On October 17, I received a brief email from a former Association of Salaried Medical Specialists (ASMS) vice-president: “Can’t wait for your blog covering the reception of Simeon Brown at conference yesterday!!”

The context was the aggressive address of Minister of Health Simeon Brown to the ASMS annual conference.

As reported by Radio New Zealand’s Ruth Hill (October 16), Brown accused senior doctors of crossing an “ethical line” by taking strike action involving non-acute care.

• READ MORE: Simeon Brown accuses doctors of crossing ‘ethical line’ with mega strike
  
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His accusation was made in the lead up to the “mega strike” of around 100,000 senior doctors, nurses, teachers and public servants on October 23.

It included misleadingly Brown claiming that patients were paying the price for the strike action and that ASMS had walked “away from negotiations”.

Further, he added, “Patients should never be collateral damage in disputes between management and unions.” He urged ASMS to call off the strike action and return to negotiations (conveniently ignoring that it never left them).

Clicking my heels – but how?
As the ASMS executive director until 31 December 2019, what could I do but click my heels and obey the former vice-president. But this left me with a problem of what to focus on in a short blog.

The Health Minister had raised several options.

One was the fact that his address, reinforced by Public Services Minister Judith Collins’ stridently inaccurate “attack dog open letter” attack on the health and education unions (October 19) is the most aggressive and hardline government approach towards health unions, at least, since I first became involved with the newly formed ASMS in 1989.

Another was the deliberate use of misleading claims such as Brown accusing ASMS of not being prepared to negotiate while, at the same time, Health New Zealand was refusing to meet ASMS to discuss negotiations. Also deliberately misleading was his false claim about senior doctors’ average salaries.

Eventually I landed on the accusation that triggered much of the media interest and most of the criticisms from ASMS conference delegates — Brown’s claim that senior doctors were crossing an ethical line.

Understanding medical ethics
As Ruth Hill reported there were “audible cries of disbelief” from the delegates. Also see Stuff journalist Bridie Witton’s coverage (October 16).

Let’s get back to basics. Ethics is the branch of knowledge that deals with moral principles that govern a person’s behaviour or the conducting of an activity.

Following on, medical ethics is the disciplined study of morality in medicine and concerns the obligations of doctors and healthcare organisations to patients as well as the obligations of patients.

Medical ethics starts with the Hippocratic Oath beginning with its first principle of ‘first do no harm’.

As part of an earlier post on the ancient Oath and this principle (5 February 2022) I argued that not only were they still relevant today, but that they should be applied to the whole of our health system, including its leadership.

Who really crossed the ethical line?
Dr Elizabeth Fenton is a lecturer in bioethics at Otago University. On October 22 she had an article published in The Conversation that shone a penetrating analytical light on Simeon Brown’s ethical line crossing claim.

Her observations included:

“Striking is an option of last resort. In healthcare, it causes disruption and inconvenience for patients, whānau and the health system – but it is ethically justified.

“Arguably, it is ethically required when poor working conditions associated with staff shortages, inadequate infrastructure and underfunding threaten the wellbeing of patients and the long-term sustainability of public health services.

” . . . The real ethical issue is successive governments’ failure to address these conditions and their impact on patient care.”

In response to the health minister’s implication that striking doctors are failing to meet their ethical obligations to provide healthcare, she noted that:

“These are the same doctors who, alongside nurses, carers and allied health professionals, kept New Zealand’s health system functioning during the COVID pandemic in the face of heightened personal risk, often inadequate protections and substantial additional burdens.

“While the duty of care is of primary ethical importance, codes of ethics also recognise doctors’ duties to all patients, and responsibilities to advocate for adequate resourcing in the health system. These duties may justify compromising care to individual patients under the circumstances in which industrial action is considered.”

Further, doctors:

“. . . are striking because their ability to meet these obligations [to provide high quality care] is routinely compromised by working conditions that contribute to burnout and moral injury – the impact of having to work under circumstances that violate core moral values.

“A key goal of the industrial action is to demand better conditions for clinical care, such as safe staffing levels, that will benefit patients and staff and improve the health system for everyone.”

The penultimate final word
In the context of Dr Fenton’s incisive analysis, as reported by Ruth Hill in her above-mentioned RNZ item it is appropriate to leave the penultimate final word to the response of senior doctors at the ASMS annual conference to Simeon Brown’s ethical line crossing accusation. These comments were made in among their boos and groans.

ASMS president and Nelson Hospital anaesthetist Dr Katie Ben said:

“We have now taken to putting the number of times the patient has been cancelled on the operating list to ensure the patient doesn’t get cancelled for the fourth, fifth or sixth time. Non-clinical managers were cancelling planned care because they could not fill rosters.”

Waikato Hospital rheumatologist Dr Alan Doube said many people (with crippling chronic conditions) did not even get a first specialist appointment (FSA).

“In Waikato, we decline regularly 50 percent of our FSA so we can provide some kind of sensible ongoing care.”

Emergency medicine specialist Dr Tom Morton at Nelson Hospital added:

“Our ED waiting time have blown out with more than doubling of patients leaving without being seen, which I think is a significant marker of unmet need that’s not being recorded or reported on officially.”

