Informed consent and your rights with doctors, dentists, tattooists and skin piercers
(Last updated Nov 01)

I think I need to go to a doctor or dentist. What do I do?
What is informed consent?
How old do I have to be to give my informed consent?
What can I do if something goes wrong?
Further information:

It is sometimes hard to know when you should go to a doctor or dentist and which one you should go to. There are also rules about whether they can tell anyone of your visits.

It can be hard to understand what a doctor or dentist is doing or trying to say. This makes it very difficult if you are in need of medical treatment, but do not know what you need. The principle of "informed consent" is a way to help you understand medical treatment and to help you make better decisions about your health.

It is good to know what you can do if things do go wrong. This information sheet outlines who you can complain to and how to do that.

I think I need to go to a doctor or dentist. What do I do?

When should I go to a doctor or dentist?
How do I find a doctor or dentist?
Which doctor or dentist should I go to?
Accident and Emergency Clinics (A & E Clinics)
Do I have to tell my parents?
Can the doctor or dentist tell anyone about my visits?
Am I allowed to see my medical and dental records?
Can anyone else see my records?
If I change doctors or dentists, what happens to my records?
When should I go to a doctor or dentist?

You should go to a doctor if you are feeling unwell or want to check something out. If you are a women you should have a cervical smear when you are 20 and another one a year later. If they are normal you should then have one every 3 years after that. Dentists recommend you have a dental check up every 6 months and at the most every 2 years.

How do I find a doctor or dentist?

If you think you need to see a doctor or dentist, phone numbers and addresses are easily found in the front of the phone book. To make sure you go to a good doctor or dentist, ask friends or family members who they go to and what they are like.

Which doctor or dentist should I go to?

It is important that you go to a doctor or dentist who you like and feel comfortable with. If you do not like a doctor or dentist, you have the right to change them whenever you want. You can go to a doctors or dentist's office or to an Accident and Emergency clinic.

Accident and Emergency Clinics (A & E Clinics)

Are open for longer hours than doctors and dentists offices. You don't need an appointment and can go there in an emergency or if you are sick. They often have a number of medical services under the one roof so you don't have to travel between health specialists. Sometimes they are cheaper than private doctors or dentists so you should check.

You should also check whether it will be cheaper for you to go to a private A & E clinic or a public one at a hospital. Some private A & E clinics are cheaper than public ones if you go there for treatment for an accident rather than general medical treatment.

If you have a Community Services Card or High Use Health Card it is usually cheaper to go to a public A & E clinic at a hospital. You can go to the A & E clinic at any hospital without being referred there and it is free if you have a Community Services Card. If you have a High Use Health Card you will also get a large discount. For more information on reducing health costs see our "Health Costs and Young People: free services and ways of reducing health costs" information sheet.

Do I have to tell my parents?

You don't have to tell your parents. Any information that you tell the doctor or dentist is confidential. That means they cannot tell anyone unless you want them to.

Can the doctor or dentist tell anyone about my visits?

The doctor or dentist cannot tell anyone without your consent. But, there are certain times when a doctor or dentist is allowed to tell without your consent:

• When they have to by law. For example, in a court case, where someone is in danger.
• When talking to another medical practitioner about your care.
• When you are under 17 years old and the doctor or dentist thinks you may have been physically or sexually abused, they can tell the Police or the Department of Social Welfare.

Am I allowed to see my medical and dental records?

You are allowed to see your records whenever you want and can even ask for a copy.

Can anyone else see my records?

Only appropriate medical staff are allowed to see your records. They must treat your records as highly confidential.

If I change doctors or dentists, what happens to my records?

If you decide to change doctors or dentists, you can ask that they be sent to your new doctor or dentist. Your previous doctor or dentist must do as you ask.



What is informed consent?

When do I need to give my informed consent?
What should the doctor or dentist tell me?
What if I change my mind?
Can I have someone in the room with me?
Does the doctor/dentist have to tell me what s/he found out from the examination or treatment?

