A Policy A Day: Informed Consent in Healthcare

In the lead-up to the election, we are examining a policy a day. We’re exploring a variety of policy areas, explaining the background and analysing some of the policy options, with a mixture of technocracy and values-based approaches. Inevitably, some opinion will make its way in and we make no apology for that – after all, we’re voters too. A list of all the articles is available hereEnjoy!

Today’s post is written by Mark Hanna

New Zealand has an issue with informed consent in healthcare. Most of the time, if you’re visiting your GP or in a hospital, you probably won’t run into it, but there are some areas where there are real problems.

One area that often goes under the radar, but which I deal with a lot as the chair of the Society for Science Based Healthcare, is quackery. Misleading promotion of pills, potions, and panaceas is everywhere, and this misleading promotion undermines your right to make an informed decision about your healthcare. At the more sinister end, we see parents misled about the false “dangers” of vaccines, leading to real harm, such as 2017’s mumps outbreak in Auckland.

There is some incoming legislation to address this to some extent. The Natural Health Products Bill (previously the “Natural Health and Supplementary Products Bill”) will address the areas of the industry where many of the wildest health claims are typically seen. It has some issues, such as explicitly excluding homeopathic products, but also some really good provisions like requiring a “summary of evidence” be made available online for all natural health products sold in New Zealand.

To some degree, I’m sure these sorts of misleading health claims might be expected at health food stores and the like, but it is also commonplace in many New Zealand pharmacies. There are GPs and vets in New Zealand who promote quackery like homeopathy. We also have an industry-wide issue of misleading online advertising by chiropractors who, like medical doctors and pharmacists, are regulated under the Health Practitioners Competence Assurance Act. That’s not even to get started on the tens of millions of dollars ACC spends each year paying for acupuncture treatments that its own reviews did not find to be effective, delivered by practitioners likely to mislead their patients by talking about how they can treat diseases by manipulating non-existent “chi” energy.

As well as the quackery issue, some medical procedures are not currently based on an informed consent model. That’s not to say they don’t require informed consent – it’s a pillar of modern medical ethics – but in addition to requiring informed consent some procedures have other barriers in place that make accessing them more difficult, and often stigmatise people seeking them.

There can be reasons to gate some medical procedures in this way in order to prevent harm. For example, in David Seymour’s End of Life Choice Bill, proposed access to euthanasia is gated through several steps requiring opinions of multiple medical professionals in order to safeguard against potential harm.

But in other cases, gating a medical procedure in this way can cause more harm than it prevents. This is especially pertinent when they are specific to groups of people who already face marginalisation and have their bodily autonomy threatened in other ways.

Abortion, currently included in the Crimes Act, is an example of this. Right now, pregnant people [1] can be required to say (and in many cases, lie) that carrying their pregnancy to term would be a serious danger to their mental health, instead of the procedure being based on an informed consent model.

Similar issues with gatekeeping face transgender people who are trying to start hormone treatment or access other healthcare (such as chest reconstruction surgery) – they have to be assessed by a mental health practitioner (or sometimes more than one) before they can receive any treatment. Though different people’s experiences will vary, in some cases at least I’ve seen reports of how this can be demeaning, such as mental health professionals misgendering trans patients in their notes.

So, where do our political parties stand on these issues of informed consent in healthcare? Here’s what I’ve been able to find:

ACT

David Seymour (the only ACT MP at the time) voted against the Natural Health Products Bill’s second reading.

The ACT Party supports abortion law reform, with leader David Seymour saying “the right thing to do is reform abortion law to reflect what actually happens: women exercise choice for their own reasons”.

If the ACT Party has had anything to say about trans New Zealanders’ access to currently gated healthcare, I haven’t been able to find it. Admittedly, ever since ACT Party candidate Stephen Barry said hate speech against trans people, while disgusting, should be permitted as free speech it’s been very hard to find anything else they might have said in that area.

Greens

The Green Party has been involved in the development of the Natural Health Products Bill and has supported its passage so far.

However, the Green Party has had a problematic history with quackery. Previous Green health spokesperson Sue Kedgley (whose successful bid for a seat on the Wellington City Council was backed by the party earlier this year) gave anti-vaccination speeches and tried to get quackery like homeopathy integrated into the medical system. Outgoing Green MP Steffan Browning, who held the party’s now defunct “natural health” portfolio at the time, signed a petition in 2014 supporting the use of homeopathy to treat ebola.

Before the 2014 election, I wrote to Kevin Hague (who is no longer a Green MP or candidate but was then the Greens’ health spokesperson) to express my concerns about that aspect of their party, and I was reassured by his response.

The Green Party has called for years to decriminalise abortion. One of the reasons they gave for this in February was:

“The fact that 99% of abortions are approved on ‘mental health’ grounds reveals the dishonesty of the current legal situation.”

When I wrote to the Green Party in July to ask about their policy regarding trans New Zealanders’ access to healthcare, they responded to say that (emphasis mine):

“The Green Party agrees with the recommendations made by a coalition of groups to the panel of MPs on the International Day against Homophobia, Biphobia and Transphobia on May 17th this year, which include:

–       Require district health boards to ensure trans and gender diverse people’s access to gender affirming health services available in NZ, based on an informed consent model of healthcare

–       Provide sufficient funding to enable timely access to gender reassignment surgeries not provided through the NZ public health system

–       Support the development of training and resources on an informed consent model of healthcare for trans and gender diverse people, and provide information and resources for communities and individuals about accessing gender affirming services.”

Labour

The Labour Party has had little to say on the Natural Health Products Bill, but they have supported it.