The ultimate final word: nailing who crossed an ethical line
In a subsequent RNZ item (October 17), the Health Minister threatened a law change to remove senior doctors’ right to strike: Right to strike threatened.

The reported response of leading patient advocate Malcolm Mulholland nailed who was crossing the ethical line. Describing Simeon Brown’s threat as “pathetic”, he added:

“I think the reason why our doctors and our nurses are striking is because there’s just simply not enough staff. I don’t know how many times they have to tell him until they are blue in the face.

“You know, all this talk about crossing an ethical line, I would say, ‘take a look in the mirror, minister’.”

Indeed Health Minister — look in the mirror! It is the striking doctors who are acting in accordance with the Hippocratic Oath and adhering to the principle of “first do no harm”. It is the Health Minister who is not.

Ian Powell is a progressive health, labour market and political “no-frills” forensic commentator in New Zealand. A former senior doctors union leader for more than 30 years, he blogs at Second Opinion and Political Bytes, where this article was first published. Republished with the author’s permission.

Striking senior New Zealand doctors have hit back at the Health Minister’s attack on their union for “forcing” patients to wait longer for surgery and appointments, due to their 24-hour industrial action.

Respiratory and sleep physician Dr Andrew Davies, who was on the picketline outside Wellington Regional Hospital, said for him and his colleagues, it was “not about the money” — it was about the inability to recruit.

“We’ve got vacant jobs that we’re not allowed to advertise,” he said. “It’s lies that they’re not getting rid of frontline staff.

• READ MORE: Gallery: Doctors, health workers challenge NZ government over national crisis

“The job is technically there on paper, but if you’re not going to advertise for the job, you’re not going to fill it.

“In our department, we’ve waited months and months and months to fill some jobs, and you don’t just get a doctor next week. It takes six months for them to come.”

Dr Davies said no-one wanted to strike and have their patients miss out on care, but thousands of patients were already missing out on care every day, due to staff shortages.

“Every week, we’ve got empty clinics,” he said. “There is space in the clinics that’s not being used, because there’s not a doctor in the chair there.

“While, today, that’s 20 percent of the work of the week gone, because we’re on strike, in some departments, it’s 20 percent every week.

“Every day of the week, there’s a 20 percent deficit in the number of patients people are seeing.”

5500 doctors on strike
Nationwide, about 5500 members of the Association of Salaried Medical Specialists are on strike until 11:59pm today, causing the cancellation of about 4300 planned procedures and specialist appointments.

In a social media post, Health Minister Simeon Brown blamed the union for the disruption, saying an updated offer last week — including a $25,000 bonus for those moving to “hard-to-staff regions” — was rejected by the union, before members even saw it.

Union executive director Sarah Dalton said she would be very happy to facilitate a meeting between doctors and the minister — or he could accept the invitation to attend its national conference.

“They would love to feel like someone up there was listening,” she said. “They don’t at the moment.

“We need to move away from rhetoric, and actually have some time and space for meaningful discussion.

“That’s one of the reasons we’re on strike today. After eight months of negotiating, there was nothing on the table from the employer.

“It was only after we called for strike action that anything changed, so let’s do better.”

Critical workforce shortages were undermining patient care and the current pay offer, which amounted to an increase of less than one percent a year for most doctors, would do nothing to fix that, Dalton said.

“How do you tackle vacancies? You put more time and effort in good terms and conditions for your permanent workforce, and you stop spending spending $380 million a year on locums and temps.

“We shouldn’t have that heavy reliance on those people, so we’ve got to change it.”

NZ training doctors for Australia
After many years of study subsidised by the New Zealand taxpayer, Maeve Hume-Nixon recently qualified as a public health specialist, but may yet end up going overseas.

“I actually thought last year that I would have to go to Australia, where I would be paid another $100,000 minimum, because there were no jobs for me here, basically.

“In the end, I managed to get an emergency extension to my contract and this has continued, but I don’t have security and it’s a pretty frustrating position to be in.”

Neurologist Dr Maas Mollenhauer said he was not able to access the tests he needed to provide care for his patients.

“I’ve seen patients that I have sent for urgent imaging, but they didn’t receive it, and then I got an email from one of my colleagues who was on call, telling me that patient had rocked up to the Emergency Department and, basically, the front half of their skull was full of brain tumour.”

Cancer patients waiting too long
Medical oncologist Dr Sharon Pattison said the health system had reached the point where it was so starved of people and resources, it had become “inefficient”.

“Everyone is waiting for everything, so everything takes longer, and we are waiting until people get seriously ill, before we do anything about it.”

The government’s “faster cancer treatment time” target — 90 percent of patients receiving cancer management within 31 days of the decision to treat — would not give the true picture of what was happening for patients, she said.

“For instance, if I have someone with a potential diagnosis of cancer, there are so many points at which they are waiting — waiting for scan, waiting for a biopsy, waiting for a radiologist to report the scan to show us where to get the biopsy.

“That radiologist may be overseas, so if I want to talk to that specialist I can’t do that. Then the wait for a pathologist to report on the biopsy can now take up to 6-8 weeks.