Do I have to give my consent to everything the doctor/dentist does? When do I need to give my informed consent?

If you visit the dentist or doctor and they want to give you any medical or dental treatment or a medical examination, they must first get your approval. This means that a doctor or dentist can't do anything until you freely let them.

Generally, you can give your consent verbally, that is, by saying it to the doctor or dentist. If the treatment involves surgery, then the consent must be written either by you or your parents. If you have to fill in a form read it carefully and get the doctor or dentist to explain anything that you do not understand.

However, before you give your consent you must know what the doctor or dentist wishes to do. Make sure that the doctor or dentist explains what they want to do and why.

What should the doctor or dentist tell me?

The doctor or dentist must tell you:

• What the treatment or examination is and what will happen. You have the right to examine any equipment to be used.
• What the treatment or examination is for.
• How the treatment will help you.
• What the examination will tell about you.
• The things that could happen if the treatment goes wrong and any consequences.

When the doctor or dentist tells you these things, you are then informed to make a decision about the treatment or examination.

What if I change my mind?

Section 11 of the Bill of Rights Act gives you the right to refuse to undergo any medical treatment. This means you can change your mind even if you have already consented to some medical or dental treatment.

Can I have someone in the room with me?

Yes you can have anyone in the room with you that you want or you can tell the doctor/dentist that you don't want anyone in there with you.
Does the doctor/dentist have to tell me what s/he found out from the examination or treatment?

Yes. After the treatment or examination the doctor/dentist must tell you what they found our and explain it to you so you can understand.
Do I have to give my consent to everything the doctor/dentist does?

There are certain times when the doctor/dentist does not need your consent to treat or examine you:

• When your life is in danger or you can't give your consent. For example, if you are unconscious after an accident.
• If the doctor/dentist wants to examine you for any mental illnesses if you are being held for an assessment.
• In certain circumstances, if the doctor/dentist thinks you have been abused.

How old do I have to be to give my informed consent?

Tattoos And Skin Piercings
I am under 16. Am I mature enough?
Who can give consent if I can't?
What if my parents do not give their consent?
What if I refuse consent?
Is what I decide still important?
What if I don't agree with what the doctor and my parents decide?

At any age a female can give her own informed consent to an abortion.

If you are 16 years old or older, you can give your own informed consent, or refuse consent,to medical treatment or examination, including blood transfusions, dental treatment, contraceptive treatment, tattoos, ear and body piercings.

If you are under 16 years old, you can give your consent only if you are mature enough
.
Tattoos And Skin Piercings

In some areas there may be bylaws made by the city council preventing tattooists or body piercers from providing you with their services until you are older. In the Auckland city area the Auckland City Council has passed a by-law preventing someone from performing acupuncture, hair removal, pedicure, ear piercing (other than by a pharmacist), body piercing, hair restoration and tattooing on under 18 year olds unless that person's parent or guardian has consented to the procedure. The penalty for breaching the by-law is a $500 fine they have to pay.

In other areas of New Zealand tattooists belonging to the Tattoo Artists Association of New Zealand (TAANZ) work to a code of ethics which means they won't tattoo someone under 18 without their parent or guardians permission.

Wherever you go, to protect yourself from any risks of infection from diseases carried in the blood, you should make sure the treatment will be carried out hygienically using sterilised instruments and surgical gloves.

I am under 16. Am I mature enough?

The doctor or dentist will decide this question. The doctor or dentist must be sure that you understand the procedures, consequences, and risks of the treatment or examination. Your parents do not decide if you are mature enough.

If you have a disability that will stop you from giving informed consent, your parents will decide for you until you are 18.

Who can give consent if I can't?

Your parents or guardians (someone acting legally in the place of your parents) will give consent for you until you are able, that is, until the doctor or dentist thinks you are mature enough.

What if my parents do not give their consent?

