Medico-Legal Society

Once upon a time the public perception of an All Black might have been tough but a little dim. They tell the story of the All Black who thought witty repartee was the name of a Māori activist. Our current All Blacks are both talented and intelligent but our sporting prowess may remind us of former times when many people achieved their success through native ingenuity and a high degree of manual skill. But the people who will guide tomorrow's changes will require the training and the mental agility to grasp the complexity of the concepts behind the changes.

Look at the proportion of export earnings gained from intellectual input. Look at inventions, research and development, product innovation, design patents, royalties and copyrights. The fact is that while more than 60% of the annual export earnings of Japan, France, Sweden, the Netherlands and Italy depend on brain based industries, the comparable figures for both Australia and New Zealand are less than 5%.

One of the effects of technological development is that the proportion of raw materials steadily diminishes as a percentage of costs. So 100 pounds of optic fibres in a cable can transmit as many messages as one ton of copper wire. The implication is that the old division of a core of manufacturing societies (UK, Germany, USA) surrounded by other countries which provided them with raw materials is breaking down.

A recent study by the Central Institute of Technology at Upper Hutt and Massey University says New Zealand has not got enough people with technological skills to meet the requirements of industry.

The report quotes some nasty figures. Out of every 100 5th form students in New Zealand

• 14 repeat Form 5 the following year
• 31 leave at the end of Form 5
• 38 leave at the end of Form 6
  (22 of those have School Certificate/6th Form Certificate,
  3 of those have maths, chemistry and physics,
  16 have University Entrance,
  2 of those have maths, chemistry and physics.)
• 17 leave at the end of Form 7
  (5 of those have maths, physics and chemistry adequate to proceed with further technological studies)

New Zealand's young adults are not pursuing higher learning. Only 9% of the annual crop of 65,000 fifth form students meet the requirements to go on to further technological studies at tertiary institutions.

The report piles on the gloom. The under 10 age group is declining. In 1976 the group numbered 602,000 but by 1985 the group had declined 15% to 509,000. It is anticipated that between 1986 and 1999 the age group between 15 and 19 and 20 and 24 will decline by 24%. The number of pupils entering Form 3 has dropped. The number of third form boys taking maths, chemistry and physics dropped 20% between 1973 and 1985. Lastly, the report estimates that 60% of the 175,000 people who have left New Zealand since 1977 have been in the 15 to 29 age group.

Barbara Reilly of the University of Auckland has studied the role of women and technology. She observes that at primary level there is no significant difference between girls' and boys' performance in maths and science. However, at higher secondary and university levels, fewer women are to be found taking maths and science. For instance, women in 1984 made up 5% of engineering graduates and 1% of technology based Trade Certificates. Many possible job options for women are cut off in fields like computer science, maths, science and engineering. The continued underrepresentation of women in technology related areas will mean that crucial decisions will be made with an input from only a few women with the necessary expertise.

We face the danger of a New Zealand society which does not understand technology, where only a limited number of people have access to technological information and where the technocrats are mainly men while women in society remain concentrated in health and teaching, the areas which are dependent on public funding and, in today's economic climate, are vulnerable.

The modern doctor is surrounded by items of high technology which can prevent or reverse many of the ailments that used to kill people in their youth and middle years. But if the technologies for making an accurate diagnosis have been very effective, they have also become remarkably complex and expensive. I suspect the sick person perceives the hospital as an enormous whirring machine with everyone running around. The old adage of Hippocrates that "Art is long, life is short" is speeded up, almost beyond breaking point.

I have been reading a discussion between five experts on the technologies of determining sex before conception and constructing the genetic profile of a test tube baby with the possibility of weeding out unwelcome traits.

One of the participants said "As we move out of the Industrial Age into the Biotechnical Age we are increasingly able to manipulate living things for our advantage. What we're talking about is engineering the life process. We're introducing technological principles into reproduction. We're exploiting living things with the same methodology used during the Industrial Age to exploit inanimate things. Engineering is about quality controls, designs and building predictability into the product."

For the medical profession it is almost a reversal of roles. Therapy implies taking away the negatives but engineering implies putting in the positives. Before we know it, we're talking about commercial eugenics. We want perfect babies because we want perfect people. We want perfect plants and animals. We want a better economy.

The dilemma of modern medicine is the irresistible drive to do something. Patients expect it and doctors too often agree with it. But the average person who feels left behind and sidelined by technological developments is suspicious and would like to control you.

The relationship between the professional and the client is continually shifting. Most people are wanting to move from being your clients or patients to being your colleagues. As Hugh Rennie said in a lecture published in a lecture published in the New Zealand Medical Journal people are no longer convinced that because you qualified 20 or 30 years ago you are fit to practice (medicine or law) today. And just as pilots are recertificated regularly, so doctors (and lawyers) should do the same.

