The Assemblée nationale du Québec on September 12, 2024 unanimously adopted, at the request of a member of the Liberal Party of Quebec, a declaration on the language of health care services in Quebec hospitals.
Here is the text of an open letter* from Marc Ryan (Bonjour Merci Québec) to the party leaders in which we submit that the parties acted with undue haste in supporting the declaration as written, and suggest that the declaration be reworked and reintroduced.
*Unofficial translation. Only the French version was sent to the recipients.
OPEN LETTER
September 22, 2024,
To Party Leaders in the Assemblée nationale du Québec, MM. François Legault, Marc Tanguay, Gabriel Nadeau-Dubois and Paul St-Pierre Plamondon,
Cc- the members of the Assemblée nationale du Québec
Gentlemen,
The members of the Assemblée nationale du Québec on September 12, 2024 unanimously adopted, at the request of a member of the Liberal Party of Quebec, a declaration on the language of health care services in Quebec hospitals. This is a complex issue, not a simple one, and a very delicate one. Simplistic solutions, even those made in good will, should be avoided. We submit that the parties acted with undue haste in supporting the declaration as written.
We suggest, for the following reasons, that the declaration of September 12 be reworked and reintroduced.
We also suggest that section 23(2) of the Charter of the French Language be amended. This article, oddly, puts the burden on French speakers to request a translation of their medical records, instead of requiring that they always be in French and putting the burden on non-French speakers to request a translation.
Respectfully,
Marc Ryan
Biography
Background: from the Outaouais region (Ontario et Québec), of mixt parentage (mother- french canadian; father- irish canadian)
Studies; Graduate engineer (McGill U); law degree (Université de Montréal); masters in business law (Université de Montréal);
Work history: Gouvernement du Québec (Commission des valeurs mobilières -lawyer and adviser to the commissionj), then with the head office of a telecommunication company (Bell Canada et BCE Inc.- General counsel and Corporate secretary);
Past recognitions : Scarlet Key Honour Society of McGill University (member); Fondation du Barreau du Québec (Vice-president) ; Société St. Patrick’s de Montréal (board of directors); Governor general's Canadian leadership Conference) (member); Fair Canada (board member ).
Political affiliations (past and present)- none;
Creator of the website Bonjour Merci Québec https://www.bmqc.org/
An anglo QCer in a remote region, I am bilingual & happy to speak French everywhere I go in public. In Minganie (Cote Nord) I am surrounded by signs in every hospital/clinic promising me service in English if I need it. The idea that I couldn't get that in Montreal is RIDICULOUS. Post: Mary Antico (@maryantico) Sep 15, 2024
INTRODUCTION
The Assemblée nationale du Québec on September 12, 2024 unanimously adopted, at the request of a well-intentioned Quebec Liberal Party member, a declaration on the language of health care services in Quebec hospitals and the rejection of the requirement to have a certificate eligibility to have access to health care services in English. This objective in itself is laudable - we all want access to health care services. But, for the reasons we present below, we submit that the other parties acted with undue haste in supporting this declaration. As drafted, it enshrines the legal equality of English and French in health care, a significant departure from the principle of a single official language, does not treat all minority language groups equally, and does not make the distinction, which is made everywhere else, between: i ) managing a health care system to ensure access to care for all linguistic minorities pending a real mastery of the majority language, and ii) the right of minorities to receive health care in their language unconditionally and in perpetuity on an equal footing with those who express themselves in the majority language.
We suggest that the declaration be reworked (we include an example of a possible draft declaration) and reintroduced.