If you are under18 years old and you need treatment or else you might die or your health will seriously suffer, and your parents do not give consent, the doctor or hospital can apply to the Court. You may then become a ward of the Court which means that a Judge can make decisions about your treatment instead of your parents.

If your parents do not give consent and you die or are permanently injured, then your parents could be charged with a criminal offence.

What if I refuse consent?

Everyone has the right to refuse to consent to medical treatment. This is affirmed by s. 11 of the New Zealand Bill of Rights Act 1990. The Care for Children Act states that you have the right to refuse medical treatment from the age of 16.

However if you are under 18, your refusalcould be overridden by the court. This could happen when the court is satisfied that:

• that treatment is for your benefit (e.g. where you need medication for a mental illness, see Re R [1991] 4 All ER 177); or
• refusing treatment would probably kill you or leave you permanently and seriously injured (e.g. where you refuse treatment for anorexia nervosa, see Re W (a minor) [1992] 4 All ER 627).

What if I don't agree with what the doctor and my parents decide?

Then you may apply to the court. If the judge agree with you, they have the power to override your parents or guardian’s consent. If they disagree with you, they also have the power to override your consent.



What can I do if something goes wrong?

Can I do anything if something goes wrong with the treatment?
Can I complain to anyone?
Who can I complain to about medical treatment?
How do I make a formal complaint about medical treatment?
If my complaint is taken to the Tribunal what can they do?
What can the Tribunal do if it decides the doctor was wrong?
Is that as far as it goes?
Who do I complain to about dental treatment?

If you do not like what a doctor or dentist has done, or you think what the doctor or dentist has done is wrong, it is important to let someone know how you feel. This way something can be done to stop or correct what the doctor or dentist is doing wrong.

Can I do anything if something goes wrong with the treatment?

If you are injured because of medical mistreatment and the injury is severe (for example so you have to spend 14 days in hospital as a result, or have a disability which lasts more than 28 days and is very rarely caused there is only a 1% chance of it happening) or the doctor or dentist did not take a reasonable amount of care, you can claim ACC (accident compensation) for "medical misadventure".

To make a claim you will need to fill out a form at a doctor’s office. The doctor who fills out the form does not need to be the same one who caused the injury.

It will take a number of weeks for the Accident Compensation Corporation to decide whether to accept your claim. If your claim is accepted, there are a number of benefits and services which may be available to you depending on your injury and how severe it is. You can contact the Accident Compensation Corporation for more information about this. You can't get ACC for medical misadventure if the injury is caused by a tatooist or skin piercer unless that person is a registered health professional.

Can I complain to anyone?

The Code of Health and Disability Services Consumers' Rights gives you the right to complain if you are not happy with any health treatment or medical advice you receive. This probably doesn't cover tattooing and skin piercing unless it is being done to promote or protect your physical or mental health rather than for artistic reasons or decoration. If you have been injured by a tatooist or skin piercer you could complain to the police or the Association the tatooist or skin piercer belongs to.

Who can I complain to about medical treatment?

There are several people who you can complain to:

• Your own doctor, their boss or another doctor.
• The Health and Disability Commission: if the incident happened before 1 July 1996 (when the Code of Rights came into force) it is better to go straight to the Medical Council.
• The Medical Council of New Zealand: only looks at complaints about doctors not other health practitioners.
• Medical Association: if you are unhappy about how much a doctor is charging you.
• Citizens Advice Bureau: can help you to get in contact with someone who you can complain to.
• The Regional Health Authority for your area: can also help you find contacts.
• The Privacy Commissioner: if you feel information has been given out about you without you agreeing to it or your unhappy with how your medical records have been treated.
• Advertising Standards Complaints Board: if you think the doctor's services have been advertised as something different to what they are.

How do I make a formal complaint about medical treatment?

