The tabling of the final report from the Royal Commission on Abuse in Care is a watershed moment for New Zealand.
This comprehensive document lays bare the pervasive abuse and neglect experienced by children, young people, and adults in state and faith-based care from 1950-99, and beyond.
Among the many disturbing revelations was that a significant portion of this abuse occurred within the health system, implicating health professionals, through action or inaction, who became complicit in these tragic failures.
As academic researchers and registered health professionals, we find the findings particularly harrowing. The abuse detailed in the report spans physical, sexual, and emotional harm, and gives accounts of cultural, religious, spiritual, medical, educational and financial abuse.
It is a stark reminder that our health system, designed to heal and protect, can also be a place of profound harm.
Health professionals have a fundamental duty to uphold human rights, a responsibility enshrined in both domestic and international law.
Domestically, the Human Rights Act 1993 prohibits discrimination on various grounds, including disability, ensuring equal treatment and protection for all individuals.
The Health and Disability Commissioner Code of Health and Disability Services Consumers’ Rights outlines the rights of consumers to be treated with respect, dignity and care, emphasising the duty of health professionals to provide services in a manner that upholds these rights.
Additionally, the Hippocratic Oath further reinforces these obligations, compelling health professionals to "do no harm" and prioritise patient welfare.
We recognise that the vast majority of health professionals are actively committed to the benefit of those in our care and work tirelessly to prevent such harm. Yet this abuse did occur, and on our watch.
How could we have allowed this to occur and what do we need to learn from this experience?
One of the most troubling aspects of the report is how normalised practice and organisational policies have enabled and perpetuated abuse. In many instances, abusive practices were embedded in the routines and policies of health institutions.
This normalisation created an environment in which clinicians (whether knowingly or unknowingly) either participated in or tolerated abuse and, as the Royal Commission found, interventions that saw Māori disproportionately more likely to be placed in state care.
The pressure to conform to institutional norms can be overwhelming, leading to moral disengagement and the rationalisation of harmful behaviours. For example, the report highlights cases where patients were subjected to degrading and inhumane treatments, often justified as necessary medical interventions.
Such practices were not only ethically indefensible but also in direct violation of human rights. Survivor accounts are of these normalised practices, including seclusion, restraint, use of compulsory treatment, racism, ableism, and neglect in care which persist today.
The normalisation of abusive and discriminatory practices within the current health system points to a broader cultural problem among health professionals that must be addressed in New Zealand.
The complicity of health professionals in abuse is further compounded by organisational policies that prioritise institutional interests over patient welfare.
Policies that discourage whistleblowing, inadequate staff training on human rights, insufficient data collection (which renders groups like Māori with disabilities invisible), and insufficient accountability mechanisms all contribute to a culture of impunity.
The law itself can sometimes be a barrier to justice, with legal frameworks that fail to protect vulnerable individuals or provide redress for survivors.
The royal commission’s recommendations call for robust monitoring and accountability mechanisms, comprehensive training programmes, and the establishment of listening services for survivors.
These measures are essential but must be accompanied by a cultural shift within the health sector. Clinicians must be empowered to challenge harmful practices and advocate for their patients without fear of retribution.
Health professionals must recognise our collective responsibility for past abuses and commit to ensuring that such failures are never repeated. This involves not only adhering to ethical and legal standards but also actively working to change the systems and structures that enable abuse.
Training programmes must go beyond procedural compliance to foster a deeper understanding of human rights and ethical practice. Health institutions must create environments that encourage transparency, accountability, and continuous improvement.
Support networks for survivors and mechanisms of restorative justice should be integral parts of the health system, ensuring that those who have suffered abuse are heard, believed, and supported.
The royal commission’s report is a clarion call for systemic reform. It is a reminder that the health system must be a place of safety and healing for all individuals. As health professionals, we have a professional and moral obligation to uphold human rights and to challenge practices that harm those within our care.
This is not just a legal duty but a profound ethical imperative that goes to the heart of what it means to be a health professional.
— Newsroom
— Foundation for Equity and Research New Zealand chairman Associate Prof Tristram Ingham is based in the department of medicine, University of Otago, Wellington; Associate Prof Meredith Perry is based in the school of physiotherapy, University of Otago Wellington; Bernadette Jones is a research fellow in the department of medicine, University of Otago, Wellington.
