their

The Health & Disability Commissioner has found that a public hospital and a surgeon breached a patient’s rights by performing unauthorized laboratory testing on their whare tangata following a hysterectomy in October 2024. Commissioner Morag McDowell ruled that the hospital failed to provide culturally appropriate care, noting that while the surgeon apologized for the breach of tikanga, the patient’s explicit, repeated requests for the organ to be returned whole were ignored.

Did You Know? The patient, who identifies as a Māori wahine in ao Māori, specifically requested the return of their whare tangata because the organ symbolizes a connection to ancestors, the land, and future generations—a request they described as a matter of cultural and spiritual integrity rather than mere preference.

How the Breach Occurred

According to the Commissioner’s decision, the patient made their requirement for the return of the whare tangata clear to staff during pre-operative preparations. Despite these verbal requests and the submission of a “return of tissue” form, the hospital sent the tissue to a laboratory for histological analysis without consent.

Health NZ stated that the patient “incorrectly” ticked “yes” on the form regarding tissue return, suggesting the patient should have selected “temporary storage required” to avoid testing. However, the Commissioner noted that hospital staff failed to assist the patient in completing the form or explain the procedural differences. The surgeon involved acknowledged that they proceeded on an assumption that testing would occur, despite knowing the patient wanted the tissue returned.

Communication Failures and Distress

Following the surgery, the patient experienced conflicting information regarding the status of their tissue. Initially, staff informed the patient the whare tangata had been removed intact. This was later contradicted by a doctor who claimed no “cutting or dying” had occurred, before later confirming that the laboratory had indeed processed the tissue.

Commissioner McDowell noted that this breakdown in communication caused the patient to feel “lied to” and resulted in immense distress for the patient and their whānau. The patient was ultimately required to sign a second form acknowledging the lack of testing before the tissue could be returned from the hospital mortuary.

Expert Insight: This case highlights the practical consequences of misaligned clinical and cultural workflows. While medical protocols often prioritize diagnostic testing as a standard of care, the ruling underscores that clinicians have a responsibility to uphold the sacredness of human tissue when a patient’s cultural values are explicitly stated. The failure to reconcile Western administrative forms with the patient’s cultural needs led to a direct breach of the health consumer’s code.

What May Happen Next

Following the Commissioner’s findings, the surgeon has committed to changing their clinical practice to ensure patients are fully engaged on the limits of tissue testing before surgery. Future consultations with Māori consumers are expected to include explicit discussions regarding what will happen to removed tissue to ensure tikanga is respected.

Health NZ may also face pressure to review its “human tissue, management and handling” policies to ensure staff are better equipped to guide patients through the specific documentation required for cultural requests. The surgeon has offered to participate in a tikanga-based process to help resolve the grievance if the patient chooses to proceed.

Frequently Asked Questions

Why was the whare tangata tested?
The hospital proceeded on an assumption that testing would occur, and Health NZ stated the patient incorrectly filled out the “return of tissue” form by not selecting “temporary storage required.”

Did the surgeon apologize?
Yes, the surgeon acknowledged the hurt caused by the breach of tikanga and offered an unhesitating apology for the distress experienced by the patient.

What did the Commissioner rule regarding the hospital?
Commissioner McDowell found that Health NZ breached the health consumer’s code by testing the tissue without consent and failing to provide culturally appropriate care.

How can healthcare providers better balance standard laboratory practices with the cultural requirements of their patients?