You can make a complaint either by writing to or ringing the Health and Disability Commissioner or the Medical Council of New Zealand (see their contact details on page 8). Your complaint should include your name, contact details and the name and address of the doctor. It should also say what happened or didn't happen and describe the behaviour or treatment you thought wasn't good enough and when and where it happened.

* Remember that if the incident occurred before 1 July 1996 it is better to go straight to the Medical Council. If the Medical Council looks at your complaint it will be looked at after about 6 weeks by a Complaints Assessment Committee. The person you are complaining against will get a copy of the complaint.

Both you and the person you are complaining about are allowed to write to the Committee to explain what happened. If you'd rather tell them to their face you can ask to do this instead. The Committee may ask you to appear in person, anyway.

The Committee may decide to help you and the person you complained about to work the problem out yourselves. It may instead charge the doctor before the Medical Practitioner's Disciplinary Tribunal, ask the Medical Council to decide whether the doctor should remain working as a doctor (the Council can ask the doctor to go to counselling, do more training or get treatment) or recommend that nothing more happens.

* If the Health and Disability Commissioner looks at your complaint he/she can refer it to the Director of Proceedings who can decide to charge the doctor before the Medical Practitioner's Disciplinary Tribunal or under the Health and Disability Act.



If my complaint is taken to the Tribunal what can they do?

The Tribunal will decide whether the doctor was right or wrong. They must have a hearing within 60 days. The Tribunal is formal and lawyers are usually there
representing the people involved. You will not need to get or pay for a lawyer yourself but you will need to write down what happened for the Tribunal. You may also need to be at the hearing to tell the Tribunal what happened and answer any questions.



What can the Tribunal do if it decides the doctor was wrong?

The Tribunal can tell the doctor off, fine the doctor up to $20,000 (but if the incident happened before 1 July 1996 the doctor can only be fined up to $1,000), suspend the doctor for up to 12 months, or order the doctor to do something if he or she wants to keep working as a doctor. Some examples are the doctor having to go to counselling, do more training, be supervised, get treatment, or only work in a particular place. In very serious cases the Tribunal can stop the doctor from working as a doctor any more.

Although the doctor may have to pay any costs of the investigation and hearing he or she can not be made to pay you any money for what you have been through.

Is that as far as it goes?

In certain circumstances, the case may go to the District Court and the High Court if there is an appeal against the Tribunal's decision.

Who do I complain to about dental treatment?

You can complain to:

• The Health and Disability Commission: go straight to the Dental Council if the incident happened before 1 July 1996.
• The Dental Association.
• The Dental Council of New Zealand.
• Citizens Advice Bureau: can help you get in contact with someone who you can complain to.
• The Regional Health Authority for your area: can also help you find contacts.

The procedure for complaints to the Dental Council is similar to the procedure outlined above for the Medical Council.

Further information:

If you want further information about your rights and medical treatment you can contact:

Citizens Advice Bureau
See Phone book for your local office

Community Law Centres
See Phone book for your local office

Health and Disability Commissioner
PO Box 1791, Auckland.
Ph: (09) 373-1060, fax: (09) 373-1061
Wellington Ph: (04) 495-6669
Website: www.hdc.org.nz
E-mail: hdc@hdc.org.nz
Other areas Freephone: 0800 11 22 33

The Registrar Medical Council of New Zealand
PO Box 11-649, Wellington.
Ph: (04) 384-7635
Website: www.mcnz.org.nz
E-mail: mcnz@mcnz.org.nz

Medical Association
26 The Terrace, Wellington.
Ph: (04) 472 4741
Website: www.nzma.org.nz
E-mail: nzma@nzma.org.nz

Dental Association Inc
P O Box 28084, Remuera.
Ph: (09) 524 2778
Website: www.nzda.org.nz
E-mail: robin@nzda.org.nz

Accident Compensation Corporation
Medical Misadventure Unit
PO Box 1696, Wellington.
Freephone 0800 735566
Fax: (04) 499-2347