In Canada, one in five Indigenous adults has faced unfair treatment in healthcare. This shows that trust must be earned. Joyce’s Principle is about building that trust.
The Council of the Atikamekw of Manawan and the Atikamekw Nation Council proposed it in November 2020. It was in response to Joyce Echaquan’s death at Joliette Hospital Centre. Her last Facebook Live showed racism in a place meant to heal. The principle aims for fair care and the best health possible.
It’s based on Article 24 of the United Nations Declaration on the Rights of Indigenous Peoples. This principle connects legal rights to real actions. It demands cultural safety and links human rights to daily decisions in Canada.
This section explains Joyce’s Principle’s purpose and scope. It shows why the Atikamekw chose this path. It also highlights the need for healthcare change and accountability. Joyce Echaquan’s story is at the heart of it, reminding us that Indigenous rights are real and lived.
What Joyce’s Principle Means for Indigenous Rights in Healthcare
Joyce’s Principle focuses on the dignity of First Nations, Inuit, and Métis in Canada. It aims for healthcare equality based on human rights and nondiscrimination. It also respects traditional medicines and knowledge.
Grounding in the United Nations Declaration on the Rights of Indigenous Peoples
The framework is based on UNDRIP Article 24. It applies to clinics, hospitals, and social services. It ensures Indigenous rights to health practices and traditional medicines.
Federal leaders like Carolyn Bennett and Patty Hajdu say care must be free of racism. Their words support UNDRIP Article 24 and cultural competency. Joyce’s Principle connects these goals to action in programs.
Equitable access to social and health services without discrimination
The Principle fights against discrimination in care. It means equal treatment, fair referrals, and clear coverage. It also means resources match real needs and services reach remote and urban areas.
To improve healthcare equality, steps include aligned rules and portable benefits. These steps help families who travel for care. They also support Indigenous rights to respectful services.
The highest attainable standard of physical, mental, emotional and spiritual health
UNDRIP Article 24 talks about the right to health. Joyce’s Principle adds spiritual and emotional well-being to physical and mental care. Elders, midwives, and knowledge keepers help with healing.
Cultural competency is key for providers to understand community context. Safe spaces for traditional medicines and land-based healing improve outcomes. These efforts uphold human rights in health and promote equality.
The Legacy and Context Behind Joyce’s Principle
Joyce Echaquan’s story changed how Canadians view care, dignity, and accountability. It also set a path for healthcare reform based on rights, evidence, and real-life experiences. The Atikamekw Nation called for a national action because of this.
The death at Joliette Hospital Centre and public reckoning with systemic racism
On September 28, 2020, Joyce Echaquan passed away at the Joliette Hospital Centre in Lanaudière. Her Facebook Live video revealed racist insults and a lack of compassionate care.
This event led to a wider understanding of systemic racism in Quebec and Canada. A year before, the Commission Viens found discrimination in public services, including health. This finding supported calls for a transparent public inquiry and lasting change.
How the Atikamekw Nation led a national call to action
The Atikamekw Nation, through the Council of the Atikamekw of Manawan and the Atikamekw Nation Council, created Joyce’s Principle. It is a rights-based guide, based on evidence, community stories, and clear healthcare reform standards.
A two-week public consultation in October 2020 collected feedback from healthcare workers, administrators, and families. Their ideas shaped a national call to action. It focused on safe access, continuous care, and accountability in institutions.
Why status quo is not an option for Atikamekw leadership
Chief Paul-Émile Ottawa and Grand Chief Constant Awashish pushed for quick adoption by Quebec’s National Assembly and Canada’s House of Commons. They said the current situation is unacceptable when lives are at risk.
They demanded action that respects title and rights and tackles systemic racism in policy and practice. Their stance matches Commission Viens’ findings and supports ongoing public inquiry into real results, not just promises.
Joyce Echaquan
Her story changed how Canada talks about care, trust, and accountability. She named discrimination in healthcare and stood up for human dignity. This made people and institutions look inward and act.
An Atikamekw woman from Manawan, she recorded what she faced so others could see it plainly. Her choice guides how communities, health workers, and leaders respond to harm.
Remembering her courage in documenting racist treatment
From her hospital bed in Joliette, she shared Facebook Live evidence of insults and neglect. The recording made private pain public, revealing how bias can shape care and outcomes.
People across Canada watched and listened. Many recognized patterns long raised by Indigenous patients, families, and advocates. The call to uphold human dignity gained urgent force.
