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The authors of this letter are currently engaged in revising "Medical Students and informed consent: A consensus statement prepared by the Faculties of Medical and Health Science of the Universities of Auckland and Otago, Chief Medical Officers of District Health Boards, New Zealand Medical Students' Association and the Medical Council of New Zealand".1 We disagree with Dr Gray's2 proposal that the consensus statement1 is flawed. Gray argues the consensus statement is couched in ethical terms that prioritise patient autonomy, which is inconsistent with the approach of balancing the quadruple aim of quality medical practice.3 The quadruple aim encompasses improving population health, patient experience, healthcare team wellbeing and reduced costs.3 What Gray does not acknowledge is the Code of Health and Disability Services Consumers' Rights,4 as set out in the Health and Disability Commissioner Act 1994,5 is the law in Aotearoa New Zealand. Thus, the consensus statement on medical students and informed consent was written to reflect the law in the most pragmatic way possible. In particular, Right 6, the "right to be fully informed", and Right 7, the "right to make an informed choice and give informed consent".
We make no apology for supporting patient autonomy in the consensus statement. Patients have an ethical and legal right to understand "who, how and why" will be engaged in their healthcare-particularly if it is for learning. Gray does not acknowledge the distinction made in the consensus statement between involvement of students primarily for the benefit of their education, and involvement that may occasionally be necessary for the care of patients, such as when a qualified clinician is unavailable at a cardiac arrest. Doctors have an ethical and legal duty to ensure patients and their whanau are fully informed to the extent practicable in the circumstances. A student's need to be educated does not trump this duty. Patients should understand what their healthcare will involve, by whom and for what purpose, and have an input into these decisions. Such informed...