Conference Report: Medical Ethics in Aotearoa: A Postcolonial Critique of Western Medical Ethics and Exploration of Integrating Māori Worldviews

Medical Ethics in Aotearoa: A Postcolonial Critique of Western Medical Ethics and Exploration of Integrating Māori Worldviews

Introduction

This project set out to critically analyse the dominance of Western ethical frameworks in medical ethics in Aotearoa (New Zealand) and explore how Māori worldviews might be better integrated into ethical decision-making. Drawing upon postcolonial theory and my personal experiences in a Māori-led health service in Auckland, I aimed to challenge existing frameworks and reflect on how culturally grounded ethics could lead to more equitable healthcare in Aotearoa, and even globally.

Literature Review

Current ethical frameworks used in medical ethics frequently face criticism for their focus on Western ethical principles.¹ The four dominant principles most widely accepted in the West consist of autonomy, beneficence, non-maleficence, and justice. These concepts are based on deontology (duty-based ethics) and utilitarianism (consequence-based ethics).² Ultimately, they value individualism, rationality, and universality, which do not necessarily align with other worldviews, including those of Māori people.

Postcolonial theory can be used to critique these frameworks. It suggests that colonial histories continue to shape present-day structures, including healthcare systems and the ethical values underpinning them.^1,3 This could explain why non-Western knowledge systems have been overlooked in medical ethics. In Aotearoa, the prioritisation of Western medical ethics often marginalises Māori knowledge systems,⁴ thereby perpetuating inequities in health care and outcomes. There have been calls to decolonise ethical frameworks in order to develop more connected and equitable frameworks.¹

Māori ethical principles are grounded in relational and collective concepts, with Māori ‘tikanga’ (customs), ‘whanaungatanga’ (relationships), and ‘manaakitanga’ (care and respect) taking precedence over more individualistic principles.⁵ Health is not viewed solely through a physical or individual lens, but as deeply spiritual, intergenerational, and holistic. Therefore, dominant Western medical ethical principles are unlikely to be suitable for Māori health. Despite this, the latest ‘Code of Ethics’ from the New Zealand Medical Association (NZMA), which has now disbanded, predominantly focused on Western medical ethical principles, with little mention of Māori values.⁶ The Treaty of Waitangi which was ratified in 1840 states that the people of Aotearoa are protected by the Queen of England and have the same rights as British citizens⁴; this indicates a promise of equity for Māori, which encompasses health equity. This cannot truly be achieved without a move towards decolonising medical ethics in Aotearoa, to incorporate Māori values and conceptualisations of health and healthcare practice.

Whilst there is pre-existing literature advocating for the use of Māori values in healthcare in Aotearoa, this largely focuses on clinical, practical, and research applications, rather than the ethical principles which underpin medical decision-making and policy. Therefore, there is a need for literature which goes beyond culturally appropriate medical care and research and aims to explore the needs and possibilities for reframing medical ethics in Aotearoa within a Māori worldview.

Reflections from Māori-Led Healthcare Settings

During my time in Aotearoa, I had the opportunity to observe first-hand how Māori values underpin daily medical practice. A striking difference from Western models was the emphasis on ‘whanaungatanga’. Relationships between clinicians and patients, and with the wider community, were at the heart of care delivery. Patients were not treated as isolated individuals but as members of families and communities, with care decisions made collaboratively. In one case, I observed a consultation where ‘whānau’ (family and friends) were invited to participate in discussions about a patient’s treatment plan. This reflected inclusion and recognition of collective wellbeing. From a Western point of view, this might raise questions about patient autonomy. However, within a Māori worldview, autonomy is in relation to others, which contests the applicability of Western ethical norms. Using Gibbs’ reflective cycle,⁷ I initially found myself questioning whether group involvement might pressure the patient or compromise consent. However, I recognised that the patient was reassured and empowered by the involvement of their ‘whānau’, illustrating how relational approaches can do not necessarily undermine agency. This is not only something I can remember to enhance my skills as a culturally safe practitioner but is also a valuable contribution to medical ethics discourse.

‘Manaakitanga’ was also deeply embedded in Māori healthcare settings. Māori-led healthcare organisations went beyond their clinical responsibilities to ensure that emotional, spiritual, and cultural health needs were met. Services were not limited to the treatment of illness but were intertwined with the local community, partnering with schools, supporting whānau through social initiatives, and engaging with cultural and spiritual life. This approach challenged the biomedical model and showed how ethical care can be embedded into community life. In many Western healthcare systems, extensive community care is often neglected in favour of efficiency and clinical metrics. Upon reflection, I realised that the Māori model actually aligns closely with Western ethical principles of beneficence and non-maleficence through compassionate, preventative care, and justice by addressing health inequities.² Māori worldviews can not only offer alternative ethical frameworks but also highlight how Western healthcare could better fulfil its own ethical commitments through community-based practice. Rather than seeing these frameworks in conflict, I saw how Māori ethics could enrich the application of Western ethical principles, reminding us that true ethical care must be holistic, and rooted in the lives and needs of the communities we serve.

Conclusion

The insights gained through this project support the view that Western medical ethical frameworks cannot be applied universally, especially in postcolonial contexts such as Aotearoa. Māori ethical principles offer alternative ways of understanding care and responsibility, which are relevant in a society shaped by colonisation and committed to the Treaty of Waitangi obligations.

This project has illuminated both the tensions and harmonies between dominant Western ethical frameworks and Māori worldviews. There is clear value in incorporating Māori worldviews into national, and even global, ethical frameworks, with concepts such as ‘whanaungatanga’ and ‘manaakitanga’ reframing, or reminding us, what it means to act ethically in healthcare. Integration of the two knowledge systems in Aotearoa should be conducted through co-design with Māori health leaders for meaningful decolonisation of medical ethics.

Literature, theory, and first-hand reflection have revealed that the ethical foundations of healthcare in Aotearoa are contested, evolving, and culturally situated. Personally, this experience has deepened my critical thinking, cultural safety, and understanding of what it means to practice ethical medicine. It has reaffirmed my belief that decolonising medical ethics is not only a theoretical endeavour but an applicable, important step toward more just and equitable healthcare.

References

1. Rentmeester, C.A. Postcolonial Bioethics, Camb Q Healthc Ethics, 2012 July; 21(3): 366-374. Available at: https://doi.org/10.1017/S0963180112000084
2. Beauchamp, T.L. and Childress, J.F. Principles of Biomedical Ethics. Oxford University Press; 1979.
3. Said, E.W. Orientalism. New York: Pantheon Books; 1978.
4. Wepa D. Cultural Safety in Aotearoa. Cambridge: Cambridge University Press; 2015.
5. Mead, H.M. Tikanga Māori: Living by Māori Values, Wellington, New Zealand: Huia Publishers; 2003.
6. New Zealand Medical Association. Code of Ethics, 2020.
7. Jasper, M. Beginning Reflective Practice, Cheltenham, United Kingdom: Nelson Thornes; 2003.

Leyna Roy