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●NZ MMI ethics prepFree guide

The Ultimate NZ Medical Ethics Guide
MCNZ, Te Tiriti & Hauora Māori

Auckland and Otago MMIs test a distinctly New Zealand ethical framework — not the UK's four pillars and GMC guidance, but the MCNZ Code of Ethics, Te Tiriti o Waitangi, cultural safety, Hauora Māori, Pacific health equity and the HDC Code of Rights. This guide prepares you for all of them.

Ethical frameworksMMI scenarios

Why NZ medical ethics is different

UK framework

  • ×GMC Good Medical Practice
  • ×Four pillars: autonomy, beneficence, non-maleficence, justice
  • ×NHS resource allocation and funding context
  • ×Mental Capacity Act 2005

NZ framework

  • ✓MCNZ Code of Ethics
  • ✓Te Tiriti o Waitangi: partnership, protection, participation
  • ✓HDC Code of Rights (ten legally enforceable rights)
  • ✓Cultural safety and Hauora Māori (Te Whare Tapa Whā)
  • ✓Pacific health equity and relational frameworks
  • ✓End of Life Choice Act 2019
  • ✓Mental Health (Compulsory Assessment and Treatment) Act 1992

Key ethical frameworks for NZ MMIs

Framework

MCNZ Code of Ethics

  • —Duties to patients: informed consent, confidentiality, non-abandonment
  • —Professional conduct: honesty, maintaining competence, appropriate boundaries
  • —Obligations to colleagues and the profession
  • —Broader duties to society, public health and the environment
Framework

Te Tiriti o Waitangi — Three Principles

  • —Partnership: shared decision-making between Crown/clinicians and Māori
  • —Protection: actively protecting Māori health and tino rangatiratanga
  • —Participation: Māori involvement in designing and governing health services
  • —Pae Ora (Healthy Futures) Act 2022 gives Treaty obligations statutory force
Framework

Te Whare Tapa Whā — Hauora Māori

  • —Taha tinana — physical health and bodily wellbeing
  • —Taha hinengaro — mental and emotional health
  • —Taha whānau — social, family and community wellbeing
  • —Taha wairua — spiritual health and sense of identity
Framework

Health and Disability Commissioner Code of Rights

  • —Right 1: to be treated with respect and without discrimination
  • —Right 6: to receive information that a reasonable consumer would expect
  • —Right 7: to make informed choices and give or withhold informed consent
  • —Right 10: to complain and have complaints taken seriously
Framework

Cultural Safety (Kawa Whakaruruhau)

  • —Reflect on your own cultural identity and power in clinical encounters
  • —Create environments where patients feel safe to express cultural needs
  • —MCNZ cultural safety requirement applies to all registered practitioners
  • —Distinct from cultural awareness — focuses on power and the patient's experience
Framework

Pacific Health Equity

  • —Talanoa — Pacific dialogue and consultation as a relational process
  • —Fa'aaloalo — respect as a foundation of Pacific therapeutic relationships
  • —Vā — relational space that must be tended and not violated
  • —Family-centred decision-making: Pacific patients may prefer collective disclosure

NZ MMI ethics scenarios

Worked through by our tutors — each scenario includes the question, the key ethical principles engaged, and how to structure your answer.

Scenario 01

Te Tiriti Partnership in a Clinical Encounter

Medium

Question

“A Māori patient asks for a karakia before her procedure and requests that her whānau be present. The senior surgeon says there is no time. How do you respond?”

Key points for a strong answer

  • Immediate action: speak with the surgeon privately, advocate for a brief karakia (under two minutes)
  • Whānau presence where possible — consent is often a collective process for Māori patients
  • Document the advocacy and any accommodation or refusal in the notes
  • Raise systemic pattern with the team: does the unit have a policy for cultural safety on admission?
Scenario 02

Informed Consent and the HDC Code

Medium

Question

“A 72-year-old Samoan man has signed a consent form for a bowel resection. His son tells you his father does not read English well and the family was not present when consent was taken. The procedure is booked for tomorrow.”

Key points for a strong answer

  • Right 7 (HDC Code): informed consent requires the patient to understand what they are consenting to
  • Arrange a professional interpreter — family should not be used as interpreters for consent discussions
  • Meet with the patient and son together; reassess understanding; give information at an appropriate pace
  • Consider whether consent should be retaken — a signed form does not automatically mean informed consent
Scenario 03

MAPAS Values — Autonomy vs Community Obligation

Hard

Question

“A MAPAS student tells you she feels torn between her community's expectation that she return home to work as a GP in a rural Māori community and her own desire to specialise in cardiology. How do you approach this ethical tension?”

