This book was initiated to gather together the papers presented at a 2008 conferenceTwenty years after the Cartwright Report: What have we learned? and much of that material is presented here.
However, with the 2009 publication of a book by an Auckland historian, Prof Linda Bryder, putting forth a different version of the science, proposing a feminist conspiracy, and asserting that the Cartwright Report got the wrong answer, The Cartwright Papers took on the additional task of critiquing this work.
The rebuttal of Bryder’s revised history is formidable. The mistakes, misunderstandings and mischief in the scientific material and the failure of process in her research are laid bare.
Many of the assertions have been dealt with before; in the Inquiry, the Report, and the NZMJ in the past. However there is much else of interest in The Cartwright Papers.
The Cartwright Report was released in 1988 and was the result of a six-month judicial inquiry into the research of Dr Herbert Green at National Women’s Hospital. It found that Green had been experimenting on women without their consent by withholding treatment for carcinoma-in-situ of the cervix, and that his research had led to significant harm.
The Report sparked a cascade of change in the health system and debate about the practice of medicine in New Zealand, which was accompanied by widespread discomfort and demoralisation in the profession, and considerable resistance from some quarters.
As well as documentation of the events by those who were present, this book provides thoughtful reflections on the big issues that were raised by the Inquiry and its aftermath. Following the Foreword by Professor Sir David Skegg, Joanna Manning provides an introduction and then a succinct summary of the Cartwright Report.
The first set of essays includes Clare Matheson’s personal story as one of Herbert Green’s patients, Sandra Coney’s description of the initial investigation that prompted the Inquiry and the real role of feminism, and Ron Jones’ account of being a true insider at National Women’s and the inability of his profession to say “I’m sorry”.
Then Professor Charlotte Paul, who was a medical adviser to the Inquiry, discusses the scientific nature of Green’s study and the subsequent research that confirms the substantial harm that was done to the women involved.
The second set of essays comprises three responses to Linda Bryder’s book by Professor Barbara Brookes, a medical historian at the University of Otago, Charlotte Paul, and Sandra Coney.
In the final part, the essays focus on the lessons learned. The Cartwright Report changed the way we conduct medical research and also the way we deliver health care. An intense focus on patients’ rights and informed consent highlighted the central roles of communication and partnership with patients when making health care decisions. The shift in health professionals’ attitudes that has followed may have been largely unspoken but has been far-reaching and has been cemented in place with structural changes.
Ron Paterson, the former Health and Disability Commissioner, and Joanna Manning, both experts in medical law, discuss the New Zealand Code of Patient’s Rights that was developed after the Inquiry. Jan Crosthwaite responds to “Could it happen again?” from the perspective of an ethicist, and Alastair Campbell, Voo Teck Chuan and Jacqueline Chin discuss the international implications of the Cartwright legacy.
This is a fascinating book. Partly because of the light it sheds on the revised version of events that has attracted recent media attention. Mostly because it is a very engaging account of an important period of recent New Zealand history, of complex scientific and ethical issues, and of rapid change in the power politics of medicine in this country. This account is provided by a diverse group of intelligent and thoughtful critical thinkers, most of whom have been involved in this story since its beginnings.
Department of Preventive and Social Medicine
University of Otago