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It would be natural for the most dedicated Aboriginal mother on earth to feel fear when in the clutches of such a system—even if we leave aside literally every other fact in the history of Aboriginal-state relations in Canada. You could call the feelings paranoia if the rational justification for them were not so stunningly obvious. And it is easy to see how this syndrome can make a total mess of an Aboriginal patient’s interactions with social workers, nurses and doctors. All are there to help and want to help—but what constitutes “help”?

It would be natural for the most dedicated Aboriginal mother on earth to feel fear when in the clutches of such a system

Sometimes, “help” might take the form of a doctor warning a pregnant woman, using technical language, that she has vague health problems that might affect future pregnancies. Sometimes, he might tell scary stories of women who were killed or injured by a risky childbirth, perhaps as a well-intended way of avoiding the same technical language. Sometimes, doctors and nurses—knowing that a particular woman is not likely to have or obtain a regular family physician—might go a little further than they ought in selling tubal ligation as a contraceptive solution. It is mostly innocent behaviour—until you consider it from the other side.

One of the more heartbreaking parts of the report is the part in which the witnesses talk about the aftereffects of having to live with an unwanted tubal ligation. Some of these effects are strictly emotional. But some women found that their relationships with men suffered, or their chances of finding a relationship compromised, because they were no longer fertile.

Most of us are trained by schools and media to think of contraception as a good thing, and I suppose most of us would encourage these women to accept that femininity is separate from fertility. But words will not solve their practical problem, or reverse the procedure that has altered their lives in a negative way. Nor is it really an answer to propose that they may simply be suffering buyer’s remorse. Their consent to permanent sterilization was supposed to have been informed: that is a duty that pertains to the doctor and the hospital, not to the patient.

National Post