Key points for a strong answer

  • Autonomy is a foundational principle — a student's career is ultimately her own decision
  • Obligation to community is not unethical; it can be a source of purpose and identity
  • The tension is real and reflects broader rural workforce ethics in NZ; do not dismiss either side
  • RRAS and MAPAS pathways exist precisely to address rural and Māori health workforce gaps
Scenario 04

End-of-Life Care and Tikanga

Hard

Question

“A Māori patient in palliative care wishes to return home to die on his marae. His family supports this, but the clinical team is concerned about pain management at home and whether district nursing can be arranged in time.”

Key points for a strong answer

  • Te Whare Tapa Whā: taha wairua and taha whānau are as important as taha tinana at end of life
  • The End of Life Choice Act 2019 is relevant context, but here the patient's wish is to die at home on the marae — not assisted dying
  • Clinical team must facilitate, not obstruct — involve palliative care, a Māori health navigator and district nursing urgently
  • Document the plan, ensure adequate analgesia can be managed at home, and respect tino rangatiratanga
Scenario 05

Rural Workforce Ethics and the RRAS Pathway

Medium

Question

“New Zealand has a significant rural health workforce shortage. A rural GP tells you she is the only doctor for 4,000 people and works 60-hour weeks. Is this an individual problem, a systemic problem, or both? What does medical ethics say about it?”

Key points for a strong answer

  • Justice principle: equitable distribution of healthcare — rural populations should not have worse access
  • Beneficence vs non-maleficence for the GP herself: unsustainable workload creates risk of burnout and clinical error
  • Systemic solution: RRAS, bonded scholarships, international medical graduates, telehealth expansion
  • Individual doctors have limits on what they can change alone; advocacy through professional bodies is part of professionalism
Scenario 06

Te Whatu Ora Structural Change — Post-DHB Integration

Easy

Question

“What changed in the New Zealand health system in 2022 and why? How might these structural changes affect health equity for Māori and Pacific communities?”

Key points for a strong answer

  • 20 DHBs replaced by Te Whatu Ora (Health New Zealand) — national governance replacing fragmented regional boards
  • Te Aka Whai Ora (Māori Health Authority) created alongside — later reintegrated into Te Whatu Ora (2024)
  • Stated aim: reduce inequity, enable national workforce planning, create consistent standards across regions
  • Risk to flag: centralisation can reduce responsiveness to local and iwi needs — balance efficiency with local voice
Scenario 07

Climate Change, Environmental Health and Intergenerational Equity

Medium

Question

“A Māori kaumātua tells you that his whānau's respiratory health has worsened since a large forestry operation began near their land, and that younger whānau cannot afford to move away. What ethical principles are engaged?”

Key points for a strong answer

  • Justice and intergenerational equity: Māori communities often bear disproportionate environmental health burdens
  • Te Tiriti protection principle: the Crown/health system is obliged to protect Māori wellbeing
  • Non-maleficence: health professionals can and should document environmental health impacts and advocate for change
  • Practical steps: refer to environmental health officer, support the whānau in making a formal complaint, document the pattern in the medical record
Scenario 08

Mental Health, Whānau Dynamics and Compulsory Treatment

Hard

Question

“A 25-year-old Māori man has been brought to the ED by his whānau, who are concerned he has stopped eating and is hearing voices. He does not want to be assessed. His mother says that in their family, decisions like this are made together. How do you navigate autonomy, tikanga and the Mental Health Act?”

Key points for a strong answer

  • The Mental Health (Compulsory Assessment and Treatment) Act 1992 applies if there is serious risk — the clinical threshold for assessment must be met independently of family consent
  • Tikanga: whānau involvement in decision-making is culturally appropriate and should be welcomed, not overridden
  • Autonomy must be balanced against capacity — a person experiencing psychosis may lack capacity for this decision
  • Avoid stereotyping: collective decision-making is not a reason to override a patient's wishes; it is a reason to include the family respectfully in the conversation

Key NZ ethics topics covered in this guide

Treaty & Cultural Safety

  • Te Tiriti partnership, protection and participation in clinical settings
  • Cultural safety vs cultural awareness — the distinction MCNZ makes
  • Tikanga practices in hospital: karakia, whānau presence, tapu
  • MAPAS values and community obligation vs individual autonomy

Hauora Māori & Pacific Health

  • Te Whare Tapa Whā — four dimensions of Māori health
  • Pacific health equity: Samoan, Tongan, Cook Island Māori disparities
  • Talanoa and family-centred diagnosis disclosure
  • Rural Māori health: RRAS, workforce ethics, access inequity

