Why professional regulation in health care matters.
The therapeutic relationship—not a clinician's unfettered hot takes—is the point of such regulation.
Political Wellington suspects every rule or regulation is a plot by clipboard bureaucrats to ruin a good kiwi Southland sausage roll. Fair enough—bad rules deserve repeal. But here's one domain where smart regulation isn't ideology, it's clinical necessity: healthcare. This week, a news outlet will report the outcome of a professional complaint I lodged about a psychotherapist. I won't relitigate the particulars here. The point is broader: professional regulation is how we translate human rights—dignity, equality, non-discrimination—into the everyday, high-stakes relationships on which care depends. the stakes.
A transgender person turning up at ED doesn't want a surgeon who has publicly derided trans people. A Muslim seeking counselling shouldn't have to disclose trauma to a therapist who promotes "great replacement" conspiracies on their weekly RCR show. This isn't about hurt feelings. It's about foreseeable harm. The relationship between patient and clinician isn't some nice-to-have extra—it determines whether treatment often works at all, especially in mental healthcare.
The evidence is overwhelming. Across nearly 300 studies covering more than 30,000 patients, the quality of the therapeutic alliance reliably predicts better outcomes, regardless of therapy model. Randomised trials show that strengthening the patient-clinician relationship produces measurable improvements in health outcomes. Clear, respectful communication correlates with patients actually following treatment plans—so strongly that communication training improves adherence. The "how" of care changes the "what".
This is why regulation exists. New Zealand's Health Practitioners Competence Assurance Act isn't a culture-war instrument; its purpose is to protect the public by ensuring practitioners are competent and fit to practise. The Health and Disability Commissioner's Code of Rights puts a floor under every clinical encounter: respect, freedom from discrimination, effective communication, services of an appropriate standard. These aren't bureaucratic niceties. They're the legal expression of basic human rights in the clinic.
For marginalised communities, this matters desperately. Systematic reviews show that clinicians—like all of us—can harbour implicit biases. Those biases are linked to poorer interactions and, in some contexts, worse outcomes. For trans and non-binary people in Aotearoa, large-scale surveys document discrimination and its predictable consequence: delaying or avoiding care entirely. Regulation is the tool we use to reduce those risks.
At this point, civil libertarians who should know better argue that regulators are "compelling ideology" and should be made "politically neutral", complete with draft bills to cordon off "lawful speech" from professional consequences. One prominent organisation has made this their consistent programme: narrow what regulators can call unprofessional, resist cultural-safety standards, and frame it all as protecting dissent. I understand the instinct. But it fundamentally misunderstands what professions are.
Professions are voluntary compacts. You join for the privileges—status, livelihood, public trust. You accept correlative duties. Those duties mean you can't say things that make patients unsafe or destroy trust in your profession. Lawyers are the clearest example: you simply cannot say whatever you like and keep your practising certificate if your conduct brings the profession into disrepute or crosses into harassment or discrimination. Medicine and psychology work the same way. The Medical Council's standards emphasise that behaviour—on or off the ward—must sustain safe care and public trust. These aren't culture tests. They're fiduciary guardrails in high-risk settings.
None of this licences regulators to wander into politics or punish legitimate professional disagreement. The line should be narrow and principled. First, nexus: is the conduct closely connected to practice or public confidence in the profession? Second, risk: does it create a real risk of harm, inequity, or a breakdown of trust that impairs care? Third, process: are the standards clear, applied proportionately, and subject to fair procedure? Get those three right and we protect both the public and intellectual freedom within the craft.
For the avoidance of doubt, this protects clinicians too. Good relationships aren't soft skills—they are clinical skills. Training clinicians to communicate well and recognise bias isn't ideological; it's quality improvement. Patients do better. Adherence improves. Complaints drop. That's the Wellington value-proposition even the most sceptical Treasury analyst can understand: better outcomes at lower downstream cost.
So by all means, prune bad rules. But in health and psychological care, the answer to culture-war fatigue isn't declaring the clinic a free-for-all with regard to speech. The answer is to regulate what actually matters: the competence and conduct that make trust possible and care effective. That's how human rights move from charters to consultations, from the statute book to the bedside. The Ontario Court of Appeal reinforced this point in its judgment against Jordan B Peterson.
In a city suspicious of every rule, here's one worth keeping: the one that ensures your therapist or surgeon sees you as a person, not a platform for their politics. Because when you're at your most vulnerable—in crisis, in pain, seeking help—you deserve a professional whose commitment to your care transcends their personal opinions. That's not bureaucracy. That's basic decency with regulatory teeth.