The Code of Rights: What Each of the 10 HDC Rights Asks of NZ Health Practitioners

Why the Code is every practitioner's legal floor

The Code of Health and Disability Services Consumers' Rights is a regulation made under the Health and Disability Commissioner Act 1994. It has applied since 1 July 1996, and it is the yardstick for every complaint the Health and Disability Commissioner (HDC) handles. Our fitness to practise overview explains the route a complaint takes from HDC to your responsible authority and beyond. This guide deals with the content: what you are actually being measured against.

Three features make the Code different from the professional codes you sign up to on registration.

• It covers everyone who provides care, not just registered practitioners. The HDC Act defines a health care provider to include any health practitioner, ambulance services, people in charge of certified hospital and rest home services, and "any other person" who provides health services to the public or a section of it, whether or not they charge. A healthcare assistant, a practice, a district of Health New Zealand and a private clinic company are all providers.
• It is written as consumer rights with provider duties. Clause 1 says consumers have the rights, providers have the duties, and providers must take action to inform consumers of their rights and enable them to exercise them. Putting the Code poster on the wall is the minimum, not the whole duty.
• It sits above your professional code, not instead of it. Right 4(2) requires services that comply with legal, professional, ethical and other relevant standards, so a breach of your Council's code of conduct can become a Code of Rights breach too. Our comparison of NZ health practitioner codes of conduct shows what those professional standards contain.

Health and Disability Commissioner annual report 2024/25 (year to 30 June 2025). HDC also closed 4,406 complaints and made 809 recommendations, with 91% of those reviewed complied with.

Most complaints never reach a breach finding. HDC says around 68% of the complaints it closed in 2024/25 went through early resolution pathways. But the opinions it does publish show, in detail, how each right is interpreted, and those are the patterns this guide draws on.

How the Code is built: clauses 1 to 6

The Code is short. The ten rights sit inside clause 2, framed by clauses that decide who holds the rights, how compliance is judged and how the Code fits with other law. Practitioners tend to know the rights and skip the frame, yet the frame is where many HDC findings are won or lost.

Clause 3: the reasonable actions defence

Clause 3 is the provision every practitioner should know by heart. It says a provider is not in breach of the Code if it has taken reasonable actions in the circumstances to give effect to the rights and comply with the duties. Two further subclauses do the heavy lifting:

• The onus is on you. Clause 3(2) puts the burden of proving reasonable actions on the provider. The consumer does not have to prove you acted unreasonably.
• "The circumstances" are broad. Clause 3(3) says they mean all the relevant circumstances, including the consumer's clinical circumstances and the provider's resource constraints.

In practice this means a breach finding often turns on what you can show, years after the event. HDC investigations commonly run for a long time, and your memory of a ten-minute consultation will not carry the weight of a contemporaneous note. The defence is strongest when your record shows what you knew, what you considered, what you told the consumer and why you chose the path you did.

The decisions discussed below show the line. In a 2026 opinion about a planned Caesarean, the Commissioner accepted that the obstetrician believed she was acting in the woman's best interests and that a Caesarean was probably the clinically preferred option, but still found a breach because the situation was not an emergency and there was time to pause and tell the woman that the promised check on her baby's position had not been done. Good intentions and a defensible clinical plan did not prevent a breach finding.

Clause 4 definitions that change how the rights apply

Several definitions widen or sharpen the rights in ways that catch practitioners out.

The 10 rights at a glance

Before going right by right, here is the whole Code on one screen, framed as the duty each right places on you.

Rights 1 to 3: respect, exploitation and dignity

These three rights are short, but they reach into every encounter. They are often found alongside other breaches rather than alone, and they are the rights most closely tied to how the consumer felt they were treated.

Right 1: respect, privacy and cultural needs

Right 1 has three parts. Every consumer has the right to be treated with respect (1(1)), to have their privacy respected (1(2)), and to receive services that take into account the needs, values and beliefs of different cultural, religious, social and ethnic groups, including the needs, values and beliefs of Māori (1(3)).

• Respect is judged from conduct: how you speak to people, whether you listen, whether you belittle concerns. HDC's complaint data counted 138 complaints in 2024/25 where a disrespectful manner or attitude was the primary issue.
• Privacy in Right 1(2) overlaps with the Health Information Privacy Code but is wider than information. It also covers physical privacy: curtains, exposure, conversations overheard in shared rooms. For the information side, see our guide to the Health Information Privacy Code 2020 in clinical practice.
• Cultural needs under Right 1(3) are an explicit legal duty, not just a professional expectation. Asking about whānau involvement, karakia, language preference or tapu around the body, and acting on what you learn, is how you meet it. The professional requirements behind this are compared in our article on cultural safety CPD requirements.

