Background

 

Introduction

“The Unfortunate Experiment at The National Women’s Hospital” was the title of a magazine article published the New Zealand “Metro Magazine” in 1987 written by Sandra Coney and Phillidia Bunkle. The article made several allegations against an experimental research program that had been undertaken at the National Woman’s hospital.[1] The most severe of these allegations was that women had died as a result of participation. Due to these allegations, a National inquiry led by Judge Silvia Cartwright was established. The report of the committee of inquiry was released in August of 1988, providing a detailed analysis of the events as well as its recommendations.

The experiment

The basis of the experiment was to study the natural course of cervical cancer – carcinoma in situ. Dr Green was not convinced that carcinoma in situ would result in invasive cancer.[2] The experiment was overseen by Dr. Herb Green over the course of two decades from 1955-1976 and conducted in the National Women’s hospital. During this time period, approximately 948 women were involved. [3]

The experiment began with a pap smear. A papsmere is a method of cervical screening to detect any cancerous or precancerous cells in the cervix. People who tested positive were given a cone biopsy, in which a segment of tissue was removed for further investigation. Although these women tested positive, they were not notified nor given any treatment; but instead were monitored over the course of two years. [4]

The findings

The report confirmed the article published by the Metro Magazine, supporting the claim that there was inadequate treatment for the disease carcinoma in situ. Dr. Herbert Green was never brought before medical disciplinary authorities, and eventually 19 women who took legal action received an out of court settlement. [5]

There were many social and legal ramifications that resulted from this trial. The Cartwright report had two focal points: protecting the rights of the patient, and implementing a national screening program for cervical cancer. [6]

The Cartwright Report resulted in:

  • Greater protection for patients involved in treatment or research
  • In the fifth term of reference of the final chapter of the court report, Judge Cartwright made significant recommendations to ‘improve the rights of patients in respects to research and/or treatment.’
  • Many of these suggestions focused upon involving the patients more in their treatment.
    • ‘Written and visual material should be prepared for patients…[to] help the patient’
    • ‘General information on therapeutic or non-therapeutic research should be offered to all patients whose permission is sought for the trial.’
  • Implementation of a national screening program in New Zealand
    • ‘A nationally planned population based screening program should be implemented urgently. There should be a full consultation with consumer groups.’

Historical Context  

The Cartwright enquiry occurred during a wave of ‘rights’ movements across the United States. The 60s and 70s marked a time period where women, homosexuals and African-Americans fought for the right to equality. The feminist health movement presented itself as a challenge to the social and medical dominance of doctors during the time. In order to challenge the patriarch of the medical profession, Women’s Health advocates and groups dedicated themselves to empower women and to be active partners in their health care. [7]

Groups who were influenced by the initiatives of women in Great Britain and the United States appeared in Wellington and Auckland, eventually spreading across New Zealand. Phillida Bunkle, one of the writers of the ‘Unfortunate Experiment,’ is a woman’s rights activist herself.[8] Her article is an expression of feminism that challenged a patriarchal structure and restructured the medical profession. The Cartwright Inquiry not only represents a major leap forward for the rights of patients in New Zealand, but also a leap forward for the rights of women, worldwide. [9]

Tuskegee Syphilis Study 

The infamous Tuskegee Syphilis study is a very similar to the Cartwright Inquiry in terms of circumstances and outcomes. The study ran over a period of 40 years from 1932 to 1972 by the U.S Public Health Service to investigate the natural course of syphilis.[10] The controversy stemmed from the study’s lack of ethical procedure. This included failing to inform as well as treat those who were infected by the disease.

Partly in response to the study, the National Commission for the Protection of Human Subjects of Biomedical and Behavioural research released the ‘Belmont Report’ in 1978. The report summarises the ethical principles and guidelines for research involving human subjects. The report has an emphasis upon protecting the rights of patients as evident in its three core pillars: respect for persons, beneficence and justice. [11]

Upon analysing and comparing the two case studies, there are important similarities to be drawn:

  • Both cases involved a minority group that were exploited in pursuit of biomedical advancement
  • Both cases resulted in legal recognition for the rights of the patient
  • Both cases were legally resolved during the 70s

References

[1] Coney, Sandra; Bunkle, Phillida (June 1987). “An Unfortunate Experiment at National Women’s” (PDF). Metro. Auckland. pp. 47–65. Retrieved 23 August 2016. P.47 

[2] Joanna Manning (2009) The Cartwright papers: essays on the cervical cancer inquiry, 1987-88, Wellington, N.Z: Bridget Williams Books, Ltd.. p.11

[3] Manning 2009 p.942

[4] Manning 2009 p. 130

[5] Bryder, Linda (2009). A history of the ‘unfortunate experiment’ at National Women’s Hospital. Auckland, N.Z.: Auckland University Press. ISBN 9781869404352. P. 170 

[6] Cartwright, Silvia (5 August 1988). The Report of the Committee of Inquiry into Allegations Concerning the Treatment of Cervical Cancer at National Women’s Hospital and into Other Related Matters. Auckland: Government Printing Office. ISBN 0-473-00664-2. P. 212-215

[7] Collins, Gail. America’s Women: 400 Years of Dolls, Drudges, Helpmates, and Heroines. New York: Harper Collins, 2004 p149-160

[8] Bunkle, Philidia, Women’s Studies Journal, Volume 24 Number 2, November 2010: 8-24. ISSN 1173-6615 p.2

[9] Bunkle 2010 p.3

[10] “Tuskegee Study – Timeline”. NCHHSTP. CDC. June 25, 2008. Retrieved October 21, 2016.

[11] Office of the Secretary, United States Department of Health, Education and Welfare (18 April 1979). “Protection of Human Subjects; Notice of Report for Public Comment” (PDF). Federal Register. 44(76): 23191–7.