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New Health New Zealand Incorporated v Director-General of Health [2023] NZHC 3183 (10 November 2023)

Last Updated: 14 November 2023

IN THE HIGH COURT OF NEW ZEALAND WELLINGTON REGISTRY
I TE KŌTI MATUA O AOTEAROA TE WHANGANUI-A-TARA ROHE
CIV-2023-485-330
[2023] NZHC 3183
UNDER
the Judicial Review Procedure Act 2016 and Part 30 of the High Court Rules
IN THE MATTER
of an application for judicial review of directions made by the Director-General of Health under section 116E(1) of the Health Act 1956
BETWEEN
NEW HEALTH NEW ZEALAND INCORPORATED
Plaintiff
AND
DIRECTOR-GENERAL OF HEALTH
First Defendant
ATTORNEY-GENERAL
Second Defendant
Hearing:
18 September 2023
Counsel:
L M Hansen and C F J Reid for Plaintiff
A M Powell and K M Eckersley for First and Second Defendants
Judgment:
10 November 2023

JUDGMENT OF RADICH J

Table of Contents

Paragraph

Introduction [1]

The preliminary issue in context [4]

Background [16]

New Health v South Taranaki District Council – section 11 of

the Bill of Rights Act is engaged [16]

NEW HEALTH NEW ZEALAND INC v DIRECTOR-GENERAL OF HEALTH [2023] NZHC 3183

[10 November 2023]

Part 5A of the Health Act [23]

The Director-General’s decision [27]

Positions of the parties [31]

Consideration of the issue in New Zealand [40]

The position in the United Kingdom [55]

The position in Canada [75]

Discussion [84]

Was the Director-General required to undertake a rights assessment? [84] Did the Director-General undertake a rights assessment? [104] Relief? [110]
Result [116]

Introduction

  1. New Health v South Taranaki District Council [2018] NZSC 59, [2018] 1 NZLR 948 [New Health v South Taranaki District Council (SC)] at [99]–[100] per O’Regan and Ellen France JJ, at [172] per Glazebrook J and at [243] per Elias CJ.

2 The Director-General, when the decision was made, was Dr Ashley Bloomfield.

whether it is demonstrably justified, quite apart from an assessment by the Court of whether any restriction is so justified.

The preliminary issue in context

  1. The [Bill of Rights Act] imposes a substantive constraint on the first respondent and before making the directions the [Director-General of Health] was required to turn his mind to and be satisfied that the directions were a reasonable limit on the right to refuse medical treatment.
  1. The [Director-General of Health] failed to turn his mind to whether the directions were a reasonable limit on the right to refuse medical treatment.
  1. By so failing, the first respondent made an error of law and failed to recognise the application of s 3 of the NZBORA to his exercise of the statutory power under s 116E of the Health Act.

  1. The New Zealand Bill of Rights Act 1990 applies to acts done by the legislative, executive or judicial branches of the Government of New Zealand or by any person or body in the performance of any public function, power, or duty conferred or imposed by that person or body by or pursuant to law; see s 3.

  1. Moncrief-Spittle v Regional Facilities Auckland Ltd [2022] NZSC 138, [2022] 1 NZLR 459 at n 118.
  2. Wallace v Chief Executive of the Department of Corrections [2023] NZHC 2248 at [65] and New Health New Zealand Ltd v The Minister for COVID-19 Response [2023] NZHC 2647 [New Health v Minister for COVID-19 (HC)] at [71].
the fluoridation of drinking water. In a letter of 12 May 2023 to the Director-General in which reference was made to the intention to bring this proceeding, counsel for New Health asked whether or not the Director-General had considered the application of s 11 of the Bill of Rights Act when it made the decision.

We agree there is no explicit reference to NZBORA in the decision-making documents. However, we do not agree that where a right is engaged the right is a mandatory relevant consideration. The point is for the decision-maker to reach a rights-consistent conclusion, not to simply refer to relevant rights. In Moncrief-Spittle v Regional Facilities Auckland Ltd [2022] NZSC 138, the Court left open the question of whether the failure to consider a relevant right would be a failure to consider a mandatory relevant consideration (the decision-maker in that case had considered the relevant right) but the Crown would argue that the United Kingdom position as outlined in Belfast City Council v Miss Behavin’ Ltd [2007] UKHL 19 is the proper one and should be followed in New Zealand.

