The Front Page: Ethnicity in healthcare: Is Te Whatu Ora’s new policy ethical?

News that Auckland surgeons are now required to consider a patient’s ethnicity when deciding who should get an operation first sparked sharp debate around the country.

Politicians and medical professionals have quickly weighed in, with some saying the Equity Adjuster Score introduced by Te Whatu Ora (Health New Zealand) was indefensible given the weight it affords to the ethnicity of patients.

Supporters have, however, pointed out that ethnicity is just one of several factors being considered alongside clinical priority, time spent on the waitlist, geographic location and deprivation level. And they further argue that Māori and Pacific Island communities continue to suffer poor health outcomes in New Zealand.

So where does the ethical line lie on this issue? Can this move be ethically justified, particularly given the divisiveness sparked by these revelations?

Addressing those questions on The Front Page podcast, University University of Auckland associate professor Monique Jonas, an expert in healthcare ethics, says it’s important to remember this isn’t a case of ethnicity suddenly being introduced in an area where it wasn’t a consideration in the past.

“Ethnicity already is a factor in treatment decisions in New Zealand,” Jonas says.

“We don’t want it to be like that, but it is. To pretend otherwise is just to kid ourselves. Ethnicity matters when it comes to healthcare in New Zealand, so what we have to try to do is use our knowledge of that to create equitable outcomes. I think that’s what everybody wants. They don’t want advantage for some groups and disadvantage for other groups.”

Research has shown that health outcomes vary across ethnic groups, with Māori having a seven-year shorter lifespan than non-Māori.

Jonas says there are myriad studies and examples showing that medical professionals aren’t always as objective as we’d like to believe - and this applies to both ethnicity and gender.

“One example that concerns gender relates to women’s experience of endometriosis, which can be a very painful, prolonged and seriously debilitating condition for some women. And what women find is when they report their symptoms, they’re not always given full weight by doctors. They might not be believed. They might be seen as exaggerating these symptoms. And that speaks to the way we identify with individuals that seem close to us, whose experiences seem like us and whose experiences we can understand. And when we can’t understand people’s experiences because they’re different from us, it becomes much easier to approach them with a sense of moral distance that means we don’t activate all our compassion.”

Most often, these judgments aren’t made on purpose, with Jonas explaining that it often comes down to unconscious bias.

Jonas explains clinicians aren’t precluded from the impact of unconscious bias and are just as likely as the general population to make certain assumptions or judgements without realising it.

“Just recently I was speaking with a clinician who told me that In a clinical setting, some of their colleagues said extremely racist things quite openly among other clinicians, and students also report the same thing to me,” says Jonas.

“One can only imagine that those sentiments colour some of the decisions that they make. When it comes to unconscious bias, we make judgements that we are totally unaware of. We bring our stereotypes, our tropes about other people that we don’t think are like us to our interactions in ways that we don’t even realise.”

To hear answers to all these questions, listen to the full episode of The Front Page podcast.

The Front Page is a daily news podcast from the New Zealand Herald, available to listen to every weekday from 5am. It’s presented by Damien Venuto, an Auckland-based journalist, with a background in business reporting, who joined the Herald in 2017.

You can follow the podcast at iHeartRadio, Apple Podcasts, Spotify, or wherever you get your podcasts.