“We know that, for some people with cancer, if you wait for that long before we can even make your treatment plan, we’re going to make your outcomes worse.

“The whole system is at the point where we are making people more unwell, because we can’t do what we should be doing for them in the framework that we need to.”

This article is republished under a community partnership agreement with RNZ.

When New Zealand’s opposition National Party’s transport spokesperson, Simeon Brown, questioned the logic of bilingual traffic signs, he seemed to echo his leader Christopher Luxon’s earlier misgivings about the now prevalent use of te reo Māori in government departments.

Genuine concern or political signalling in an election year? After all, Luxon himself has expressed interest in learning te reo, and also encouraged its use when he was CEO of Air New Zealand.

He even sought to trademark “Kia Ora” as the title of the airline’s in-flight magazine.

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And for his part, Brown has no problem with Māori place names on road signs. His concern is that important messaging about safety or directions should be readily understood. “Signs need to be clear,” he said.

“We all speak English, and they should be in English.” Adding more words, he believes, is simply confusing.

It’s important to take Brown at his word, then, with a new selection of proposed bilingual signs now out for public consultation. Given the National Party’s enthusiastic embrace of AI to generate pre-election advertising imagery, one obvious place to start is with ChatGPT, which tells us:

Bilingual traffic signs, which display information in two or more languages, are generally not considered a driver hazard. In fact, bilingual signage is often implemented to improve safety and ensure that drivers of different language backgrounds can understand and follow the traffic regulations.

ChatGPT also suggests that by providing information about speed limits, directions and warnings, bilingual traffic signs “accommodate diverse communities and promote road safety for all drivers”.

‘They should be in English’: National to ditch te reo Māori traffic signs https://t.co/7FGYyQDrPu

— RNZ News (@rnz_news) May 26, 2023

Safety and culture
With mounting concern over AI’s potential existential threat to human survival, however, it’s probably best we don’t take the bot’s word for it.

Fortunately, government transport agency Waka Kotahi has already examined the use of bilingual traffic signs in 19 countries across the Americas, Asia, Europe and the Middle East. Its 2021 report states:

The use of bilingual traffic signage is common around the world and considered “standard” in the European Union. Culture, safety and commerce appear to be the primary impetuses behind bilingual signage.

Given Brown’s explicit preference for the use of English, it’s instructive that in the UK itself, the Welsh, Ulster Scots and Scots Gaelic languages appear alongside English on road signs in Wales, Northern Ireland and Scotland.

More to the point, on the basis of the evidence it reviewed, Waka Kotahi concluded that — providing other important design considerations are attended to — bilingual traffic signs can both improve safety and respond to cultural aspirations:

In regions of Aotearoa New Zealand where people of Māori descent are over-represented in vehicle crash statistics, or where they represent a large proportion of the local population, bilingual traffic signage may impart benefits in terms of reducing harm on our road network.

‘One people’
Politically, however, the problem with a debate over bilingual road signs is that it quickly becomes another skirmish in the culture wars — echoing the common catchcry of those opposed to greater biculturalism in Aotearoa New Zealand: “We are one people”.

It’s a loaded phrase, originally attributed to the Crown’s representative Lieutenant Governor William Hobson, who supposedly said “he iwi tahi tātou” (we are one people) at the signing of the Treaty of Waitangi in 1840.

Whether or not he said any such thing is up for debate. William Colenso, who was at Waitangi on the day and who reported Hobson’s words, thought he had.

But Colenso’s account was published 50 years after the events in question (and just nine years before he died aged 89).

Either way, the assertion has since come to be favoured by those to whom the notion of cultural homogeneity appeals. It’s a common response to the increasing public visibility of te ao Māori (the Māori world).

But being “one people” means other things become singular too: one law, one science, one language, one system. In other words, a non-Māori system, the one many of us take for granted as simply the way things are.

Any suggestion that system might incorporate or coexist with aspects of other systems — indeed might benefit from them — tends to come up against the kind of resistance we see to such things as bilingual road signs.

Fretful sleepers
The discomfort many New Zealanders still feel with the use of te reo Māori in public settings brings to mind Bill Pearson’s famous 1952 essay, Fretful Sleepers.

In it, Pearson reflects on the anxiety that can seep unbidden into the lives of those who would like to live in a “wishfully untroubled world”, but who nonetheless sense things are not quite right out here on the margins of the globe.

Pearson lived in a very different New Zealand. But he had his finger on the same fear and defensiveness that can cause people to fret about the little things (like bilingual signs) when there are so many more consequential things to disrupt our sleep.

Anyway, Simeon Brown and his fellow fretful sleepers appear to be on the wrong side of history. Evidence suggests most New Zealanders would like to see more te reo Māori in their lives, not less.

Two-thirds would like te reo taught as a core subject in primary schools, and 56 percent think “signage should be in both te reo Māori and English”.

If the experience in other parts of the world is anything to go by, bilingual signage will be just another milestone on the road a majority seem happy to be on.

Dr Richard Shaw, Professor of Politics, Massey University.  This article is republished from The Conversation under a Creative Commons licence. Read the original article.