Background

New Health v South Taranaki District Council – section 11 of the Bill of Rights Act is engaged

6 New Health v South Taranaki District Council (SC), above n 1.

We are not called on in the present appeal to consider whether the decision of the Council to add fluoride was lawful if found to be authorised. The challenge brought by New Health to the substantive determination of the council is not before us. The Court does not have available to it the materials which show how the council weighed the human right in s 11 in reaching its decision, as it was obliged to do even if authorised to limit rights on a justifiable basis.

7 William Young, Glazebrook, O’Regan and Ellen France JJ.

8 See above, n 1.

9 At [334], per Elias CJ.

10 At [210], per William Young J.

11 At [176], per Glazebrook J.

12 At [223], per Elias CJ.

justify a limitation on the right to refuse medical treatment, and that the right was impaired no more than was necessary to achieve the purpose sufficiently.13

Part 5A of the Health Act

(a) enable the Director-General to direct a local authority to add fluoride or not to add fluoride to drinking water supplied through its local authority supply; and

(b) require the local authority to comply with the direction.

116E Director-General may direct local authority to add or not to add fluoride to drinking water

(1) The Director-General may direct a local authority to add or not to add fluoride to drinking water supplied through its local authority supply.

(2) The Director-General must seek and consider advice from the Director of Public Health on the matters in subsection (3)(a) and (b)(i) before deciding whether to make a direction.

(3) Before making a direction, the Director-General must consider—

(a) scientific evidence on the effectiveness of adding fluoride to drinking water in reducing the prevalence and severity of dental decay; and

(b) whether the benefits of adding fluoride to the drinking water outweigh the financial costs, taking into account—

(i) the state or likely state of the oral health of a population group or community where the local authority supply is situated; and

(ii) the number of people who are reasonably likely to receive drinking water from the local authority supply; and

(iii) the likely financial cost and savings of adding fluoride to the drinking water, including any additional financial costs of ongoing management and monitoring.

13 New Health v South Taranaki District Council (SC), above n 1 at [126], [131], [134], [143].

14 Health (Fluoridation of Drinking Water) Amendment Act 2021.

15 Health Act, s 116C.

(4) For the purpose of subsection (3)(b)(i), the Director-General may take into account any evidence that the Director-General considers relevant.

(5) As soon as practicable after making a direction, the Director-General must publish the direction and the reasons for the decision to make the direction on the Ministry of Health’s Internet site.

The Director-General’s decision

16 Section 116G.

17 Section 116H.

18 Section 116I.

19 Sections 116J and 116K.

20 Directions were issued to Kawerau District Council, New Plymouth District Council, Rotorua Lakes Council, Auckland Council, Tararua District Council, Tauranga District Council, Waitaki District Council, Western Bay of Plenty District Council, Nelson City Council, Hastings City Council, Far North District Council, Waipa District Council, Horowhenua District Council, Whangārei District Council.

the optimum levels (between 0.7 ppm to 1 ppm, parts per million)” at the relevant water supply.

In reaching my decision to issue this direction to you, I considered the scientific evidence on the effectiveness of adding fluoride to drinking water in reducing the prevalence and severity of dental decay. I am satisfied that community water fluoridation is a safe and effective public health measure that significantly reduces the prevalence and severity of dental decay. In reaching this conclusion, I considered: Water fluoridation to prevent tooth decay (Cochrane Collaboration 2015), Health effects of water fluoridation: A review of the scientific evidence (PMCSA and Royal Society Te Aparangi 2014) and Fluoridation: an update on evidence (PMCSA 2021).

In reaching my decision, I also considered whether the benefits of adding fluoride to the drinking water outweigh the financial costs, taking into account: the state or likely state of the oral health of your community served by the [water supply relevant to the local authority]; the number of people who are reasonably likely to receive drinking water from these supplies; and the likely financial cost and savings of adding fluoride to the drinking water of the supplies, including any additional financial costs of ongoing management and monitoring.

Positions of the parties

The question here, one not yet finally settled in New Zealand, is how the NZBORA fulfils its aims when it applies to administrative decision-makers and whether it imposes a procedural obligation on them to consider relevant rights or whether it operates as a substantive constraint to ensure the ultimate decision is rights-consistent.

