the family doctor is a hub in an interdisciplinary team of medical specialists, therapists and support services. Effective care requires time at each visit for a thorough consultation. Barring this, the risk undiagnosed or misdiagnosed issues increases significantly. Further, instituting quotas provides incentives physicians to follow only those in good health, effectively penalizing and marginalizing more ‘vulnerable’ populations. More egregiously, Bill 20 robs people with disabilities of their basic rights and reinforces normative societal values rather than celebrating the incredible diversity that it is to be human. We have a moral responsibility to take care of all Quebec residents. Dr. Barrette’s legislation threatens this in favour of political maneuvering under the guise of economic reform.
We write representing three of the multiple experiences of disability:
As a parent of a child with a disability, our family has already faced multi-year long wait lists for access to services. Research has clearly demonstrate the lifelong benefits of early intervention medical care and therapies for children with Down syndrome, like my son. This medical care is vital to ensuring positive futures. Effective follow-up from qualified medical professionals is also essential as children with Down syndrome are at a higher risk of life-threatening diseases like leukemia. Parents of children with disabilities are being increasingly expected to take on medicals roles they are not trained for or forced to seek medical care and therapies through private practitioners, creating a two-tiered system and putting unbearable personal and financial strain on Quebec families. We need an effective, accessible medical system that supports our kids with diverse abilities. Bill 20 achieves the opposite.
As people with disabilities, we already face numerous obstacles in the healthcare system. With constant government budget cuts, we find ourselves in more precarious positions than a year ago. In the case of Bill 20, there is nothing to persuade us to believe that access to health care will be improved at all. We are completely aware that we are considered “complicated patients” and often require more time than most other patients. Based on our own experiences, we have found that the best doctors take the time with us to discuss and understand disability beyond medical models. It is important to know that disability is more than a diagnosis. Medical practitioners need both time and resources to help us make informed decisions about our health and well-being. Due to the complexity of our health conditions, it is vital that we are able to use emergency health care (such as walk-in clinics or the ER) without feeling that we are punishing our family doctors. Such situations promote an ableist environment that is not welcoming to people with disabilities. We would also like to raise the potential impacts Bill 20 has on doctors who, for family or health reasons, may not be able to meet patient quotas. Our healthcare system should not penalize doctors who take more time with their patient and/or cannot work more than full-time. Ultimately, the medical profession should be accessible to all regardless of their gender or disability.
As allies to the disability community, Bill 20 only sets another example of how Quebec remains an able-ist province. In solidarity, we also reject the idea that Bill 20 is able to improve accessible healthcare for all Quebec citizens, particularly people with disabilities. We would like you, Monsieur Gaétan Barrette, to drastically reconsider the implementation of Bill 20. We passionately recommend you work with the disability community to find better alternatives that will ensure an improvement to accessible healthcare for both medical practitioners and their patients.
Dr. Barrette, you are failing people with disabilities. You are failing those who care for them and about them. The politics of austerity and rhetoric of economic prudence are hurting those who most need and rely on access to health care. This is wholly irresponsible and unethical, particularly for someone, who as a physician, is expected to uphold the Hippocratic oath to “first do no harm”. It is the wrong prescription for Quebec health care and reinforces an able-ist system that upholds barriers rather than facilitating access for people with disabilities.
Jacqueline Wallace, PhD
Laurence Parent, PhD candidate
Critical Disability Studies working group
Signed in solidarity and support:
Kim Sawchuk, PhD
Associate Dean of Graduate Studies and Research, Faculty of Arts and Sciences
Shira Avni, PhD
Associate Professor, Cinema/Animation
Owen Chapman, PhD
Associate Professor, Communication Studies
Steven High, PhD
Professor and Canada Research Chair in Oral History
Department of History, Concordia University
Giuliana Cucinelli, PhD
Department of Education
Arseli Dokumaci, PhD
Florian Grond, Phd
Janis Timm-Bottos, PhD, ATR-BC, ATPQ, PT
Assistant Professor, Creative Arts Therapies
Shauna Janssen, PhD
Research & Development
Topological Media Lab
Thomas Strickland, PhD
Lecturer + Studio Instructor
Azrieli School of Architecture and Urbanism
PhD Student, Communication Studies
Juan Carlos Castro, PhD
Assistant Professor, Art Education
MA Candidate, Communication Studies
PhD Candidate, Department of Integrated Studies in Education
Dept of English