Bill to criminalize forced or coerced sterilization could have unintended consequences: physicians

TORONTO — Survivors of forced or coerced sterilization – many of whom are Indigenous – are pushing for legislation that would explicitly criminalize the procedure, but several physician and legal groups worry the bill could lead doctors to hesitate when a patient’s life is at risk.

The intent of the bill – to condemn sterilization without informed consent – has unanimous support, including from medical groups who have raised concerns about its potential unintended consequences during House of Commons committee hearings.

The Survivors Circle for Reproductive Justice estimates between 12,000 and 15,000 Indigenous people have been sterilized without consent in Canada since the 1890s, some as recently as last year. That’s based on historical research, lawsuits, studies, medical billing records and applications to the group’s national registry, which launched in 2024.

Survivors have sought to criminalize the act since 2015.

“It gives teeth to the law where patients who have gone through this have never been able to have adequate access to justice,” said Dr. Don Wilson, an obstetrician-gynecologist, member of the Heiltsuk Nation in British Columbia, and medical expert for the Survivors Circle for Reproductive Justice.

Wilson said he is not aware of any physician who has been charged for forced or coerced sterilization, and therefore, he doesn’t know of “any patients who have had effective justice.”

The proposed legislation was introduced with the previous government in 2022 and revived as Bill S-228 in 2025. It passed in the Senate last fall and is now being considered by a committee in the House of Commons.

If Bill S-228 passes, the Criminal Code would be amended to clarify that a “procedure performed on a person that results in the permanent prevention of reproduction” without legal consent constitutes aggravated assault, carrying a maximum penalty of 14 years.

That includes “severing, clipping, tying or cauterizing, in whole or in part, of the Fallopian tubes, ovaries or uterus.”

Among those who recently testified at the Standing Committee on Indigenous and Northern Affairs was Silvia Mckay, a 52-year-old Cree woman from Peepeekisis First Nation in Saskatchewan, who says she was sterilized against her will after giving birth in 2001.

“I was so vulnerable and helpless,” said Mckay, who first publicly shared her experience a decade ago, and testified for the Standing Senate Committee on Human Rights in 2022. She is also a plaintiff in a class-action lawsuit in Saskatchewan, one of several ongoing civil cases launched across the country.

“This terrifying experience left a void inside of me.”

UNINTENDED CONSEQUENCES

The Society of Obstetricians and Gynaecologists of Canada (SOGC), Association of Obstetricians and Gynecologists of Quebec, Federation of Medical Women of Canada and Action Canada for Sexual Health and Rights say they support the intent of this bill – to end non-consensual sterilization.

However, they are concerned about the unintended consequences for women’s sexual and reproductive health care and have submitted briefs saying so to the committee, including calling out, in the SOGC’s case, a “questionable lack of consultation” with physicians and surgeons.

Obstetrician-gynecologist Dr. Modupe Tunde-Byass said if a physician hesitates for even a split-second to think about whether they could be taken to court for acting in an emergency without consent, a patient could die in a ruptured ectopic pregnancy, when a fertilized egg bursts outside the uterus, or a postpartum hemorrhage of excessive bleeding after childbirth.

“In an emergency situation, my question is, who determines sufficient consent? Tunde-Byass, president of the Federation of Medical Women of Canada, asked the committee. “These decisions must be made on purely clinical grounds without the fear of criminal prosecution.”

Tunde-Byass said efforts should be focused on creating a nationwide consent process for health-care providers, rather than on criminalizing reproductive health in Canada.

“Criminalization will not address structural racism and systemic discrimination that enable the egregious acts to occur in the first place and continues to impact equity deserving populations to date,” she said.

Wilson, who has been practising obstetrics and gynecology for almost two decades, said he is amply familiar with clinical situations that can make informed consent “nearly impossible,” and acknowledges the concerns of his colleagues, but still supports the passing of the bill.

“I am here to try to centre the experience of survivors,” he told the committee.

“If you listen to the arguments of the survivors they often bring up the fact that whenever doctors are under legal threat, they have enormous legal capacity to protect themselves and the burden of evidence falls on these vulnerable patients,” Wilson said in a subsequent interview.

It is already illegal to perform surgery on a person without their informed consent, but Wilson said survivors want a legal backstop that specifically addresses non-consensual sterilization.

Sen. Yvonne Boyer said Section 45 of the Criminal Code protects physicians acting in life-saving emergencies, and the introduction of this bill will not change that, nor does it aim to criminalize lawful, medically necessary or consent-based care.

“Nothing changes there,” Boyer said in the House of Commons.

The Survivors Circle for Reproductive Justice also said the bill does not alter current legal protections for doctors in cases that involve life-threatening emergencies.

“Physicians can be assured that when they are saving lives, they will not be held criminally accountable if those lifesaving measures result in permanent sterilization as a byproduct of that lifesaving care,” Executive Director Harmony Redsky said in an email statement prepared on behalf of the organization.

The statement also said survivors report not seeing any accountability or consequences under existing frameworks.

“Bill S-228 is not about restricting care. It is about ensuring consent is truly valid, informed, protected, ongoing and enforceable.”

The bill has the support of the Canadian Medical Association, which says Bill S-228 is a “critical piece of legislation.”

CMA President Dr. Margot Burnell expressed “strong support” for the bill.

ACCESS TO CONTRACEPTION

Amanda Therrien, a lawyer with the National Association of Women and the Law, agreed that Section 45 would continue to protect physicians if the bill is passed, but she said the law is less clear about some non-emergency medical situations, such as prescribing cancer medications that result in infertility later in life.

“I think there is a gap there,” Therrien said.

“And that could lead to a chilling effect where physicians maybe second-guess permanent contraception or even temporary contraception that could lead to infertility.”

She said that she’s also concerned that the bill could reduce the number of physicians offering permanent contraception, particularly for those experiencing family violence and reproductive coercion, and suggested amending wording of the bill to explicitly state it should not limit the availability of permanent contraception.

“We’re just concerned that the criminal law is maybe too blunt a tool,” Therrien said.

The Association of Obstetricians and Gynecologists of Quebec said in a brief that, in its experience, “a climate of fear almost inevitably has a chilling effect: professionals avoid perfectly legitimate procedures when the line between permission and prohibition becomes blurred or when there is an increased risk of complaints, investigations or legal challenges.”

The group said it rejects the bill given the serious risks it poses for patients, physicians and the health care system.

SOGC President Dr. Lynn Murphy-Kaulbeck said she fears this could be a “slippery slope” that could paradoxically erode access to reproductive health care and put women at risk.

“That’s the hardest thing, I think, to iterate about this, to get out, but by putting this bill in place, it’s almost doing the opposite, or has the potential to have the opposite effect. We’re going to take away access to women’s care.”

This report by The Canadian Press was first published April 7, 2026.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Hannah Alberga, The Canadian Press