The steady stream of doctors and lawyers who are struck off their professional lists makes people less willing to leave the control of the professionals with the professionals. The public wants a greater say in the regulation, control or management of your professions. Consequently aspects of the practice previously left to the professionals' judgment are being taken over by the intervention of Parliament. Doctors, for instance, have recently become subject to provisions of the Fair Trading Act and the Commerce Act.

Hugh Rennie has a warning. If a coherent structure for regulating your profession cannot be established then we may see a freer entry for less qualified people. The prospect may not please but doubtless some would say that market forces will prevail and the good doctors or lawyers will bet the custom.

Leading and following are mysterious processes, ultimately beyond analysis but bound by trust or a sense of common purpose. These elements are at the heart of any professional relationship. I want to pursue them in a wider context and with a bit of historical perspective.

In Umberto Eco's novel The Name of the Roseone of the characters says "The Anti-Christ can be born from piety itself, from excessive love of God or of the truth, as the heretic is born from the Saint and the possessed from the seer. Fear prophets, Adso, and those prepared to die for the truth, for as a rule they make many others die with them, often before them, at times instead of them."

The October 1987 sharemarket collapse has been for many people a crisis of leadership. They took advice, they invested and they lost. The historian senses that he has seen all this before in New Zealand, and specifically in the Auckland of 100 years ago.

J. C. Firth was a merchant with an opinion about most things, including Bishop Selwyn, whom he called a monster of iniquity and an enemy of his fellow creatures. Firth's sense of moral outrage at the Bishop sticking up for Māori interests did not prevent him from gambling on a continuation of the buoyant times which alone could have made his interest payments possible. Firth's downfall, it was said, was not the fall in land values. It was overborrowing on the eve of a depression. In 1889 Firth defaulted on his payment of 9200.13s 7d. to the New Zealand Loan and Mercantile Company. They sold up his securities. As Tom Paine said "Credit is suspicion asleep."

The BNZ was formed in 1861 as the angry response of Auckland businessmen to the severe credit restrictions imposed by the Union Bank of Australia. On 3 October 1888, George Buckley, the President of the BNZ, told a special meeting of shareholders that 800,000 of the Banks' capital had been lost. More than half the disclosed losses were said to have arisen from Auckland advances. Furthermore, over 160,000 of the losses came from advances made to certain of the directors upon insufficient security.

Commercial life in Auckland one hundred years ago was rough and ready but the colonies were seen as places which offered chances to those who wanted to get on! Of course it paid to bring some money with you, like David Nathan, Logan Campbell, Edward Costley or James Dilworth. It also paid to have arrived young. James Williamson, in 1880 President of the BNZ and NZI Co. and owner of the suburban estate, the Pah, had once been a ship's mate who laid the foundation of his fortune in a grog shop on the beach at Kororareka (Russell) described by J. D. Hooker, an early visitor, as having "its one bad hotel, three cheating stores, many grog shops and more houses of ill fame."

Commercial life in 19th Century Auckland was certainly not attractive. Too many people were laying the foundations for their own dynasties. But 'economy' and 'economics' refer to much more than money and financial systems. Economy is a word which in its Greek origin refers to the strength of a household. Economics encompasses social well being as well as the state of your money.

Having said that, income and wealth largely determines peoples' standards of living and the extent to which they can take part in society. By income, I mean a flow of revenue, by wealth, a stock of assets. For most people wealth is accumulated in the form of an investment in a house while paid employment provides 90% of the overall market income received by households.

For a growing number of people there is now less prospect of owning a home and having secure employment. The consequence is that the opportunity of these people to contribute to society has been lessened. The essence of poverty is powerlessness and frustration.

Let me give you an illustration. The media has concentrated on Māori issues recently. I observe the media struggling to understand. Indeed the media reminds me of a curious person surveying a strange and distant land through a telescope and reporting back what it observes.

Consequently, the media speaks out about Maoris. But the media rarely speaks out of Māori experience or a Māori point of view. Maoris feel they have to defend themselves to the media. Often I wonder how we can open up our experience of life to each other so that we may learn before we rebut.

Recently an elderly Māori woman died who had been a profound influence on my wife and me for nearly 25 years. She had never gone to school but in difficult economic circumstances she had raised two families. At the opening of the Te Māori Exhibition in New York she was on top of the steps in front of the Metropolitan Museum and gave the Karanga at 5.30 am on that clear summer morning and welcomed the Māori Elders who had travelled from New Zealand to be there. She was also one who gave evidence to the Waitangi Tribunal on the effect of the effluent on traditional shell fish beds by asking "how would you like **** going through your kitchen cupboard?"

This women was defined partly by her ethnic origins, her cultural assumptions but also by her economic circumstances. Her lack of money and her lack of creditworthiness restricted her ability to take part in the widest possible New Zealand society.

If there is to be better communication and the possibility of a better relationship between ethnic groups in New Zealand, Māoris must move out of the poverty trap. If we have problems they may not be racial in character but economic in origin.