MIDDLES Letterfrom New Zealand

For one entire year in New Zealand a judicial inquiry has been under way into the treatment of carcinoma in situ of the cervix at the National Women's Hospital in Auckland. The National Women's is the teaching hospital for the Auckland University School of Medicine's department of obstetrics and gynaecology and the Postgraduate School of Obstetrics and Gynaecology. The inquiry was set up after a magazine article, entitled "An 'unfortunate experiment' at National Women's,"' alleged that an experimental research programme had been undertaken at the hospital entailing the study of the natural course of carcinoma in situ of the cervix by withholding conventional treatment from some patients. The authors of the article further alleged that an internal inquiry, set up after criticisms of the programme by two hospital doctors, had been a "white wash" and that there was no evidence that the research and the withholding of conventional treatment had ever formally ceased. These allegations resulted in the setting up of a committee of inquiry led by one woman, Judge Silvia Cartwright. At the public hearings further claims were made. Among these were that vaginal smears had been taken from over 2000 new-born babies, as part of the same research, apparently without the knowledge or consent of their mothers; that a randomised controlled trial of treatment for invasive cervical cancer had been undertaken without the consent of patients; that groups ofstudents had carried out vaginal examinations of anaesthetised women without their consent; and that postgraduate students had inserted and removed intrauterine devices on anaesthetised women before hysterectomy. The public hearings started in August 1987 and continued until January 1988. The judge's report was released on 5 August 1988.2 I served as one of the three medical advisers to Judge Cartwright. I believe that the ethical issues raised by the inquiry go beyond the specific difficulties in one institution to the underlying problem of accountability in medicine. Indeed, the study at the centre of the inquiry was widely known to gynaecologists beyond New Zealand; yet only one attempted to intervene.