Consideration of the issue in New Zealand

21 Moncrief-Spittle, above n 4.

22 At [81]–[84] citing Zaoui v Attorney-General (No. 2) [2005] NZSC 38, [2006] 1 NZLR 289 at [93]. Zaoui was concerned with whether the principle of non-refoulment was to be taken into account when a minister decided to ask the Governor-General to order deportation of a refugee found to be a threat to national security. The Court in that case referred to the need for the minister to be satisfied in a substantive way that the person would be in danger of being subjected to torture or cruel, inhumane or degrading treatment or punishment if deported.

[footnotes omitted]

23 Wallace, above n 5.

(a) The decision-maker must turn their mind to this, and engage with the question whether the limitation involves a reasonable limit on that right.

(b) The outcome that the decision-maker may reach is also constrained. If the Court concludes that the decision is an unjustified limitation on the right it is unlawful.

...

[110] As the Supreme Court confirmed in Moncrief-Spittle, discretionary decision-making which limits fundamental rights in the NZBORA requires the decision-maker to take into account the limitation and whether it is justified. I have already addressed whether the decisions did so limit the right provided for in s 19, and concluded that it did for the three reasons identified. I have also concluded that that limitation was not demonstrably justified. But it is also necessary for the decision-maker [to] take into account, and address the question of limiting a fundamental right.

The fact that a decision-maker does not expressly refer to the particular section of the NZBORA is not what is most important. What is necessary was a consideration recognising, as a matter of substance, that the decisions had discriminatory effect on women prisoners, and addressing whether that was justified. That did not occur, and I uphold this ground of review.

24 At [111].

25 At [111].

26 New Health v Minister for COVID-19 (HC), above n 5.

fundamental right in the Bill of Rights Act, the decision-maker must address that restriction and consider whether it is demonstrably justified and the Court must, in addition, be satisfied that any restriction is so justified. Cooke J referred to the first of the two requirements as being subjective and to the second as being objective.27

Furthermore, in applying the concepts of promotion and support to the publications in question, s 5 of the Bill of Rights Act requires that such application favours freedom of expression over objectionability if the case is marginal. It is not clear how the board approached the construction and application of the concepts of promotion and support in the present case. There is, however, a likelihood, by reason of the board’s reference to, and its being bound by the decision of, the Full Court in News Media, that the Board erroneously regarded Bill of Rights Act considerations as having no part to play. For these reasons the board should reconsider the book on the correct basis as outlined in the next paragraph.

27 At [71] and [82].

28 Moonen v Film and Literature Board of Review [1999] NZCA 329; [2000] 2 NZLR 9 at [28]; The Court was referring here to News Media Ltd v Film and Literature Board of Review (1997) 4 HRNZ 410, which the Court overruled in this decision.

29 At [40].

30 Schubert v Wanganui District Council [2011] NZHC 48; [2011] NZAR 233 at [160], [162] and [171].

[86] The application of the provisions of the NZBORA is a mandatory relevant consideration, and must be taken into account by the Authority if it is considering upholding a complaint. While the Courts in earlier decisions were prepared to accept that the consideration was implicit, it is now clear that the consideration, and in particular the s 5 NZBORA analysis, should be articulated in the Authority’s decision.

A “culture of justification” means a culture in which citizens are entitled to call upon the provision of reasons for measures that affect their rights, are entitled to challenge those reasons, and in a sense more importantly, are entitled to expect that in advance of impairment thought will have been given to the reasonableness of a particular limit. The culture of justification contributes to principles of good government, such as transparency, accountability, rational public policy development, attention to differing interests, and so on.

31 Television New Zealand v West [2011] NZHC 435; [2011] 3 NZLR 825 (TVNZ v West).

32 At [97], [98], [103] and [104].

  1. Andrew Butler and Petra Butler The New Zealand Bill of Rights Act: A Commentary (2nd ed, LexisNexis, Wellington, 2015) at 181.
  2. E Mureinik “Emerging from Emergency: Human Rights in South Africa” (1994) 92 Mich L Rev 1977.

35 Butler and Butler, above n 33, at 181.

The position in the United Kingdom

36 At 181.

37 The Human Rights Act 1998 (UK) provides that (subject to override by primary legislation) it is unlawful for a public authority to act in a way which is incompatible with the rights and freedoms protected by the Convention for the Protection of Human Rights and Fundamental Freedoms 2889 UNTS 221 (opened for signature 4 November 1950, entered into force 3 September 1953).

38 R (SB) v Governors of Denbigh High School [2006] UKHL 15, [2007] 1 AC 100 [Denbigh High School (UKHL) at [29]–[31]; European Convention on Human Rights, above n 37.