BILL 96 AND THE SEPTEMBER 12 DECLARATION
Some English speakers (commonly referred to sometimes inaccurately as anglophones de souche, historic anglophones or historic english speakers) have special rights in education that were granted to them in the 1982 Constitution adopted without the consent of Quebec on the initiative of the Trudeau government of that time. The Quebec government, in Bill 96, attempted to please both parties on the linguistic issue of health care services, by reassuring historic English speakers while at the same time requiring other English speakers and allophones to have access to health care services in French; see section 22.3 of the Charter of the French Language, added by section 15 of Bill 96 – 2022 SQ c. 14. The government wanted to use the certificate of eligibility necessary to historic English speakers to receive special rights in education to distinguish between these three groups (historic English speakers versus other anglophones and allophones), and to allow historic anglophones to have particular rights in health care services.
In our opinion, this approach was doomed to failure, because it would never satisfy anglophones, many of whom have never accepted anything other than total freedom of choice in education and also in health care.
The declaration adopted on September 12, as drafted, introduces into the field of health care the freedom of choice approach favored by anglophones.
THE DECLARATION AS ADOPTED
The declaration, as formulated and adopted, reads as follows*:
“That the Assemblée nationale du Québec declares that it is not necessary for English-speaking [Quebecers] to obtain a certificate of eligibility for education in the English language to have access to health care and social services in the English language in Quebec;
"That it requires the government to ensure that any directive given to the health and social services network be clear and explicit on this subject."
*Unofficial translation
FLAWS IN THE ADOPTED DECLARATION - A SUMMARY
This declaration seeks to address a single principle, access to health care by Anglophones, to the exclusion of all other equally applicable linguistic principles.
It has the following major flaws:
-it ignores the fundamental and priority right to receive health care in French.
-it seems to want to put English and French on the same legal footing, a violation of the principle of a single official language. What message are we sending to members of the various linguistic minorities when we allow Anglophones who truly master French to choose to receive their health care in English?
-it ignores the principle that the language of work in hospitals must be French. This reminder is important to protect the right of all health care workers to work everywhere in that language; maintain the obligation to file documents in French in the patient's file; and to send a message to patients that the usual language of service is French.
-it can be interpreted as granting a linguistic group a firm and permanent right (without the obligation to eventually acquire a real mastery of French) to health services in a language other than that of the majority. Elsewhere, minority groups, for example Hispanics in the USA, the health care system is managed in such a way so as to accommodate unilingual Hispanics, but in anticipation that they will eventually acquire bilingualism and choose to receive care in the language of the majority.
-it creates two classes of minority groups. A particular treatment is given to English speakers (historic or not), and other minority linguistic groups, those designated as allophones, are not treated fairly, and are de facto treated like Hispanics in the USA (which we later describe as a management type of accommodation). Such differential treatment is reminiscent of when Italians in St. Leonard in 1969 objected to being treated differently from English speakers in the education system.
PROPOSED DECLARATION TO REPLACE THE ADOPTED ONE
We suggest that the Assemblée nationale du Québec adopt a revised declaration. We offer the following draft declaration as an example of such an amended declaration:
“That the Assemblée nationale reiterates that all [Quebecers] have the right to receive health care and social services in French in Quebec.”
“That the Assemblée nationale declares that the management of the health care and social services system in Quebec must have as its objective that all [Quebecers] who are not French-speaking have access to health care and social services in their language pending their acquiring a real mastery of French.”
"That the Assemblée nationale declares that it is not necessary for English-speaking [Quebecers] to obtain a certificate of eligibility for English-language education in order to have access to health care and social services in English in Quebec."
"That this management accommodation must be made taking into account the other linguistic principles in Quebec, in particular that: the only official language in Quebec is French; every worker has the right to work in French; the working language in all hospitals and other health and social service centers in Quebec is French; and the clinical record and the documents deposited in any record in the health system must be in French."
"At the request of any [Quebecer] who does not have a real mastery of French and who is authorized to obtain these documents, a health service or social service must, as soon as possible and at its own expense, provide a summary, written in English, of a clinical record as well as the English version of any document in the record that contains information in French.” (1)
That this declaration replaces the declaration of September 12 on the same subject adopted by the Assemblée nationale.”
“That the government, to the extent possible, use its regulatory power to make this declaration enforceable, and if necessary, table a bill in the Assemblée nationale to complete this objective.”
