An Ethical Conundrum:
It remains clear from a medical and ethical perspective that scores of women received insufficient medical treatment for their cervical carcinoma in situ by Dr. Herbert Green, causing many of these women to unnecessarily suffer and occasionally die[1]. Green’s medical dealings towards the afflicted women in these cases were found to be deceitful and dishonest, lacking the integrity and virtue of proper medical care. Such was validated by Judge Silvia Cartwright at the conclusion of the Cartwright Inquiry between 1987-1988[2]. Poor medical practices- including health professionals failing to act, and a healthcare system buoyed down with ethical misconduct through a lack of informed consent- were tolerated statewide and ultimately provided the impetus for an inquiry. For centuries, there has been a history of medical professionals placing their professional ego above the livelihood of the patient. From doctors snatching corpses from graves, to retaining organs from infants post-autopsy for experimental research[3], medical progress has historically come at a human cost. The ‘Unfortunate Experiment’ at the National Women’s Hospital is no exception.
Professional Negligence:
Dr. Green’s position was problematised as his medical notes articulated significant gaps between what he and his colleagues had practiced, and what he had said during the inquiry. These clinical notes exposed delays in the treatment of carcinoma in situ by months and years[4]. Within these notes, investigators described how biopsy results classified as ‘strongly suggestive’ or even ‘malignant’ were ignored, with many patients tracked for years as their cancers grew malevolent and severe[5]. Similarly, Green’s reports described how action was at times only taken once the patient had symptoms equivalent to aggressive cancer of the vagina and/or cervix. By this time, the cancer had spread so aggressively that any form of intervention was problematic or almost inoperable[6]. Within the inquiry’s findings, Judge Cartwright concluded that the potential hazards and vulnerabilities of the experimental research could be discerned as early as 1967. As such, this gave Cartwright greater evidence to prove Green’s professional negligence towards his patients[7]. Green’s failure to act in an ethical or efficient manner- by using his patients for research at the cost of their lives- ultimately resulted in a failure of care and trust in his role as a medical professional.
Informed Consent:
Similarly, Cartwright believed this experimental research was unethical, as none of the patients had been given the right to informed consent; rather, they had been included in the research study without their knowledge or approval of the experiment in its entirety. As such, no adequate measures were in place to protect their health and safety. Despite evidence that women in ‘treatment’ began to die from invasive cancer, Green kept practicing his research[8]. Whilst informed consent was not as thoroughly monitored or understood during this time, scholars such as Manning suggest international legislation -such as the Declaration of Helsinki (1964)- clearly outlined how consent could only be achieved through an full, transparent and accessible explanation of the trial’s risks and objectives[9].
The problem of Internal Morality:
The complicit negligence between Green and his colleagues brought the National Women’s Hospital into disrepute, and brought forth the virtue of internal morality as it existed within the medical profession in New Zealand. Scholars have probed the concept of internal morality (or the shared norms, rules and values that remain essential to medical pursuits and practice) in relation to this case[10]. Paul describes the necessary community of health practitioners (doctors, nurses etc.) that forge the concept and practice of internal morality in a clinical setting[11]. At its conclusion, the Cartwright Inquiry illustrated the failings of internal morality within the New Zealand healthcare system. Whilst internal inquiries were established as a result of concerns over patient wellbeing, they did not recommend stopping the trial despite evidence women had developed malignant cancers. Post-1975, the rate of carcinoma in situ declined, however those patients diagnosed before this time were still inadequately treated beyond this period[12].
References:
[1] Ron Patterson, “The Cartwright Legacy: shifting the focus of attention from the doctor to the patient”, The New Zealand Medical Journal, 123, 119 (2010): 6-10.
[1] Patterson, “Cartwright Legacy,” 7.
[1] David Hall and J.S. Lilleyman, “Reflecting on Redfern: What Can We Learn from the Alder Hey Story?”, Archives of Diseases of Childhood 84 (2001): 455-456
[1] Phillida Bunkle, “Patient-centred ethics, the Cartwright Inquiry and feminism: Identifying the central fallacy in Linda Bryder, A History of the ‘Unfortunate Experiment at National Women’s Hospital”, Women’s Studies Journal, 24, 2 (2010): 8-24.
[1] Bunkle, “Patient-centred ethics”, 13.
[1] Bunkle, “Patient-centred ethics”, 13.
[1] “An Unfortunate Revision”, Chris Barton, NZ Herald, last modified August 15 2009, http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10590850.
[1] “Controversy over the ‘unfortunate experiment’ ”, Anne Else.
[1] “An Unfortunate Revision”, Chris Barton.
[1] Charlotte Paul, “Internal and external morality of medicine: lessons from New Zealand”, British Medical Journal, 320, 7233 (2000) : 499-503.
[1] Paul, “Internal and external morality,” 499.
[1] Paul, “Internal and external morality,” 500.
The Cartwright Inquiry 