In the name of equity, surgeons in Auckland, New Zealand, have been told to consider the ethnicity of their patients when trying to prioritise care, namely to specifically prioritise patients from Maori and Pacific Islander backgrounds, placing them ahead of those with European or Asian ancestry.
The policy, which is part of Health New Zealand’s ‘Equity Adjustor Score,’ aims to use several factors to determine the priority of patients waiting for surgeries, including if they live in isolated communities or how long they have been waiting for a procedure.
However, the rules also factor in the ethnicity of the patient, with a report from the New Zealand Herald newspaper explaining that surgeons have reacted particularly negatively to the new guidelines, with one even going as far as to say they were disgusted.
The surgeons, all of whom spoke anonymously to the newspaper, stated that patient priority should come down to how urgent the treatment was or how long they had been waiting, with one surgeon saying, “It’s ethically challenging to treat anyone based on race, it’s their medical condition that must establish the urgency of the treatment.”
Ayesha Verrall, New Zealand’s Health Minister, defended using ethnicity to prioritise health care saying, “The reformed health system seeks to address inequities for Māori and Pacific people who historically have a lower life expectancy and poor health outcomes.”
Prime Minister Chris Hipkins also defended the guidelines saying, “Those who are arguing we should do nothing need to explain why they think we should expect those on low incomes, in rural areas and Māori and Pacific to wait longer.”
“I’ve seen concerns that have been raised about the mechanism that they are using to do that, and I’ve asked the minister of health to look at that to make sure that there is a reassurance that we are not replacing one form of discrimination with another,” he added.
David Seymour, leader of the right-wing ACT party, accused the government of “promoting racial discrimination” saying “prejudice and discrimination” were becoming official government policy in New Zealand.
New Zealand is by no means the only country to factor in ethnic backgrounds for health care as the premise is seemingly common in several English-speaking countries, such as the UK, where the National Health Service (NHS) states that it also factors in ethnicity as part of a clinical prioritisation programme.
In Canada, Indigenous Canadians were prioritised for the rollout of the COVID-19 vaccine in 2021 and others urged the government to prioritise minority groups, known as “racialized” in Canada, claiming that “systemic racism” was one reason why black Canadians had high rates of hospitalisation in areas like Toronto during the pandemic.
In 2021, the Canadian Medical Association Journal published an article that claimed there is “systemic anti-black racism” in the Canadian healthcare industry and called for the industry “to dismantle systemic racism in its structures and institutions.”
Recommendations for change include training health care providers in anti-racism, anti-oppression and decolonialization, as well as routinely collecting race-based data in partnership with racialized communities. Finally, the Black Medical Student Association of Canada provides recommendations for medical schools to address anti-Black racism in medical education and admissions, and outlines the need for medical reform to be guided by critical race theory.
While Canada does not prioritise surgeries based on ethnicity, the country does prioritise them based on COVID-19 vaccination status.
In 2018, Alberta resident Annette Lewis learned that she had a terminal illness that would require an organ transplant but was refused the transplant last year because of her refusal to take the COVID-19 jab.
A court of appeal in Alberta later ruled that unvaccinated people like Ms. Lewis were ineligible for transplants stating, “Being vaccinated against COVID-19 is a necessary component of proper medical care for individuals, including Ms. Lewis, who are seeking an (organ) transplant.”
Earlier this year, Ms. Lewis attempted to take her case to the Canadian Supreme Court but the Canadian top court simply refused to hear her.
A similar case was seen in Australia, in which a woman was refused a heart transplant because she did not take the vaccine, as she feared that the established side effects of myocarditis could be too risky for her.