MCNZ & HDC Code

  • Informed consent in NZ: HDC Right 7 and capacity assessment
  • Confidentiality exceptions: mandatory reporting, harm to others
  • Professional conduct: maintaining competence, managing conflicts
  • Whistleblowing and raising concerns as a junior doctor

Contemporary NZ Scenarios

  • End of Life Choice Act 2019 — assisted dying framework
  • Mental Health Act — compulsory assessment and tikanga
  • Climate change and intergenerational health equity
  • Te Whatu Ora structural reform and post-DHB health system

Frequently asked questions

The Medical Council of New Zealand (MCNZ) publishes the Code of Ethics that sets out the professional obligations of registered medical practitioners in New Zealand. It covers duties to patients (including informed consent, confidentiality and non-abandonment), responsibilities to colleagues and the profession, and broader obligations to society. Familiarity with the MCNZ Code — rather than the UK GMC guidance — is essential for Auckland and Otago MMI ethics stations.

Te Tiriti o Waitangi (the Treaty of Waitangi) establishes a partnership between the Crown and Māori. In health, the three Treaty principles — partnership, protection and participation — require health professionals to work collaboratively with Māori (partnership), to actively protect Māori health and cultural identity (protection), and to ensure Māori can participate in decisions that affect their health (participation). These are not merely symbolic: they have statutory force under the Pae Ora (Healthy Futures) Act 2022 and are assessed in MCNZ registration and in medical school MMIs.

Hauora Māori is the concept of Māori health and wellbeing, which encompasses physical, mental, social and spiritual dimensions. Te Whare Tapa Whā, developed by Sir Mason Durie, models health as a four-walled house: taha tinana (physical), taha hinengaro (mental/emotional), taha whānau (social/family) and taha wairua (spiritual). Medical school applicants are expected to understand this model and explain why a purely biomedical approach is insufficient for Māori patients.

The Health and Disability Commissioner (HDC) Code of Rights sets out ten rights for consumers of health and disability services in New Zealand. Key rights for MMI purposes include: the right to be treated with respect (Right 1), the right to be fully informed (Right 6), the right to make an informed choice and give informed consent (Right 7), and the right to complain (Right 10). Unlike the UK's GMC guidance, the HDC Code is a legally enforceable instrument.

Cultural safety (kawa whakaruruhau) goes beyond cultural awareness or sensitivity. It requires health professionals to reflect on their own cultural identity and the power dynamics of clinical encounters, and to create an environment where patients feel safe to express their cultural needs. The MCNZ requires cultural safety as a core competency. In practice it means asking at admission what a patient needs to feel culturally safe, not assuming a monocultural approach is neutral.

When a patient or whānau raises tikanga (Māori cultural practices) around death and dying — such as the presence of whānau, karakia, tangihanga (funeral rites), or returning a body to ancestral land — you should: (1) listen and show genuine respect, (2) facilitate rather than obstruct tikanga where clinically possible, (3) involve a Māori health navigator or kaiāwhina if available, and (4) balance tikanga with any clinical obligations (e.g. infection control, organ donation consent). End-of-life care in NZ is also shaped by the End of Life Choice Act 2019, which legalised assisted dying from November 2021.

Pacific peoples in New Zealand (Samoan, Tongan, Niuean, Cook Island Māori, Fijian and others) experience significant health disparities including higher rates of diabetes, cardiovascular disease, obesity and mental health conditions. Cultural concepts like talanoa (Pacific dialogue/consultation), fa'aaloalo (respect) and vā (relational space) shape how Pacific patients interact with health services. NZ medical school interviews may ask about how you would approach a Pacific patient's reluctance to receive a diagnosis alone, preferring to hear it alongside family.

In July 2022, the New Zealand government replaced the 20 district health boards (DHBs) with a single national health agency, Te Whatu Ora — Health New Zealand, and a separate Māori Health Authority, Te Aka Whai Ora (disestablished in 2024 and its functions absorbed into Te Whatu Ora). The rationale was to reduce fragmentation, increase equity and enable national workforce planning. For MMI purposes, understand that "DHBs" no longer exist, the health system is now nationally governed, and the structural reform was partly driven by persistent inequities in Māori and Pacific health outcomes.

Want to practise NZ ethics scenarios with an AI mock interviewer?

Prometheus includes 30+ NZ-specific ethics and cultural safety MMI questions with instant AI feedback on your answers — practise at your own pace before your Auckland or Otago interview.

Practice with PrometheusAll NZ resources
Reviewed by Isaac Butler-King, medical student at the University of Glasgow. Last reviewed: 1 July 2026