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Quebec Premier François Legault has refused to yield to the coroner’s finding that systemic racism contributed to Joyce Echaquan’s death, despite introducing mandatory sensitivity training for all employees at the Joliette hospital and naming a representative of the Manawan community to the board of the health authority overseeing the hospital.Jacques Boissinot/The Canadian Press

The coroner’s report into the preventable death of Atikamekw woman Joyce Echaquan in a Joliette, Que., hospital last year is one long, illustrated definition of “systemic racism.” It describes a system that functions off implicit assumptions (this Indigenous woman is agitated, maybe she’s on drugs) and differential treatment (let’s just strap her to the bed; no need to give her options), all of which, according to coroner Géhane Kamel, led to Ms. Echaquan’s death.

The same forces of structural discrimination and bias killed 45-year-old Brian Sinclair of the Sagkeeng First Nation, who languished in a Winnipeg emergency room for 34 hours with a treatable infection in 2008. And they explain why staff at a Northwest Territories care home assumed Aklavik elder Hugh Papik was drunk when he was actually having a massive stroke in 2016.

Individual acts of anti-Indigenous racism certainly contributed to each outcome. But nurses don’t mock patients crying out in pain without someone intervening, as happened in Ms. Echaquan’s case, unless bias and racism have seeped into the walls.

And yet, Quebec Premier François Legault has refused to yield to the coroner’s finding that systemic racism contributed to Ms. Echaquan’s death. His intransigence is odd, not only because the evidence presented in Ms. Kamel’s report is so unequivocal, but because the remedies Mr. Legault’s government has instituted are distinctly systemic in nature. Indeed, there would be no reason to introduce mandatory sensitivity training for all employees at the Joliette hospital, or to name a representative of the Manawan community to the board of the health authority overseeing the hospital, if the problem was just a couple of rogue nurses.

Clearly, Mr. Legault understands there is a systemic problem in Quebec’s health care system, but the phrase “systemic racism” is to the Premier what Macbeth is to theatre actors: It cannot be said aloud.

For Mr. Legault, this goes beyond bog-standard political stubbornness. The Premier has been largely successful in building a new brand of Quebec nationalism, which is less about traditional sovereignty and more about autonomy within Canada, protection of the French language and a collectivist, shared identity for Quebeckers. His government introduced Bill 96, which seeks to amend the 1867 Constitution Act to recognize that “Quebecers form a nation.” Mr. Legault also got the party leaders in recent federal election campaigns to yield to his demand to let the province control its immigration agenda and succeeded in making Conservative Leader Erin O’Toole promise to respect Quebec’s “distinct system” of child care.

Mr. Legault’s popularity among Quebeckers – which did drop last month but has nevertheless remained remarkably high throughout the pandemic – is rooted in this unapologetic nationalist pride and perceived control over the players in Ottawa. And he’s made headway in the perennial struggle to have Quebec recognized as a distinct society within Canada.

But to admit that the province’s health care system is systemically racist, even in response to a coroner’s report that pretty much spells it out, is to yield to the idea that Quebec’s distinct society is a broken one. It’s off-brand for Mr. Legault. He couldn’t say it after the Viens Commission report was tabled in 2019 – and he still can’t say it now.

The other impediment to Mr. Legault stating the obvious is that it would be somewhat contradictory for the Premier to acknowledge systemic racism in Quebec health care while defending legislation, Bill 21, that enshrined systemic racism in law in regards to hiring and employment practices in the public sector. Mr. Legault knows that prohibiting people in certain jobs from wearing religious symbols is unconstitutional, which is why his government pre-emptively invoked the notwithstanding clause when it introduced the bill. And it’s unmistakable that the law disproportionately affects certain groups of people – such as Muslim teachers who wear hijabs – which renders this policy of state-imposed secularism not universally oppressive but systemically discriminatory.

Anyone with eyes and a modicum of reading comprehension skills would come away from Ms. Kamel’s report with an understanding of how systemic racism contributed to Ms. Echaquan’s death. Mr. Legault has both, but he also has a brand to protect. And as long as that brand is thriving off the Premier’s unapologetic nationalism and lack of introspection, the words “systemic racism” cannot leave his lips.

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