The impact on public policy and national dialogues
Her death led federal ministers to convene national dialogues with Indigenous leaders, health professionals, and provinces and territories. These meetings examined discrimination in healthcare and mapped concrete steps.
Outcomes influenced public policy, including commitments to co-develop distinctions-based health legislation and invest in culturally safe services. The lessons continue to inform standards, training, and accountability.
Honouring her family’s call for real change
Her husband, Carol Dubé, urged governments to adopt measures aligned with Joyce’s Principle so no one else would suffer the same fate. That appeal anchors efforts that place human dignity at the centre of care.
Communities and institutions echo the family’s message: listen, act, and measure progress. The focus stays on safety, respect, and responsive systems that leave no room for discrimination in healthcare.
| Catalyst | What Changed | Who Took Part | Why It Matters |
|---|---|---|---|
| Facebook Live evidence from the Joliette hospital room | National dialogues on anti-Indigenous racism in health systems | National Indigenous Organizations, federal ministers, provinces and territories, health partners | Centres human dignity and drives systemic actions |
| Public recognition of discrimination in healthcare | Commitments to distinctions-based health legislation | Indigenous health professionals and community leaders | Builds culturally safe, responsive, and respectful care |
| Family’s call for real change | Targeted investments and clearer accountability measures | Federal departments and health institutions | Aligns public policy with lived experience and rights |
Commitments and Funding Announced by the Government of Canada
On 28 September 2021, the federal cabinet made big promises. They linked action against anti-Indigenous racism to Joyce Echaquan’s legacy and UNDRIP. Their message was about respect, safety, and care for First Nations, Inuit, and Métis across Canada.
These commitments mean real change in clinics, hospitals, and community programs. They also pave the way for measurable progress with partners.
Statements from federal ministers reaffirming culturally safe health systems
Carolyn Bennett, Patty Hajdu, Marc Miller, and Daniel Vandal made a joint pledge. They vowed to eliminate systemic bias in care. They said culturally safe services should be the standard, not the exception.
The ministers also promised to work with Indigenous partners and provinces. They want to ensure dignity at every point of care.
They remembered Joyce Echaquan’s death and vowed for stronger clinical standards. They also promised better accountability and supports that centre Indigenous patients and families.
National Dialogues and distinctions-based health legislation
After National Dialogues in October 2020, January 2021, and June 2021, Ottawa moved forward. They are working on distinctions-based legislation. This respects the unique rights, needs, and governance of First Nations, Inuit, and Métis.
This approach aligns with UNDRIP and reflects lessons from Elders, leaders, and care providers. It means co-developing reforms that make services safer and more responsive.
$126.7 million to address anti-Indigenous racism in health care
Through Budget 2021, the federal government committed $126.7 million over three years. This funding aims to create health systems free from discrimination. It also improves program evaluation for cultural safety and strengthens Indigenous partner participation.
This funding also acknowledges the greater harms faced by Indigenous women and 2SLGBTQQIA+ people. By pairing resources with accountability, the measures support practical steps to end anti-Indigenous racism. They also advance distinctions-based legislation across jurisdictions.
Governance, Autonomy, and Self-Determination in Health and Social Services
Joyce’s Principle puts communities at the heart of decision-making. It outlines clear roles for Ottawa and Quebec. It also emphasizes respecting autonomy and self-determination in daily care.
These changes must be concrete, measurable, and rooted in lived knowledge.
Action plans co-developed with Indigenous authorities
Governments are tasked with creating action plans with Indigenous groups. This includes the Assembly of First Nations, Inuit Tapiriit Kanatami, the Métis National Council, and Atikamekw Nation leaders. Elders, clinical experts, and community health teams provide valuable insights.
These plans outline timelines, indicators, and shared oversight. They aim to embed Indigenous governance in health and social services. This ensures self-determination is practiced every day.
Implementing Joyce’s Principle regardless of jurisdictional conflicts
Care cannot be delayed due to jurisdictional disputes between Canada and Quebec. The focus is on providing services immediately, with reimbursement systems that don’t burden patients or families.
Legislative measures should enforce this rule. If a service is needed, it should be provided. Clear protocols help reduce gaps, cut red tape, and uphold autonomy at the point of care.
Linking resources to real needs and enabling service mobility
Funding should follow need, not program silos. Resource allocation should reflect local priorities, as identified by community leadership and front-line providers. This includes midwifery and land-based healing.
Service mobility is key when specialists and teams move between communities. Portable coverage, shared staffing agreements, and aligned formularies ensure care can travel with the patient.
By aligning resource allocation with community-reported outcomes and enabling service mobility, governments strengthen Indigenous governance. They also support the everyday exercise of self-determination.
