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Ron Paterson
In her 1988 Report of the Cervical Cancer Inquiry, Judge Silvia Cartwright noted that "old habits and attitudes" had provided a sense of security for the medical professionals and administrators "buffeted by the cold winds" of the Inquiry.1 Her far-reaching recommendations sought to change the regulatory landscape for patient care and research. They were a full-frontal challenge to the medical establishment, and to the model of professional autonomy and self-regulation that held sway in New Zealand. The judge said that "[t]he focus of attention must shift from the doctor to the patient",2 and made detailed recommendations to effect fundamental change.
All too often, the recommendations of major inquiries garner brief media attention, before gathering dust and being quietly shelved by officials. Inaction may be well advised; lawyers undertaking a one-off inquiry, unfamiliar with the subject matter of the inquiry, may make recommendations that are ill-conceived or impractical. And even recommendations that "hit the mark" may still be ignored. Once the inquiry body is functus officio, and the media spotlight shifts to other issues, inertia, discrete lobbying from vested interest groups, and a lack of political nerve will often lead to cosmetic change but no significant reform.
Yet from the vantage point of over two decades later, it is clear that the Cartwright Inquiry resulted in major and enduring changes to the legal and health systems in New Zealand. Why did this inquiry lead to such a seismic shift in the relationship between doctors and patients, and the medical profession and the community? What is Cartwright's legacy in the early 21st Century?
Changing times
In the 1970s and 1980s, feminism, women's health activism, and a broad range of social movements were challenging traditional norms and changing the fabric of New Zealand society. This was fertile ground for the Cartwright Inquiry. As Joanna Manning notes, "public attitudes to the medical profession were undergoing a transformation", and the Inquiry and Report "both reflected and accelerated these evolving attitudes".5
The teaching and practice of medicine was slow to react to societal changes, and the New Zealand legal system in the late 1980s provided no incentive for reform. Patients' rights (in particular the right to make an informed choice about medical treatment) were slow to develop in New...