Right 2: freedom from discrimination, coercion, harassment and exploitation

Right 2 protects consumers from discrimination, coercion, harassment, and sexual, financial or other exploitation. Read with the clause 4 definition, exploitation includes abuse of a position of trust, breach of a fiduciary duty and undue influence. That captures far more than sexual misconduct: accepting significant gifts, borrowing money, involving patients in your business, or pressing a decision on someone who depends on you.

If boundaries are a live issue for you or your team, the professional boundaries course works through these situations in more depth.

Right 3: dignity and independence

Right 3 is a single sentence: services must be provided in a manner that respects the dignity and independence of the individual. It is most often engaged in aged residential care, disability support and inpatient settings, where personal cares, continence, mobility and choice about daily routines are part of the service. Practical tests: would the person choose to be left like this? Are you doing for them what they could do for themselves with time and support? Have you asked, or decided for them?

Right 4: services of an appropriate standard

Right 4 is the clinical heart of the Code and the right most practitioners picture when they think of an HDC complaint. It has five subclauses, and each one is assessed on its own.

Right 4(1): reasonable care and skill

The test is what a reasonable practitioner in your field would have done, not what a perfect one would have done with hindsight. HDC usually obtains independent clinical advice from a practitioner in the same discipline, who is asked whether your care was consistent with accepted practice and, if not, how serious the departure was. Missed or delayed follow-up of abnormal results is a recurring Right 4(1) pattern.

Results management is a good place to test your own systems. Our list of medical audit ideas for NZ GPs includes ready-made audits on overdue results and referral follow-through.

Right 4(2): professional and legal standards

Right 4(2) is the bridge between the Code and your profession's own rules. Your Council's code of conduct, its standards and statements, clinical guidelines, legislation and your employer's policies are all "relevant standards". Working outside your authorised scope can also be a Right 4(2) issue; our guide to scopes of practice under the HPCA Act explains where those limits come from.

Right 4(3) and 4(4): fitting care to the person

These subclauses ask whether care was right for this consumer, not just technically adequate. A discharge plan that assumes a frail person can manage stairs and medicines alone, or a pain plan that ignores someone's known history, can fall short here even when each individual step looks reasonable.

Right 4(5): co-operation and continuity

Right 4(5) is where organisations are most often found in breach, because continuity depends on systems: who owns a referral, who follows up a result, how a handover is done. It is also the subclause most relevant to shared care across primary and secondary services.

Right 5: effective communication

Right 5 has two subclauses. Right 5(1) gives every consumer the right to effective communication in a form, language and manner that enables them to understand the information provided; where necessary and reasonably practicable, this includes the right to a competent interpreter. Right 5(2) gives every consumer the right to an environment that enables both consumer and provider to communicate openly, honestly and effectively.

Communication is one of the most common things complaints are about. In 2024/25 failure to communicate effectively with the consumer was the primary issue in 165 complaints to HDC, fifth on its list.

Health and Disability Commissioner annual report 2024/25, primary complaint issues table. Each complaint is counted once, under its primary issue.

Communication failures also sit underneath many of the treatment and diagnosis complaints above: a worsening symptom not reported because the consumer did not know it mattered, or a plan misunderstood at discharge. What Right 5 asks of you in practice:

• Interpreters. "Where necessary and reasonably practicable" means you need a reason, recorded, for not using a competent interpreter when the consumer's English is limited. Using a child or a distressed relative to interpret serious news rarely meets the standard of a competent interpreter.
• Form and manner. Plain language, written or visual information where it helps, extra time for people with cognitive impairment, sensory loss or a learning disability, and checking understanding with teach-back rather than asking "Any questions?".
• An open environment. Right 5(2) is about conditions as well as words: privacy for difficult conversations, permission to ask, and a culture where people are not made to feel a nuisance. It is also the right that underpins open disclosure when something goes wrong; the open disclosure training covers how to have those conversations.

Right 6: the right to be fully informed

Right 6 sets the information standard, and it is consumer-centred. Right 6(1) entitles every consumer to the information that a reasonable consumer, in that consumer's circumstances, would expect to receive. The question is not what a reasonable doctor or nurse would usually say, but what a reasonable person in this patient's position would want to know.

Right 6(1) lists what that includes:

1. An explanation of their condition (6(1)(a))

   What is wrong, or what you think may be wrong, in terms they can follow.

