Volume 4, Issue 03 - May 2001

Canada's Disability Gatekeepers: Applying a Questionable Ethic

Canada's Immigration Act is currently being challenged in the courts (Chesters v. Canada) for its prejudicial assumptions about people with disabilities. My experience with this Section of the Act is informed by my advocacy on behalf of families, who have sons or daughters with developmental disabilities, wishing to immigrate to Canada to join existing family members currently living in Canada.

In this article I will argue that the Act and its application are governed by a "medical" and devaluing view of people with disabilities that categorically denies entry to potential immigrants with disabilities. I will suggest that this view of people with disabilities is archaic and marginalizing and should be replaced by an ethic of community inclusion that values people with disabilities.

A search of the Immigration Act on the Canadian legislation website under the term "disability" points to the third section of the Act, entitled Exclusion and Removal, Inadmissible Classes, Section 19: Inadmissible Persons. It reads in part:
19. (1) No person shall be granted admission who is a member of any of the following classes:
(a) persons, who are suffering from any disease, disorder, disability or other health impairment as a result of the nature, severity or probable duration of which, in the opinion of a medical officer concurred in by at least one other medical officer,
(ii) their admission would cause or might reasonably be expected to cause excessive demands on health or social services;

This section of the Immigration Act is designed to inhibit and prohibit persons with disabilities from immigrating to Canada on the assumption that a person with a disability will create an economic burden on Canada's health or social services.

How the Act is Applied

While the Act suggests that exclusion of persons with disabilities is to be applied with discretion (in the opinion of a medical officer) and on an individual-by-individual basis, the experience of many families is one of categorical and systemic exclusion. Many medical officers, abroad and in Canada, automatically deny access to any person with a developmental disability regardless of their individual circumstances.

In the files I have reviewed, the medical officers do not give reasons for their denial. They simply state that the person has a developmental disability and use a standard format for reporting that the person will draw excessively on Canada's social services and health care system. The term "excessive" is never defined.

This categorical exclusion is applied whether the person has a mild, moderate or severe disability. Assumptions are made based on a guide to developmental disabilities that is available to the medical officers. This guide portrays all individuals with developmental disabilities as "costly" thereby suggesting that every such individual and his/her family should be excluded from Canada. There is no requirement to view the child as an individual, to consider their strengths or to take into account their successes.

The medical officers' prejudicial actions become somewhat understandable when one considers that the Immigration Act only refers to persons with disabilities in the negative. Thus, given the wording of the Act and the Act's long history of negatively stereotyping persons with disabilities, it might naturally follow that medical officers working with Canada Immigration assume that the actual intent of the Act is to universally exclude persons with developmental disabilities from entering Canada.

The Medical Model of Disability

Section 19 is reflective of the historical and continuing societal devaluation of people with disabilities. The practice of societal devaluation has been traditionally reflected in the application of the "medical model" for understanding the lives of people with disabilities.

In its most obvious forms the medical model is represented by the historical and in some instances continuing (e.g., individuals with mental illness) institutionalization, congregation and segregation of people with developmental disabilities. The medical model of disability is commonly understood to have developed from the advent of institutions for people with developmental and other disabilities. These facilities, which were often created and operated by medical personnel, assumed individuals with disabilities to be "sick" and requiring "treatment" - thus, as a threat to society, best removed from family and community.

In light of the negative societal stereotypes underlying the medical model and the "failure" of individuals with developmental disabilities to respond to treatment (as they could not be cured of their developmental disabilities), the model further led to custodial practices whereby individuals with developmental disabilities were institutionally abandoned and worse, as we know in Alberta, subjected to wholesale sterilization, excessive medication, and other abuse including at times medical experimentation.

Today the medical model is far less overt and to a large degree has been replaced by the principles of community living and inclusion. However, while the vast majority of individuals with developmental disabilities now live in the community, the ethic of the medical model still intrudes, particularly in the lives of those who are at risk of being multiply marginalized _ for example, immigration applicants with developmental disabilities.

The Community Living Approach

The principles of community living and inclusion, which have developed over the last 50 years, stand in contrast to the medical model and its ethic of stereotype and negation. A community living ethic sees individuals with developmental disabilities as valued human beings to be fully included in community life as participating members.