“That it requires the government to ensure that any directive given to the health and social services network to reflect this declaration be clear and explicit.”
Note (1): Some will note that this section is the opposite of section 23(2) of the Charter of the French Language. That section, oddly enough, places the burden on Francophones to request the translation of their clinical record, instead of requiring that it always be in French and placing the burden on non-Francophones to request a translation. This is an example of a provision that, like the September 12 statement, in seeking to address the case of Anglophones, forgets to take Francophones into account. We suggest that Article 23(2) be amended accordingly.
Here is our detailed explanation for the need for an amended declaration.
USE OF THE CERTIFICATE OF ELIGIBILITY FOR HISTORIC ANGLOPHONES
Some Anglophones have special rights in education that were granted to them in the 1982 Constitution. The government issues a Certificate of Eligibility for those who benefit from these special rights in education.
The government, in Bill 96, wanted to use the Certificate of Eligibility to allow historic Anglophones to have particular rights of access to health care services in English. With due respect, this is nonsense. Those who hold a certificate of eligibility are, for the most part, those who have gone through the Quebec English education system. They are supposed to be bilingual (section 35.3 of the Charter of the French Language presumes this), and should therefore be able to receive care in French (1). It is the patients who DO NOT hold a certificate who are most likely to not have a real mastery of French and to really need care in English.
Note (1): In reality, the English education system unfortunately continues to produce graduates who do not really have a real mastery of French and often have difficulty meeting Francophones and conversing with them in French, whether with a doctor or with a Videotron technician; for constitutional and other measures to correct this state of affairs, see the recent brief by Bonjour Merci Québec to the Comité consultatif sur les enjeux constitutionnels du Québec au sein de la fédération canadienne (Advisory Committee on Constitutional Issues for Quebec within the Canadian Federation).
So why in the context of health care, was reference made to the certificate of eligibility in PL-96? I submit that it was NOT out of concern for practical access to care in English. The vast majority of English speakers live in the greater Montreal area.
As one English speaker from Minganie put it:
An anglo QCer in a remote region, I am bilingual & happy to speak French everywhere I go in public. In Minganie (Cote Nord) I am surrounded by signs in every hospital/clinic promising me service in English if I need it. The idea that I couldn't get that in Montreal is RIDICULOUS. Post: Mary Antico (@maryantico) Sep 15, 2024: (https://x.com/maryantico/status/1835275396201239004?t=KSG7R3idepPMpkY8dDzdNw&s=03)
WHY REFER TO THE CERTIFICATE OF ELIGIBILITY?
I have only one explanation that comes to mind. It was out of a desire to respect what some call the demands of historic English speakers to freedom of choice (particularly in education and health) that they only reluctantly give up, and to control of THEIR hospitals.
Let me explain.
The English-speaking community, or its elites, accept reluctantly, or not at all, that all hospitals in Quebec have become public institutions that now belong to, and are funded by, the entire Quebec public. They consider certain hospitals, especially the most important ones (MUHC; MGH; RVH), some of which date back to the pre-Confederation English colonial period, as still being in some way THEIR hospitals.
A former leader of the Equality Party recently publicly stated that anglophones not only had the right to health care services in English, but also to the institutions themselves providing the services:
It seems whenever anglophones dare raise concerns, such as with the worrisome recent language directive for the health-care network, we start hearing again about how anglos are spoiled and ungrateful. …Quebec anglophones live here and should be entitled to institutions and services proportional to their demographic importance; voir Anglos refuse to be silent about their rights. That doesn't make them spoiled 2024 Robert Libman The Gazette.
Bill 96 seems to have accepted this nostalgic vision, and thus wanted, through the eligibility certificate, to allow historic Anglophones to have particular rights to health care services in their language, even if they really master French, something which no other minority language group benefits from.