2. The options available (6(1)(b))

   Including an assessment of the expected risks, side effects, benefits and costs of each option. Doing nothing, waiting and referral elsewhere are options too.

3. Timeframes (6(1)(c))

   Advice of the estimated time within which services will be provided, such as waiting times for a procedure or a specialist appointment.

4. Teaching or research (6(1)(d))

   Notification of any proposed participation in teaching or research, including whether the research requires and has received ethical approval.

5. Anything else required by standards (6(1)(e))

   Information that legal, professional, ethical and other relevant standards require you to give.

6. Results (6(1)(f) and (g))

   The results of tests and of procedures. A result you have seen but not passed on is a classic Right 6 breach.

Three further subclauses complete the right:

• Right 6(2): before making a choice or giving consent, every consumer has the right to the information a reasonable consumer in their circumstances needs to make an informed choice or give informed consent. This is the bridge to Right 7.
• Right 6(3): every consumer has the right to honest and accurate answers to questions about services, including your identity and qualifications, your recommendation, how to get an opinion from another provider, and the results of research.
• Right 6(4): on request, a written summary of the information provided.

Good practice under Right 6 is less about longer consent forms and more about the conversation: individualised risks rather than generic lists, alternatives including no treatment, your own recommendation and why, and a note recording what was discussed. Where the consumer asks about your experience with a procedure, Right 6(3) requires an honest answer.

Right 7: informed choice and informed consent

Right 7 is the longest right in the Code, with ten subclauses. Its opening sentence sets the default: services may be provided to a consumer only if that consumer makes an informed choice and gives informed consent, except where any enactment, the common law, or any other provision of the Code provides otherwise.

Competence: the presumption and diminished competence

Right 7(2) says every consumer must be presumed competent to make an informed choice and give informed consent, unless there are reasonable grounds for believing the consumer is not competent. Right 7(3) adds that a consumer with diminished competence keeps the right to make informed choices and give informed consent to the extent appropriate to their level of competence.

Two things follow. First, you need reasonable grounds, not a hunch or a diagnosis label, to depart from the presumption. Second, competence is decision-specific: a person may be able to consent to a blood test but not to complex surgery, or to everyday care but not to a major financial or residential decision.

Right 7(4): when the consumer is not competent

Where a consumer is not competent to make an informed choice and give informed consent, and no person entitled to consent on their behalf is available, Right 7(4) allows you to provide services only if all of these conditions are met:

1. Best interests

   It is in the consumer's best interests.

2. Reasonable steps to find out their views

   You have taken reasonable steps to ascertain the views of the consumer.

3. One of two further tests

   Either, if their views have been ascertained and you have reasonable grounds to believe the service is consistent with the informed choice they would make if competent, you proceed on that basis; or, if their views have not been ascertained, you take into account the views of other suitable persons who are interested in the consumer's welfare and available to advise you.

Note the order. Right 7(4) applies only when no one entitled to consent is available. Under the Protection of Personal and Property Rights Act 1988, that person is usually a court-appointed welfare guardian or an attorney under an enduring power of attorney for personal care and welfare. An attorney can act only if the person is mentally incapable, and for a significant matter, such as a major medical procedure, only once a relevant health practitioner has certified, or the court has determined, that the person is mentally incapable. Neither a welfare guardian nor an attorney can refuse consent to standard medical treatment intended to save the person's life or prevent serious damage to their health. Where one of them is available, clause 4 extends Rights 5, 6, 7(1), 7(7) to 7(10) and 10 to them. Whānau who hold no legal authority do not consent on the person's behalf, but under Right 7(4)(c)(ii) their views are exactly what you should seek and record where the person's own views cannot be ascertained. The legal framework for attorneys and welfare guardians is covered in the decision-making capacity and PPPR Act course.

Advance directives, writing and refusal

• Right 7(5): every consumer may use an advance directive in accordance with the common law. For assisted dying only, clause 5A says Rights 7(2) to 7(5) are overridden by the End of Life Choice Act 2019's own competence test.
• Right 7(6): where informed consent is required, it must be in writing if the consumer is to participate in research; the procedure is experimental; the consumer will be under general anaesthetic; or there is a significant risk of adverse effects on the consumer.
• Right 7(7): every consumer has the right to refuse services and to withdraw consent to services. A refusal you disagree with is still a valid choice if it is informed and the person is competent.
• Right 7(8): every consumer has the right to express a preference about who provides services and to have that preference met where practicable, such as a request for a female clinician for an intimate examination.
• Rights 7(9) and 7(10): consumers may decide about the return or disposal of body parts or bodily substances removed during a procedure. These may be stored, preserved or used only with informed consent, for ethics-committee-approved research, or for specified quality activities such as a professionally recognised quality assurance programme or an external audit or evaluation of services.