Today children with developmental disabilities grow up at home with their families, are increasingly educated in regular classrooms and form friendships with their non-disabled peers. Adults are continuing their education at colleges and universities, seeking employment, pursuing careers and living in their own homes. Community inclusion provides the means by which the contributions of individuals with developmental disabilities to family and community life are recognized. Individuals with developmental disabilities are no longer viewed as sick and needing treatment, but as individuals entitled to support to enable their participation.

Unfortunately, the actions of some of the medical officers who serve Canada's Immigration Act suggest the medical model's devaluing assumptions about people with disabilities may be alive and well - perhaps more subtly expressed, but as pernicious.

There is nothing inherent in the knowledge and training of medical practitioners that would suggest any noteworthy capacity to determine who should enter Canada. In practice, medical officers often apply categorical assumptions and Canada Immigration assumes these to be legitimate given the status medical officers are accorded in Canadian society. To do justice to their profession, medical officers should remove themselves as Canada's "disability gatekeepers".

Canadian Values and the Immigration Act

Today, most Canadians would be appalled by the application of any guide that negatively (or otherwise) categorized individuals on the basis of race. Yet, while most Canadians would recognize the irrelevance of race to an individual's suitability for entry to this country as an immigrant, the same moral consideration is not applied to persons with developmental and other disabilities.

This is because we both see the contributions that immigrants can make to Canada irrespective of race, and understand that individuals are morally equal in their deserving to flourish as human beings, regardless of their race. Unfortunately, and inconsistently, there is not a comparable Canadian ethic that recognizes the potential contributions and more importantly the inherent worth of people with disabilities; that recognizes the common good that is advanced by a diverse and welcoming society inclusive of people with disabilities. Prejudice on the basis of race abhors many Canadians; prejudice on the basis of disability ought to be recognized as a comparable ethical transgression and moral evil.

This lack of being recognized and treated as morally equal is, of course, a common experience for people with disabilities and their families. Many Canadians take for granted the rights that they enjoy and expect the principles of social justice and fairness to apply to their lives without exception. People with disabilities and their families, given their repeated experiences with rejection and exclusion, never take these values for granted.

People with developmental and often other disabilities require support in order to live, to grow as a family, to learn, to earn an income and to participate. The provision of support is necessary if the principles of equity and equality are to be applied to the lives of people with disabilities. People with disabilities are a natural part of the human family, essential to its value and well-being. The willing provision of disability-related supports is a reflection of a moral and just society.

A Canadian law that equates the necessity for support as a burden (explicitly noted as one not to be undertaken), implies Canadians with disabilities are a burden to society, draining resources that would be better allocated to those without disabilities. In effect, this is a statement that Canada would be better off without people with disabilities or that the worthiness of a Canadian with a disability can only be measured by the degree to which they do not require support. The immigration guide on developmental disabilities and the Immigration Act insult and assault the humanity of Canadians with disabilities and their families and those who would like to become Canadians.

The Alberta Association for Community Living (AACL), a family advocacy organization representing children and adults with developmental disabilities, has successfully supported families who have experienced categorical rejection by medical officers, so that they and their children were able to join their relatives living in Canada. Why not an approach to immigration applications by families who have children with developmental disabilities that contains positive assumptions about individuals with developmental disabilities? This is a proposition that clearly ought to apply to all Canadians with disabilities and to future Canadians who may have disabilities.

Accepting immigrating families who have children with disabilities and immigrants with disabilities on the same merits as any other family or individual will only enrich Canada.

Announcements

The Network staff are pleased to announce a new addition to the PHEN website: a database of the reference information for recommended bioethics journal articles and other readings arranged by topic is now available at www.phen.ab.ca/articles/home2.html. As a special offer, copies of the articles will be made available to any Alberta resident or organization, at no charge for a limited time. To order an article, please contact PHEN's Northern Alberta office.

PHEN Annual Conference Notes:
Videotapes of the various presentations made at the conference in Red Deer on May 25, 2001 will be available for purchase from the PHEN offices by early August. Look for information on titles and other details in an upcoming edition of In Touch or on PHEN's website (www.phen.ab.ca).

The poem created by Dr. Jeffrey Nisker, based upon the feedback from the participants, will be posted shortly online at PHEN's website - look for this in the coming weeks!

The mailing address for PHEN's Northern Alberta office has changed slightly. The updated address is as follows:

Provincial Health Ethics Network
#507 Guardian Building
8220 114 Street
Edmonton, AB T5N 3W6

Views offered in this article are those of the author and do not necessarily reflect the position of the Provincial Health Ethics Network.