39 R (SB) v Governors of Denbigh High School [2005] EWCA Civ 199, [2005] 1 WLR 3372.

questions would have involved the board identifying Convention rights, determining potential violation and justification, determining whether interference was prescribed by law and whether it had a legitimate aim, balancing considerations, and considering whether interference was justified under relevant Convention articles.40 In addition, a range of factual considerations and questions were identified which, it was said, the Board would “no doubt need to consider”.41

40 At [75] and [78].

41 At [81].

42 Denbigh High School (UKHL), above n 38, at [29]. It was said that the purpose of the Human Rights Act (UK) was not to enlarge the rights or remedies of those in the United Kingdom whose Convention rights had been violated but to enable those rights and remedies to be asserted and enforced in domestic courts.

43 At 115–116. The Human Rights Act (UK) was seen to be a measure which enabled those Convention rights to be asserted and enforced in domestic courts.

44 At [30].

45 At [31].

principles we employ in judicial review cases can adopt a proportionality assessment, we do not use the proportionality approach taken in judicial review in the United Kingdom. Thirdly, the extent of the reasoning on the part of the decision-maker that was thought to be necessary by the Court of Appeal in Denbigh High School goes beyond the level of engagement with rights limitations on the part of a decision-maker that is proposed here.

[13] This approach seems to me not only contrary to the reasoning in the recent decision of this House in R (SB) v Governors of Denbigh High School [2006] UKHL 15; [2007] 1 AC 100 but quite impractical. What was the council supposed to have said? “We have thought very seriously about your Convention rights but we think that the appropriate number of sex shops in the locality is nil”? Or: “Taking into account article 10 and article 1 of the First Protocol and doing the best we can, we think that the appropriate number is nil”? Would it have been sufficient to say that they had taken Convention rights into account, or would they have had to specify the right ones? A construction of the 1998 Act which requires ordinary citizens in local government to produce such formulaic incantations would make it ridiculous. Either the refusal infringed the applicant’s Convention rights or it did not. If it did, no display of human rights learning by the Belfast City Council would have made the decision lawful. If it did not, it would not matter if the councillors had never heard of article 10 or the First Protocol.

The most that can be said is that the way in which the school approached the problem may help to persuade a Judge that its answer fell within the area of judgment accorded to it by the law.

46 Belfast City Council v Miss Behavin’ Ltd [2007] UKHL 19, [2007] 1 WLR 1420.

47 Denbigh High School (UKHL), above n 38, at 68.

Of course, where the public authority has carefully weighed the various competing considerations and concluded that interference with a Convention right is justified, a court will attribute due weight to that conclusion in deciding whether the action in question was proportionate and lawful.

48 Belfast City Council v Miss Behavin’ Ltd, above n 46, at 26.

49 See, as a further example, In the Matter of B (a Child), [2013] UKSC 33, [2013] 1WLR 1911 at

[84] (per Lord Neuberger).
50 TVNZ v West, above n 31.

51 At [98].

Rather, he used it as a basis for making the point that different levels of explanation will be required of different bodies, depending on the nature of the decision-making body, its workload, and the importance of the type of right that is being restrained.52

52 At [103].

53 Professor Claudia Geiringer “Process and Outcome in Judicial Review of Public Authority Compatibility with Human Rights: A Comparative Perspective” in H Wilberg and M Elliott (eds) The Scope and Intensity of Substantive Review: Traversing Taggart’s Rainbow (Hart Publishing, Oxford, 2015) at 334.

54 At 334–338.

The position in Canada

Though this judicial review is conducted within the administrative framework, there is nonetheless conceptual harmony between a reasonableness review and the Oakes framework, since both contemplate giving a “margin of appreciation”, or deference, to administrative and legislative bodies in balancing Charter values against broader objectives.

55 Doré v Barreau du Québec 2012 SCC 12, [2012] 1 SCR 395.

56 At [59], citing R v Oakes [1986] 1 SCR 103.

57 At [55] and [56].

58 At [57].

59 At [3].

60 Loyola High School v Québec (Attorney-General) 2015 SCC 12, [2015] 1 SCR 613.

61 At [35].

Discussion

Was the Director-General required to undertake a rights assessment?