Embedding Cultural Safety and Competency Across Health Systems
Embedding cultural safety means people get respectful care that respects their choices and rights. It follows Article 24 of the United Nations Declaration on the Rights of Indigenous Peoples. This article ensures access to care and protects traditional medicines.
Health providers and administrators use Indigenous knowledge in their work. They make care plans that follow community protocols and include ceremony.
Hospitals and social services commit to Joyce’s Principle. They post clear standards, track incidents, and speak out against racism. This is part of health systems reform that aims for cultural competency.
They ensure care follows the patient, no matter where they go. This includes coverage, funding, and service mobility.
Working with First Nations, Inuit, and Métis leaders builds trust. Teams support land-based healing and involve Elders and Knowledge Keepers. They also provide interpreters and respect the use of traditional medicines.
Teams get consent and document everything with the patient’s voice at the centre.
Learning is key to this change. Organisations offer training on Joyce’s Principle. They review hiring and promotion practices and share progress with communities.
They use data to measure how well they do in cultural safety. Care protocols are designed to ensure cultural competency. This makes respectful care a standard, not just an option.
Procurement and facility design are important too. Clinics use Indigenous languages in signage and provide private spaces for ceremony. They also work with local harvesters to protect plants and materials used in healing.
Education and Professional Standards for Culturally Competent Care
Colleges and universities can lead the way in cultural competence. They can add Joyce’s Principle to all programs. This includes classroom learning and placements with Indigenous health partners.
Compulsory training on Joyce’s Principle in health and social services programs
All teaching institutions should include compulsory training. This training should be made with First Nations, Inuit, and Métis experts. The First Nations Health Authority, the Cree Board of Health and Social Services of James Bay, and the Nunavik Regional Board of Health and Social Services can help.
These modules help build cultural competence and practical skills. Learners learn about patient rights, anti-racism, and safe communication. They then apply these in simulation labs and supervised practice.
Decolonizing curriculum and supporting Indigenous learners
A decolonized curriculum goes beyond one course. Programs update case studies, assessment tools, and evaluation methods. They also make room for Elders and Knowledge Keepers.
They recognize Indigenous knowledge as equal to peer-reviewed research. To welcome Indigenous students, institutions offer dedicated advising, paid placements, and housing supports. Bridging bursaries, flexible admissions, and land-based learning help learners stay enrolled and succeed.
Professional orders’ continuing education and Indigenous representation
Professional orders like the Ordre des infirmières et infirmiers du Québec and the Collège des médecins du Québec can require ongoing education. This education should be linked to Joyce’s Principle. Modules designed with Indigenous authorities keep practice current and accountable.
Governance is also key. With community partners, professional orders should have an Indigenous person on their boards. This ensures patient safety is always the focus.
- Compulsory training aligned to practice standards
- Decolonized curriculum with co-teaching by Elders
- Targeted supports for Indigenous students
- Mandatory continuing professional development
- Board representation within professional orders
| Area of change | Current gaps | Action aligned with Joyce’s Principle | Expected impact |
|---|---|---|---|
| Program design | Limited Indigenous content; few clinical scenarios | Co-develop compulsory training with Indigenous partners | Stronger cultural competence at entry to practice |
| Curriculum | Eurocentric cases and assessment tools | Adopt a decolonized curriculum and land-based methods | More relevant care plans and safer encounters |
| Learner support | Financial and social barriers for Indigenous students | Dedicated funding, mentoring, and flexible pathways | Higher enrolment, retention, and graduation |
| Regulation | Inconsistent continuing education on anti-racism | Mandate continuing professional development on Joyce’s Principle | Ongoing skill renewal and system-wide alignment |
| Governance | Limited Indigenous voice in decisions | Designate an Indigenous board member within professional orders | Responsive standards and fair oversight |
Operational Policies for Hospitals and Social Services
Hospitals and social services improve care by following Joyce’s Principle. They make clear steps and use simple language. This helps keep patients safe and respected.
Teams work with Elders, health directors, and patient partners. They make sure care reflects local culture and Canadian standards.
Organizational policies that recognise and apply Joyce’s Principle
Organisations adopt anti-racism policies and follow a hospital policy. This policy outlines rights and how to handle emergencies. Staff learn about consent, language access, and family presence with Indigenous health experts.
Leaders track progress and share results. They work with Indigenous partners to improve care.
Agreements with Indigenous authorities and visible commitments
Facilities serving Indigenous patients make agreements with authorities. These agreements cover discharge, escorts, and complaints. They ensure care is respectful and follows local rules.
