Trust in health care after the death of Joyce Echaquan

Phoebe Friesen wonders whether clinicians can ask for trust in Canada’s system of health care after Joyce Echaquan’s death.

__________________________________________

On September 28th, 2020, Joyce Echaquan, a 37 year old mother of seven from the Atikamekw Nation, died in the Centre hospitalier de Lanaudière in Joliette, Quebec. Before her death, Joyce live-streamed on Facebook the racist and abusive comments that hospital staff were making about her as she lay on a hospital bed in pain and distress. People across Canada and the world watched the video in disgust. For some, it was shocking; for others, it was far too familiar.

In the wake of this tragedy, I have been thinking about power, trust, and medicine. When teaching ethics to medical students, I often draw on the work of philosopher Rosamond Rhodes in order to illuminate the moral obligations of health care professionals. To be a health care professional is to be granted unique powers and privileges in our society: to cure, to prescribe, to cut open, and even to end lives. To be a patient is be vulnerable: to undress, to permit invasive exams, to confess to bad habits, and to ingest mysterious pills.

Rhodes argues that this dynamic, in which one position holds power and knowledge and the other is vulnerable, creates a strong obligation on the part of those in power to both seek trust and be deserving of it.

Photo Credit: Terry Johnston/wikimedia. Image Description: The word ‘trust‘ inscribed on a black background.

Recently, while making these points in a large lecture hall, a student pushed back. He said he hated the way, as medical students, they were always being told how special they were. We’re just like everyone else, he said. I understood this to be coming from a place of modesty, a rejection of the way doctors are held up on a pedestal, and yet, it left me concerned.

After watching the video of Joyce’s final moments, I thought again of these comments. What does it mean to fail to acknowledge the unique power one has as a health care professional?

In the same introductory lecture on medical ethics, I often compare health care professionals to police officers. This makes students uncomfortable too.

The parallels between these two professions are striking, however. As with health care professionals, police are granted unique powers and privileges, and those they serve often lack agency, due to asymmetries in knowledge and deeply embedded structures of paternalism. Both professions are largely self-policing and have resisted outside efforts to reform them.

Crucially, both professions depend fundamentally on public trust. If no one is willing to call the cops or make a statement to the police, law enforcement cannot function. If no one is willing to visit a hospital or follow the advice of their doctor, health care cannot function.

However, in many communities in Canada, there is very little public trust in health care and law enforcement. Recent calls to abolish the police and the lack of surprise by many in response to Joyce’s death reflect deep and widespread distrust in both the institutions of law enforcement and medicine.  Often, this distrust is invisible or unimaginable to people in positions of privilege or power.

Law enforcement and medicine are similar because both professions have developed in a context of systemic racism, where some lives matter more than others. Today, this history appears in discriminatory policies, interactions, and the forms of knowledge that are considered legitimate. No one knows this better than those from BIPOC (black, Indigenous, and people of colour) communities, who have long experienced vulnerability, distrust, and harms at the hands of these professions.

Just a year ago, the Viens Commission in Quebec reported that those in Joyce’s Atikamekw community of Manawan knew the Joliette hospital to be an unsafe place to seek care. During the commission, an entire week was dedicated to hearing testimonies of individuals who had experienced abuse and discrimination at the hospital.

And yet, last week a clinician who works with the Atikamekw community of Manawan admitted that she heard such narratives many times before Joyce’s video, but tended to explain them as misunderstandings, to dismiss them as the actions of good but busy clinicians. From her position of power, she was asking her patients to trust the system she believed in, even if their own experiences suggested they shouldn’t.

Is it fair for health care professionals to ask for trust in our system of health care in the wake of Joyce’s death?

Is it fair to ask for trust in our system of law enforcement in the wake of the deaths of Chantel Moore, Ejaz Choudry, D’Andre Campbell, Regis Korchinski-Paquet, and Rodney Levi?

Put simply, it’s not.

Rather than asking for trust, we must trust those who say that their trust in medicine and law enforcement has been profoundly broken. And we must recognize that such a break is justified. Then, we must work towards creating institutions that are worthy of trust. Of course, many are working towards this goal on a daily basis, both at individual and systemic levels. But as Joyce’s death makes clear, we need to do much more.

__________________________________________

Phoebe Friesen is an Assistant Professor in the Biomedical Ethics Unit at McGill University @PhoebeFriesen