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Professional Codes Of Ethics

Health Practitioners Competence Assurance Bill: Professional Codes Of Ethics

The Association of Salaried Medical Specialists (ASMS) is the professional union that represents salaried senior doctors and dentists, the large majority of which are employed by district health boards. This is the fourth issue of our Parliamentary Briefings to MPs that outlines our concerns on the Health Practitioners Competence Assurance (HPCA) Bill supplementing our previously forwarded Issues Paper. The previous Parliamentary Briefings covered why we believed the Medical Practitioners Act should not be repealed and the appointment of members of registration authorities. This issue discusses our concerns over professional codes of ethics. We hope MPs will give the points raised below serious consideration and that you will take them into account when the HPCA Bill proceeds to its committee stages.

The HPCA Bill makes the setting of ‘standards’ of ‘ethical conduct’ the responsibility of the registering authorities (Clause 114), the Medical and Dental Councils in the case of medical and dental practitioners.

The intention of this clause may not be unreasonable as the Councils already do much of this type of work. However, the specific wording creates confusion over interpretation in relation to the role and status of codes of ethics developed by health professions. Currently, for example, the medical, dental and nursing professions have developed their own code of ethics that form a valuable part of the resource that the courts and relevant statutory bodies draw upon in their deliberations.

In the case of medicine, the code of ethics is developed for the medical profession, following consultation with and the consent of other medical groups, by the NZ Medical Association. The NZ Dental Association performs a similar role in dentistry.

However, the wording of Clause 114 (i), lends itself to an apparently unintended interpretation that the registration authority (in this case Medical or Dental Council) could set a profession’s ethical code.

This would destroy an important check on the power of government, especially when coupled with the Minister of Health appointing the membership of the authorities. It is inappropriate and unwise to have this function of setting ethical codes performed by a statutory body, whether or not it is largely and possibly wholly politically appointed.

The medical and dental professions are accountable and responsible to its ethical codes but the Medical and Dental Councils are neither accountable to nor responsible for the medical and dental professions.

Instead the Councils’ accountabilities and responsibilities are derived from statute. In the event that the registration authority was able (as under the proposed Bill) to set the medical or dental professions’ ethical codes, it is likely that the medical and dental professions would continue to develop their own regardless. Potentially there could be two codes in competition thereby risking confusion and uncertainty in future interpretations and deliberations including in the judiciary.

There are three possible ways of avoiding this unintended confusion and to differentiate standards appropriate set by the relevant Council from codes of ethics developed by the relevant profession.
First, Clause 114 could be amended to read:

(i) to set standards of clinical competence and cultural competence and monitor standards of ethical conduct developed by the profession.

Second, the words ‘ethical conduct’ in Clause 114 could be replaced with ‘professional conduct’.

Third, Clause 114 could remain unchanged but renumbered sub-section (1) and a further sub-section (2) be added:

Sub-section (1) (i) does not include codes of ethics developed by health professions.
All three options above are minor amendments that do not detract from the intent of Bill but better clarify it and avoid the confusion and unintended consequences discussed above. The ASMS recommends that MPs adopt one of these options during the committee stages of the Bill.

Ian Powell


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