(a) the decision-maker must address that restriction and consider whether it is demonstrably justified under s 5; and

(b) the Court must be satisfied that any such restriction is so justified.62

  1. As explained in Wallace, above n 5 at [65] and in New Health v Minister for COVID-19 (HC), above n 5 at [82].
High School, the decision-maker will be assisted by, and will attribute due weight to, the decision-maker’s views in the course of its own assessment.

63 Turner v Pickering [1976] 1 NZLR 129 at [141]–[142].

64 TVNZ v West, above n 31 at [110].

65 Hansen v R [2007] NZSC 7, [2007] NZLR 1.

66 At [116] and [124].

of a shooting target, Tipping J expressed the Court’s consideration of a decision- maker’s rights assessment in the following way:

[119] This general approach, with which I respectfully agree, can be figuratively described by reference to a shooting target. The Court's view may be that, in order to qualify, the limitation must fall within the bull's-eye. Parliament’s appraisal of the matter has the answer lying outside the bull's-eye but still on the target. The size of the target beyond the bull's-eye will depend on the subject matter. The margin of judgment or discretion left to Parliament represents that area of the target outside the bull's-eye. Parliament's appraisal must not, of course, miss the target altogether. If that is so Parliament has exceeded its area of discretion or judgment. Resort to this metaphor may be necessary several times during the course of the proportionality inquiry; indeed the size of the target may differ at different stages of the inquiry. The court's job is to delineate the size of the target and then say whether Parliament's measure hits the target or misses it.

67 Moncrief-Spittle, above n 4, at [86].

(a) the nature of the decision and the nature of the rights involved;

(b) the number of people whose rights are affected and the precedent that the decision will create for others;

(c) the nature and expertise of the decision-maker;

(d) the relevance of human rights issues to the purpose and functions of the decision-maker;

(e) the time frame in which the decision needs to be made;

(f) the resources available to the decision-maker; and

(g) the extent to which reasons could generally be expected to be given by a decision-maker of the type in question..

68 Wallace, above n 5, at [111].

69 As described in paragraph [57] above.

of members of an organised group to demonstrate in a handful of sentences that he or she has considered the nature of the right involved, the extent to which it is infringed by the restriction and the reasons for believing that the restriction is justified.

70 Ellis v R [2022] NZSC 14.

inconsistency with the Bill of Rights Act will render a decision ultra vires, whereas, otherwise, public law grounds are more procedural in nature.

Did the Director-General undertake a rights assessment?

71 Given in particular the cost barrier involved in litigation; see, for example, Law Commission

Delivering Justice for All (Law Commission, Report 85, March 2004) at 36.

72 Butler and Butler, above n 33 at 181.

73 At [12] and [22] of the affidavit.

(a) In 2018, the Supreme Court determined that fluoridation was a demonstrably justified limit on the right to refuse medical treatment – a finding made with reference to relevant scientific evidence; and

(b) The issue was not revisited in making the decision because nothing of substance had changed in the intervening period.

(a) it is not quite right to say that the Supreme Court found that there was a demonstrably justified limit if there was credible scientific evidence about safety and effectiveness in the relevant area; and

(b) while there is evidence that the Director-General turned his mind to the science, there is no evidence that he turned his mind to the relevant terms of the Bill of Rights Act.

have available to it materials that would enable it to make that assessment.74 Glazebrook J said that the application of s 5 would depend upon local conditions.75

Relief?

74 New Health v South Taranaki District Council, above n 1 at [223].

75 At [176].

76 At [134] and [143].

the memorandum of counsel which accompanied the application for determination of the preliminary issue of law, it was said that “if the applicant is correct [on the allegations in the second ground] the directions are invalid and should be set aside”. But an order of that sort does not follow as a matter of course. As mentioned in [87] above, the requirement for a decision-maker to address Bill of Rights Act considerations and the Court’s own assessment of those considerations will more often than not go hand in hand and be considered by the Court alongside each other. Accordingly, when it comes to considering relief, a balanced assessment may be made having regard to the nature and extent of both procedural and substantive shortcomings. Therefore, in many ways, it is artificial to separate a procedural and a substantive assessment.

Result

14 local authorities under s 116E of the Health Act were in each case a reasonable limit on the right to refuse medical treatment, he needed to be satisfied that they were and, if satisfied, he needed to say why that was so. Accordingly, the second cause of action in the proceeding is made out.

Radich J

Solicitors:

Maxwell Law, Wellington for Plaintiff

Crown Law, Wellington for First and Second Defendants

77 Pascoe v Minister for Land Information [2023] NZHC 795 at [6] and [7].


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