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When is it acceptable to speak English in Quebec hospitals? The answer is more complicated than you might think. 

Quebec’s Ministry of Health and Social Services issued a directive July 18 detailing when a language other than French could be used in its health-care network. The directive follows-up on a requirement of the Act respecting French, the official and common language of Quebec, also known as Bill 96.  

The law, adopted in June 2022, requires ministries and agencies under the authority of the government to specify when the use of a language other than French – essentially English – will be tolerated.  

The overarching principle is that French is to be reaffirmed ‟as the sole official language of the State of Quebec,” and the network’s bodies are subject to three general obligations: they must exclusively use French in writing; they must only use French in oral communications; and if an exceptional situation requires the use of another language, they must revert to French as quickly as possible. 

The directive devotes seven pages to written and oral communications with patients and their relatives. It also contains a non-exhaustive list of exceptions to the obligation to communicate only in French and identifies the circumstances in which such exceptions are possible, as well as what health-care network employees should do when language issues arise. 

The conclusion is that a language other than French may be used both orally and in writing when required for health reasons. This is defined as ‟any emergency or circumstance” in which a patient must receive care, consent to care or participate in decisions affecting his or her health.  

A language other than French may also be used with individuals declared ‟eligible to receive instruction in English,” as well as with individuals with whom the health care organizations were corresponding in English before May 13, 2021 (the date on which the bill was introduced). It is also possible to communicate in another language than French with First Nations and Inuit people, as well as with immigrants. But once again, it’s a bit more complicated than one might think at first glance. 

Exceptions to exceptions 

Quebecers eligible to receive instruction in English will need to have received from the Ministry of Education a declaration of eligibility to receive instruction in English. They will also have to make an explicit request for communications to take place in English. Regarding correspondence in a language other than French that took place before May 13, 2021, it may continue if the said correspondence directly concerned the same people, that it was not motivated solely by the pandemic, and that the organization in question has a record of this correspondence. 

First Nations and Inuit people will also have to request that conversations take place in a language other than French. In the case of written communications, a French version must also be made. Finally, in the case of immigrants, an organization will only be able to communicate with them in a language other than French during the six months following their arrival in Quebec. 

From a governmental point of view, it was necessary to follow up on Bill 96. The content of the resulting directive shows that officials at the Ministry of Health engaged in an impressive exercise in sophistry, identifying and setting out the exceptions that could be authorised. 

However, from the perspective of parties other than the Quebec government, the precision with which the exceptions are described has drawbacks. For example, some have interpreted that the requirement to have received beforehand an authorization to attend English schools is a condition that Anglo-Quebecers must meet in order to receive health care in their language. 

After adding up the exceptions, the conditions under which they apply and all the circumstances that could justify the use of a language ‟other than French,” one can’t help but raise an eyebrow when imagining the questionnaire those wishing to make a linguistic exception will have to answer. 

In the same vein, one might smile (or feel exasperated) when imagining the cat-and-mouse game as a nurse or a doctor wait for a patient to voice their expectation of being served in English, before feeling justified in addressing them in that language. Finally, what will happen to immigrants who go to hospital on the morning of the first day of the seventh month after their arrival in Quebec? 

Kafkaesque obstacles instead of openness  

The directive leaves the impression that the Quebec government is granting exceptions only because it has no choice but to allow them. Worse still, the way those exceptions are worded suggests that it is fussy about the exceptions, seeking to block every conceivable way out. 

And what about the risk of things getting out of hand to the detriment of patients? It is not impossible that an employee could takes literally the need to hold proof of eligibility to receive instruction in English, and refuses to deal in English with an English-speaking patient, with the potential risks that such an interpretation could entail to that patient’s health.  

The government could have worded the directive differently. It could have said more explicitly that the affirmation of French in the healthcare system will not be to the detriment of Quebecers who are more at ease in another language, as it is currently doing by littering their access to care with almost Kafkaesque obstacles. 

Some clarification would still be needed, particularly regarding eligibility criteria for receiving education in English, or immigrants who do not have a sufficient command of French after their first six months in Quebec. A more open wording would at least help reduce the impression the government is only granting linguistic exceptions with the greatest reluctance.