Facilities show their commitment by posting patient rights and creating ceremony-friendly spaces. They also use Indigenous languages in signs and announcements. Public statements highlight their goals and anti-racism efforts.
Ombudsman access and annual public reporting on progress
Patients should have access to an Indigenous health ombudsman. This person can investigate and solve complaints. In Quebec, there’s a push for a province-wide office made with Indigenous partners.
Facilities report their progress every year. This includes updates on training, hiring, and service experience. Open data builds trust and keeps everyone accountable.
| Policy Element | Operational Detail | Evidence of Impact | Accountability Mechanism |
|---|---|---|---|
| Anti-racism policies | Zero-tolerance rules, bias screening in hiring, mandatory refreshers | Reduced complaints linked to discriminatory conduct | Quarterly audits and corrective actions |
| Agreements with Indigenous authorities | Co-signed protocols on transfer, escorts, language support | Fewer missed appointments and safer discharges | Joint review committees with meeting minutes |
| Indigenous health ombudsman | Independent intake, trauma-informed investigation, binding recommendations | Faster resolution times and higher satisfaction | Annual case summaries and trend analyses |
| Public reporting | Yearly publication of indicators and action plan status | Clear progress on cultural safety targets | External verification by community partners |
| Hospital policy integration | Embed Joyce’s Principle in triage, consent, and discharge procedures | Improved continuity of care and trust | Board oversight with standing agenda items |
Community, Public Awareness, and Human Rights
Joyce’s Principle calls for action in the public sphere. It focuses on public awareness, community engagement, and respect for human rights in health settings. The aim is to prevent discrimination through visible, trustworthy actions.
Fighting stigma and systemic racism through education campaigns
Effective education campaigns are led by Indigenous authorities. They are supported by the Government of Quebec and the Government of Canada. These campaigns highlight real health barriers and promote anti-stigma messages.
They also encourage allies to act. Funding should support local languages, Elders’ guidance, and youth voices.
National Dialogues hosted by federal ministers helped build a shared map of the problem. The lessons guide practical tools for staff and patients, from triage to discharge.
Social leaders’ responsibility to prevent and condemn discrimination
Mayors, hospital CEOs, professional colleges, and school boards shape public awareness daily. When they name racism, set clear standards, and support community engagement, discrimination prevention becomes routine. Public denouncements must be backed by resources, data, and timelines.
“Silence is complicity. We all have a duty to act when rights are at risk.”
Aligning with human rights frameworks and Indigenous rights
Joyce’s Principle aligns with human rights instruments, including UNDRIP Article 24 on the right to health. It supports unbiased care and safety. This approach affirms the Atikamekw Nation’s call for tools and funding to confront systemic racism.
When governments and institutions follow UNDRIP and uphold Canadian law, communities see change. This builds trust and ensures lasting results.
| Action Area | Lead Partners | Purpose | Community Benefit | Human Rights Link |
|---|---|---|---|---|
| Education campaigns | Indigenous authorities, Health Canada, Quebec ministries | Promote anti-stigma learning across health services | Better patient experiences and safer care pathways | UNDRIP Article 24; discrimination prevention |
| Public awareness in hospitals | Hospital leadership, professional orders | Visible commitments and staff training | Faster, fair triage and respectful communication | Equality in access; human rights safeguards |
| Community engagement forums | First Nations, Inuit, and Métis communities, municipalities | Co-design solutions and share data | Local control and culturally safe services | Self‑determination within human rights frameworks |
| Rapid response to incidents | Ombudsperson offices, health networks | Immediate support and accountability | Reduced harm and clear remedies | Remedy and protection against discrimination |
Conclusion
Joyce’s Principle demands action to end racism in healthcare for Indigenous peoples. It aims for the highest health standards. This principle is key to achieving healthcare equity in Canada.
The Government of Canada has started by promising to work on health legislation. They also plan to hold dialogues and invest $126.7 million over three years. These steps are in line with MMIWG Calls for Justice and human rights in healthcare.
But, there’s a lot more work to do. Progress needs clear goals, regular updates, and working together with Indigenous peoples. Grand Chief Constant Awashish and Chief Paul-Émile Ottawa have made it clear that change is needed now.
Joyce Echaquan’s family and Carol Dubé want to see an end to racism in healthcare. They believe in culturally safe care for everyone. Their message is clear: we can’t wait for healthcare equity.
Canada can make a difference by fully implementing Joyce’s Principle. This means working together and listening to communities. It’s about building trust and making sure care is safe and respectful.
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