All individuals who speak a language other than the usual language (in Quebec), for example unilingual Arabs, Italians, Greeks, Chineses, etc., obviously also want to be able to receive health care services despite the fact that they speak a minority language. This is normal, and it is no different for the Chinese in British Columbia or the Hispanics in Florida. All health systems in America, if not the world, MANAGE their hospitals in order to offer, through interpreters or in other ways, services to linguistic minorities. But elsewhere, the working language remains the predominant local language, and minorities, over time, agree to learn the language of the majority. And gradually become comfortable receiving health care services in the local majority language.
What is particular in Quebec is that:
- many English speakers, or at least the English-speaking elite, do not consider themselves as a cultural community among others (for example, on the same level as people of Arabic, Italian, Greek, Chinese descent, etc.). They have difficulty accepting minority status, and demand particular rights for their linguistic group.
-A significant portion of Anglophones, or the Anglophone elite, have never accepted that Anglophones or allophones be forced to send their children to school in French, so they do not accept that they be required to receive health care services in French. This explains their rejection of the proposed use of the eligibility certificate in Bill 96. They want i) this particular access to care in English to apply to all Anglophones and allophones, whether they come from Quebec, the rest of Canada or even outside Canada; and ii) no limit to access to health care services in French, even if they have a real mastery of French.
In a declaration on access to health care, it is important, as much as possible, to treat Anglophones and other linguistic minorities equally. And it is important that the declaration distinguish between the right to health care services in the main language of Quebec and an administrative MANAGEMENT approach that seeks to provide health care services to Anglophones and other linguistic minorities.
THE NOSTALGIC VISION OF HISTORY - IMPACT ON THE LANGUAGE OF WORK
In this nostalgic vision, Anglophones consider that certain public hospitals belong to them in some way, despite the public nature of the hospitals and despite the great cultural and linguistic diversity of Quebec today.
It is not surprising that these same people expect that the language of work in THEIR hospitals should be their own.
It is important that the government, in a linguistic declaration that recognizes access to health care services in English, be clear that this does not mean an acceptance of English as the language of work, including the language of clinical records, and of the documents in them.
IN SUMMARY,
The members of the National Assembly of Quebec on September 12, 2024 unanimously adopted a declaration on the language of health care in hospitals in Quebec and the rejection of the requirement to have a certificate of eligibility to have access to health care in English. For the reasons we present, we submit that the parties acted with undue haste in supporting this declaration. As written, it enshrines the legal equality of English and French, a significant departure from the principle of a single official language, does not treat all minority language groups equally, and does not make the distinction, which is made everywhere else, between: i) the management of a health care system to ensure access to health care services for all minorities pending the acquisition of a real mastery of the majority language; and ii) the right to receive those services unconditionally in perpetuity on the same footing as the majority.
We propose that the September 12 declaration be reworked (we include an example of a draft amended statement) and reintroduced.
We also suggest that section 23(2) of the Charter of the French Language be amended. This section, oddly, places the burden on Francophones to request a translation of their medical records, instead of requiring that they always be in French and placing the burden on non-Francophones to request a translation.
Respectfully,
Marc Ryan
BIOGRAPHY
Background: from the Outaouais region (Ontario et Québec), of mixt parentage (mother- french canadian; father- irish canadian)
Studies; Graduate engineer (McGill U); law degree (Université de Montréal); masters in business law (Université de Montréal);
Work history: Gouvernement du Québec (Commission des valeurs mobilières -lawyer and adviser to the commissionj), then with the head office of a telecommunication company (Bell Canada et BCE Inc.- General counsel and Corporate secretary);
Past recognitions : Scarlet Key Honour Society of McGill University (member); Fondation du Barreau du Québec (Vice-president) ; Société St. Patrick’s de Montréal (board of directors); Governor general's Canadian leadership Conference) (member); Fair Canada (board member ).
Political affiliations (past and present)- none;
Creator of the website Bonjour Merci Québec https://www.bmqc.org/
Marc Ryan
Author