Bioethics

Description

Introduction
Decisions made in the delivery of health care often involve making moral choices when the ‘right’ thing to do is not immediately obvious. For example:
What should clinicians do if they prescribe a treatment that they know will save the life of the person in their care but this is refused because of a piece of popular literature that advises against it?
What should managers do when clinicians want a newly developed, expensive piece of equipment that has been shown to improve clinical outcomes but the institution they work in cannot afford it?
Bioethics is a recent phenomenon that was developed to help people make difficult decisions about health care, health research and the application of technical advances. In New Zealand the discipline came to fore in the mid-1980s after a Royal Commission investigated clinical research being carried out at National Women’s Hospital in Auckland, that had been on-going since the 1960s. An Auckland obstetrician and gynaecologist, Herbert Green, after observing many women who came to him for treatment, had come to believe that a condition called cervical dysplasia (where women were found to have abnormal cervical cells after a pap smear) did not always progress to invasive cancer.  He therefore thought that the condition did not warrant the conventional treatment of the time, a cone biopsy or hysterectomy, as this had significant lifelong implications for the women involved, including affecting their ability to have children.
The processes he used to test his hypothesis came into question, and were published in a popular magazine. The political fallout led to the then government setting up a Royal Commission of inquiry into his practices (the Cartwright Report, 1988).  The inquiry led to the introduction of ethics committees, the development of codes of ethics and bioethical training for health professionals, health sector managers and researchers, and to the setting up of the role of Health and Disability Commissioner.