Labour leader Jacinda Ardern has said she would take abortion out of the Crimes Act, saying “People need to be able to make their own decisions”.

Among other things, Labour’s rainbow policy says the party will (emphasis mine):

“improve access to affordable primary care based on the informed consent model, particularly for younger, trans, and intersex New Zealanders. This also includes training and resources for health professionals about sexual orientation and gender diversity“

Māori

A somewhat bizarre press release from “New Image Group” in June asserted that the Māori Party opposes the Natural Health Products Bill, though I haven’t found anything directly from the Māori Party about this. They voted yes at its second reading, and at its first reading in 2011 current party co-leader Te Ururoa Flavell said: “the public should be and can be confident that products are safe and are true to what has been stated on the label.”

The Māori Party supported a call in 2016 for parents or caregivers to be notified when someone under 16 had an abortion. As far as I can find, they don’t have a stance for or against abortion law reform in terms of removing it from the Crimes Act.

The Māori Party doesn’t have a specific LGBT policy, or anything addressing trans New Zealanders’ access to currently gated healthcare.

National

The National Party has been involved in the development of the Natural Health Products Bill and have supported its passage so far. Though National Party MPs were quick to mock the Green Party in response to Steffan Browning’s homeopathy incident in 2014, with them PM John Key calling him “barking mad”, they have their own dirty secret when it comes to endorsements of quackery. In an interview in 2016, National Party MP Maureen Pugh said “there’s nothing wrong with getting a cold or getting a flu” and revealed that she only ever gives her children chiropractic care. Many chiropractors make a lot of claims about various ways in which they can treat children, and these claims are typically false. It’s the antithesis of informed consent, and I personally hope the National Party will never let her be involved with anything related to health.

National Party leader Bill English is a staunch Catholic, and personally opposes decriminalising abortion. He has said that a National government would not “liberalise” abortion law because it’s a “law that’s stood the test of time”.

The National Party doesn’t have a specific LGBT policy, or anything addressing trans New Zealanders’ access to currently gated healthcare.

NZ First

NZ First has called for the Natural Health Products Bill to be scrapped, saying the regulation is “adequately provided for under other legislation”. For what it’s worth, I think that’s untrue and I wrote about why on The Spinoff in May.

NZ First’s health policy also says this:

“NZ First will… Consult with the natural health industry and other stakeholders to ensure there is an appropriate regulatory regime for complementary medicines.”

I’m not really clear on what their plan is here. They apparently think new regulation is unnecessary because we already have good legislation, but also would look into making sure there is an appropriate regulatory regime.

NZ First doesn’t seem to have a policy on abortion. When asked by Michelle Duff in July, NZ First MP Tracey Martin said she would be hesitant to remove abortion from the Crimes Act, though she considers herself pro-choice.

NZ First supported a petition in 2016 that called for parents or caregivers to be notified when someone under 16 had an abortion.

If NZ First has had anything to say on trans New Zealanders’ access to currently gated health services, I haven’t been able to find it.

TOP

I haven’t been able to find any position from the TOP Party on access to gated healthcare like abortion and transition treatments. They also haven’t had the opportunity to vote on the Natural Health Products Bill, and as far as I can tell they’ve never commented in that area.

United Future

The United Future Party has had little to say on the Natural Health Products Bill, but they have supported it.

Peter Dunne, who has been the United Future Party’s leader since 2002 but is stepping down with this election, has previously expressed support for abortion law reform. In a 2008 interview with Scoop’s Gordon Campbell, Dunne said:

“I think probably, you should be looking at the woman, her doctor and informed consent. I have a very strong view that – and I appreciate the moral issue involved here – but the moral issue is actually the individual’s morals. I don’t think it’s a matter of the state imposing a moral code.”

However, in 2014 United Future Party president Damian Light responded to questions from ALRANZ (Abortion Law Reform Association of New Zealand) to say:

“We don’t have a policy on [the removal of abortion from the Crimes Act], so it would be a conscience vote for United Future MPs.”

The United Future Party’s LGBT+ policy says the party will (emphasis mine):
“Ensure trans and gender diverse people’s access to gender affirming health services based on an informed consent model of healthcare. Where not available in New Zealand, provide sufficient funding to enable timely access.”

Conclusions

The Green, Labour, and United Future parties are the only ones that put a focus on changing to an informed consent model of healthcare for transgender New Zealanders. The Greens and Labour also have strong stances on removing abortion from the Crimes Act, whereas United Future’s stance on this is less certain. Likewise, these three parties have all shown support for the Natural Health Products Bill, with the Green Party having the closest involvement with it.

On the other hand, the National Party remains conservative on abortion, and doesn’t have any policy regarding access to gated healthcare for transgender New Zealanders. New Zealand First seems to be the only party that has gone so far as to actively oppose the Natural Health Products Bill, though ACT and possibly the Māori Party may not be too far behind them on that front.

Informed consent in healthcare is one of the things I’ll be considering when I vote this September, and I mean to continue doing my best to hold whatever government we end up with accountable on it after the election as well. I hope you’ll join me in this.

Mark Hanna (pronouns he/him) is the chair of a volunteer activism group, the Society for Science Based Healthcare, which works to counter misinformation about health services based on the idea that everyone has a right to make informed decisions about their healthcare. He also cares about issues of equality, and tries to do the right thing. You can read more about health regulation, science, and other topics Mark thinks are important at http://www.honestuniverse.com

[1] I say “pregnant people” instead of “women” because it is an issue that affects everyone with a uterus. This also includes trans men and nonbinary people who have a uterus.

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