Editorial: Principles and Process: Lessons from Winter

Issue 22, August 2007

"The principles of partnership, participation and protection of resources contained in the Treaty of Waitangi cannot be ignored in any debate which brings us so close to the heart of human existence and our relationship to the whole of nature..."

--New Zealand Catholic Bishops' Conference Submission to the Royal Commission on Genetic Modification – 2000

In the opening address of his November 1986 tour of New Zealand Pope John Paul II described culture as "the first voice of the sacred." As shared systems of meaning and as rich templates for the celebration of life and death, birth and ritual, worship and service, cultures become the wellspring or soil into which the Gospel is received. Ideally such a process is mutually enriching and beneficial.

The increased use of Māori phrases is a reality in everyday conversation, in media reports, in cultural events and in sacred liturgy. This was clearly evidenced throughout Aotearoa in the use of "Te Reo - the Māori language" in the annual Māori Language Week recently, leading several commentators to remark that New Zealanders are becoming "more comfortable" with our bicultural heritage.

Such heritage and cultural sensitivity are increasingly in evidence in clinical practice in our nation's healthcare. For example, the ethical principles of partnership, protection and participation, which originate from New Zealand's Treaty of Waitangi, play a central role in the use of innovative treatment and in all healthcare research.

While "language weeks" help to raise awareness of possibility, and remind us of their necessity the effect of these events can remain cosmetic and superficial. Similarly ethical principles, which provide a necessary framework for healthcare delivery and for ethical practice in healthcare, require application if the culture of medicine is to be renewed and enhanced. Medicine is a science as well as an art. The ethical and cultural principles of participation, protection and partnership provide a rich backdrop for the healer's art when they are integrated into best practice.

Those coming to terms with a terminal or chronic illness may be overwhelmed by feelings of abandonment and hopelessness. In these circumstances particularly, communication and the giving of bad news requires great sensitivity. When truth-telling is done with sensitivity it becomes a model of partnership in practice. The truth can be harsh and shattering for patient and family alike. Nevertheless the telling of it need not be brutal!

Similarly the care of those living with chronic illness or diminished decision-making capacity, when done with sensitivity and compassion, becomes a form of protection in practice. The need for such protection is especially apparent when the elderly and terminally ill are admitted to an emergency department. Protection in practice not only includes thorough diagnosis, but also, and equally, adequate referral. Even given the pressures on the healthcare system in New Zealand, a two-three day stay in an overcrowded emergency department does not equate with the protection afforded by an in-patient hospice or designated palliative care bed.

In healthcare the ethical and cultural principles of partnership, protection and participation must be expressed in practice at the interface between the patient and healthcare system. This will only happen if adequate attention is given to them at all levels, from public consultation to allocation of resources and personnel.

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Rev Michael McCabe, PhD
Director
The Nathaniel Centre