Consent breaches in practice

Two recent opinions show the most common Right 7 failure: doing something different from what the consumer agreed to, without going back to them.

In both cases the clinical skill was not the problem. The lesson is simple and practical: if circumstances change after consent is given, or a step the consumer relied on has not happened, stop and tell them before you proceed, unless there is a genuine emergency. Our audit ideas include a consent documentation audit if you want to test your own records.

Rights 8 and 9: support persons, teaching and research

Right 8: the right to support

Every consumer has the right to have one or more support persons of their choice present, except where safety may be compromised or another consumer's rights may be unreasonably infringed. The exceptions are narrow. Excluding whānau because it is inconvenient, because the room is small or because staff find a family member challenging is unlikely to meet them. Where you do limit support people, record the safety or rights reason and revisit it. HDC's 2024 review recommended strengthening this right, including allowing support people to be involved when they cannot be physically present, but that recommendation is not yet law.

Right 9: teaching and research

Right 9 says the rights in the Code extend to consumers taking part, or proposed to take part, in teaching or research. It works with two other provisions: Right 6(1)(d), which requires you to tell consumers about any proposed participation in teaching or research, and Right 7(6)(a), which requires written consent to research. Because "teaching" includes the training of providers, a student observing, examining or performing a procedure engages these rights. Ask the consumer in advance, make it easy to say no, and record the answer, especially for intimate examinations and anaesthetised patients.

Right 10: complaints

Right 10 gives consumers the right to complain about a provider in any form appropriate to them, to the provider, to anyone authorised to receive complaints, or to others such as an independent advocate or HDC. It then sets out how providers must handle complaints. The key duties and timeframes:

Right 10(6) requires every provider, unless an employee of a provider, to have a complaints procedure that also informs the consumer of internal and external complaint options, including advocates and HDC, documents the complaint and your actions, and gives the consumer all relevant information you hold. If you are employed, your employer's procedure applies, but the other duties in Right 10 still apply to you personally.

Right 10 can be breached on its own. In Director of Proceedings v Wilding International Ltd [2021] NZHRRT 45, a rest home operator that declined or ignored at least ten HDC requests for a resident's clinical notes was declared in breach of Right 10(3), which HDC's Director of Proceedings understood to be the first such finding. A defensive, slow or obstructive response can create a breach where the original care might not have.

This guide does not cover how to respond to an HDC letter step by step. If you are dealing with one, the responding to a complaint course and the process sections of our fitness to practise overview are the places to start.

How HDC decides whether the Code was breached

Knowing how breach opinions are built helps you understand what the Code asks of you on an ordinary day. Without going into the complaint process itself, these are the features that recur.

Individual and organisational providers

HDC assesses each provider involved separately: the individual practitioner, the practice or clinic, and the district or company that runs the service. Its 2024/25 annual report notes that systems and organisations are found in breach of the Code more often than individuals. Many published opinions find an organisation in breach for systemic failures while making only an adverse comment, not a breach finding, about an individual, or the reverse. In 20HDC01421, the surgeon was found in breach and Health New Zealand was not, though HDC commented adversely that its response focused on clinical judgement rather than the patient's right to refuse.

Employer liability under section 72

Section 72 of the HDC Act makes an employing authority responsible for its people. Anything done or omitted by an employee is treated as done or omitted by the employer as well as by the employee, whether or not the employer knew or approved. Acts of agents and members are treated the same way, unless they acted without the authority's express or implied authority. Under section 72(5), an employer has a defence if it proves it took such steps as were reasonably practicable to prevent the employee from doing the act or omission, or acts of that description.

For you as an employee, the point is that your employer's potential liability does not replace your own. HDC can find the individual in breach, the employer directly in breach for its systems, the employer vicariously liable for the employee, or any combination. HDC's 2024 review also asked the Ministry of Health to look at changing the wording of section 72, but no change has been made.

Outcomes of a breach finding

When HDC forms the opinion that a provider breached the Code, the HDC Act allows the Commissioner to report to the provider with recommendations, report to the provider's responsible authority or other bodies, and refer the provider to the Director of Proceedings, who decides whether to take proceedings. In the decisions in this guide, typical recommendations were a written apology, HDC's online learning modules, an audit of records or policies, and, for one GP, referral to the Medical Council to consider a competence review. In 2024/25 HDC referred 12 providers to the Director of Proceedings.

