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The Cartwright Inquiry

A Fortunate Outcome of the Unfortunate Experiment.

Joseph Kim, Saint Kentigern College student, 2024




































In 2024, Our Health Journeys partnered with Saint Kentigern College in Auckland and challenged a number of students to conduct research into an aspect of the medical history of Aotearoa New Zealand. The students, ranging from Years 8-13, produced their research in written, oral, or video format and the top projects were chosen for publication to Our Health Journeys. A new project will be published weekly until October.

Professor Green - By Doctor Alice - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=80464805

The Cartwright Inquiry

The ‘Cartwright Inquiry’, published on the 5th of August 1988, was a judicial inquiry conducted by Silvia Cartwright in response to a 1987 Metro article, titled the ‘Unfortunate Experiment’. 

The article revealed how at the National Women’s Hospital, a gynaecologist, Herbert Green, MD, had experimented on 86 women with cervical carcinoma in situ (CIS)1 without their consent. The exposé revealed how he had either left the conditions of the women untreated to see whether CIS would progress into invasive cancer or treated them in an unconventional way causing eight women to sadly pass away. 

The findings, criticisms, and suggestions of this Inquiry will be discussed.

Accountability

In the inquiry two main parties were held accountable: Dr Herbert Green and the Hospital’s Medical and Ethical Committees. 

Firstly, Dr Green was rebuked for failing to communicate with his patients and put the requirements of his patients first. In the inquiry, it describes how he both failed to gain the “consent”2 of the women before experimenting on them and as well as to share the possible “risks” of his “1966 trial”3 beforehand. Dr Green was, however, mainly criticised for putting his desires to obtain results above the “cultural, social, and emotional needs”4 of his patients. 

Overall, Dr Green was found to have neglected the autonomy and needs of his patients and thus was charged for disgraceful conduct by the Medical Council. However, by the time he was charged, Dr Green was found to be too mentally and physically unfit to serve time in prison and hence the charges against him were dropped. 

One possible reason why Dr Green could have conducted this experiment was to try to preserve the fertility of the women with CIS. This is because the ability to conceive would most likely be lost after undergoing conventional treatment for CIS. It seems that he believed that if he was able to convince the medical community that CIS was harmless, he would be able to reduce the number of women being rendered sterile by the treatment. It appears that this view stemmed from his firm belief that the fertility of a woman was a “unique possession”5 that should be preserved at all costs.

However, the Hospital Medical Committee and Ethical Committee were held the most accountable for this tragedy as they had allowed the experiment to continue despite being presented with “detailed and well documented statements of concern” about the trial, including evidence that many of the women were developing invasive cancer. In the inquiry, Cartwright declared that that the committees “failed” their ethical “duty to ensure that the 1966 trial was terminated”.6 

One possible reason why the committees may have decided to continue the experiment was the assurance that Dr Green gave them that this experiment would pave the way for important medical discoveries. The authority and influence of Dr Green may have also swayed the decisions of the committees as he was a well-respected expert in Cervical Cancer, both within New Zealand and internationally.

By Government House. The Governor-General of New Zealand - The Hon Dame Silvia Cartwright, PCNZM, DBE, QSO, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=62152862

Its legacy

The Inquiry also contained many recommendations to improve patient rights and healthcare in New Zealand. Many of these suggestions were implemented and have had profound impacts. 

The National Cervical Screening Programme. 

- Since 1990, this programme has screened every woman in New Zealand every five years and has successfully reduced the occurrence of Cervical Cancer by around “50%” and mortality by around “65%”.7 

The Office of the Health and Disability Commissioner

- Since 1994, this Office has investigated complaints against potential ethical breaches without charge and advocated for the rights of a patient. For New Zealand, this organisation was the first of its kind. 

The focus on teaching medical ethics at the University of Auckland

- The suggestion to “improve the teaching of ethical principles” was a pivotal suggestion which helped the University foster a new generation of doctors committed to respecting and upholding patient ethics.8

The change in the “focus of attention”

- The most important suggestion of this inquiry, without a doubt, was its call for the “focus of attention… [to] shift from the doctor to the patient”. Since then, this recommendation has been able to facilitate better communication and negotiation between doctors and patients. 

The Cartwright Inquiry stands today as a reminder of the importance of communication, ethics, and prioritisation of the patient’s needs when practicing medicine.

References:

1 Coney, Sandra, and Phillida Bunkle. “An Unfortunate Experiment at National Women’s.” Metro, June 1987.

2 Cartwright, Silvia. The Cartwright Inquiry. 5 Aug. 1988, pp.67, www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/legislation/cervical-screening-inquiry-0

3 Ibid, pp.210.

4 Ibid.

5 https://cartwrightinquiry.com/index.php/2021/02/26/timeline-summary

6 Cartwright, Silvia. The Cartwright Inquiry. 5 Aug. 1988, pp.101, www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/legislation/cervical-screening-inquiry-0.

7 https://www.beehive.govt.nz/release/twenty-years-cartwright-inquiry

8 Cartwright, Silvia. The Cartwright Inquiry. 5 Aug. 1988, pp. 176, www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/legislation/cervical-screening-inquiry-0.