What happens next with your responsible authority depends on your profession; see the MCNZ complaint process, the Nursing Council complaint process or the Professional Conduct Committee guide.

Is the Code changing? The 2024 review

The HDC Act requires regular reviews of the Act and Code. HDC's latest review ran from 2023, and it delivered its recommendations to the Minister of Health in December 2024. Here is what is verified as at October 2026.

HDC concluded the Act and Code are generally working well and recommended mostly targeted changes. Those relevant to the rights in this guide include:

• adding tikanga to the cultural needs wording in Right 1(3);
• strengthening the right to support to make decisions, and allowing support people to take part when they cannot be physically present;
• a right to support to make a complaint, and more explicit protection against retaliation for people who complain;
• replacing "under general anaesthetic" in Right 7(6)(c) with wording about medication given to alter consciousness, awareness or recall for the procedure.

HDC recommended that Code changes be finalised once the policy direction for the Act is clear, alongside other reforms including the review of the Health Practitioners Competence Assurance Act. It is up to the Government whether to progress them. For the HPCA side of that reform, see our article on the HPCA Amendment Bill 2026. Until the Code is formally amended, HDC will keep assessing complaints against the current wording.

Practitioner checklist: the Code in your next clinic

Use this as a quick self-audit. Each item maps to the right it protects.

• I introduce myself and my role, and answer honestly if asked about my qualifications or experience (Right 6(3)).
• I ask about cultural, religious and whānau needs and act on the answers (Right 1(3), Right 8).
• Physical privacy and confidentiality are protected during examinations and conversations (Right 1(2)).
• I use a competent interpreter where needed, or record why it was not reasonably practicable (Right 5(1)).
• I check understanding with teach-back, not "Any questions?" (Right 5(1)).
• I explain options, including no treatment, with risks, benefits and costs relevant to this person (Right 6(1)(b), 6(2)).
• Every result I order has a named person responsible for acting on it and telling the consumer (Rights 4(1), 4(5), 6(1)(f)).
• I start from the presumption of competence, and document a decision-specific assessment where I have reasonable grounds to doubt it (Right 7(2), 7(3)).
• Where a person lacks competence, I find out who can legally consent, and if no one can, I meet and record all three Right 7(4) conditions.
• I get written consent for research, experimental procedures, general anaesthesia and significant-risk procedures (Right 7(6)).
• If anything changes after consent, I stop and re-consent unless it is a genuine emergency (Right 7(1)).
• Students and trainees are involved only with the consumer's agreement (Rights 6(1)(d), 9).
• I respond to complaints openly, on time and without defensiveness (Right 10).

• Relying on a signed form alone as proof of informed consent.
• Using family members, especially children, to interpret serious information.
• Personal, financial or intimate contact with a current or former patient where a power imbalance remains.
• Leaving whānau out of decisions for someone who lacks competence.
• Assuming someone else will follow up a result or referral.

Self-check: which right is engaged?

Try each scenario before opening the answer.

Frequently asked questions

Primary sources

16 official documents

1. New Zealand Legislation: Health and Disability Commissioner (Code of Health and Disability Services Consumers' Rights) Regulations 1996
2. New Zealand Legislation: Health and Disability Commissioner Act 1994
3. New Zealand Legislation: Protection of Personal and Property Rights Act 1988
4. Health and Disability Commissioner: Code of Health and Disability Services Consumers' Rights
5. Health and Disability Commissioner: Annual Report 2024/25
6. Health and Disability Commissioner: Annual report shows major lift in complaint resolution
7. Health and Disability Commissioner: Review of the Act and Code 2024
8. Health and Disability Commissioner: Review of the HDC Act and Code, Recommendations Report (December 2024)
9. Health and Disability Commissioner: Review of the HDC Act and Code, Executive Summary (March 2025)
10. Health and Disability Commissioner: Decision 20HDC01421
11. Health and Disability Commissioner: Decision 25HDC00165
12. Health and Disability Commissioner: Decision 20HDC00204
13. Health and Disability Commissioner: Decision 19HDC00666
14. Health and Disability Commissioner: Decision 20HDC01728
15. Health and Disability Commissioner: Decision 21HDC00473 media release
16. Health and Disability Commissioner: Director of Proceedings v Wilding International Ltd [2021] NZHRRT 45