Melbourne’s St Vincent’s Hospital has found itself at the center of a storm over its controversial emergency department policy giving Aboriginal and Torres Strait Islander patients automatic triage priority.
While intended to address historical disparities in healthcare access, the policy has ignited fierce debate over ethics, law, and clinical integrity.
At the heart of the controversy is a fundamental principle: medical care should be provided according to clinical urgency, not social or racial identity. Professor John Wilson, former president of the Royal Australasian College of Physicians, rightly described the policy as “a sad situation that should never have occurred.” By prioritising patients based on race rather than medical need, the hospital forces clinicians into a profound ethical dilemma, contradicting decades of professional practice.
Supporters of the policy argue that Indigenous Australians historically experience longer wait times and worse health outcomes. Yet this justification raises an important question: if triage decisions are meant to be based purely on clinical urgency, why were Aboriginal patients waiting longer? If systemic bias or inefficiency caused delays, the correct solution should be to eliminate those barriers, not implement a blanket race-based priority.
Critics warn that the policy may breach not only domestic medical codes of conduct and ethical standards, but also international obligations. The Declaration of Geneva and Australia’s commitments under international human rights treaties enshrine the principle of non-discrimination in healthcare. Additionally, the policy could conflict with the Australian Charter of Healthcare Rights, Commonwealth anti-discrimination laws, and obligations under the National Health Reform Agreement, all of which emphasize that access to medical treatment must be based on need and urgency, not racial identity.
The policy, introduced in April 2024, mandates that all Aboriginal and Torres Strait Islander patients receive at least a triage category three rating—meaning they must be seen within 30 minutes. This can place less urgent Indigenous patients ahead of non-Indigenous patients with more pressing medical needs, creating inequities that undermine public confidence in hospital triage systems. Opposition figures, including Brad Battin and Georgie Crozier, have formally asked Prime Minister Anthony Albanese’s office to investigate whether St Vincent’s policy complies with domestic and international legal standards.
Even as legal experts defend the measure as a tool to redress systemic disadvantage, the broader ethical dilemma remains:healthcare decisions should be guided by clinical need above all. Symbolic gestures or blanket policies, however well-intentioned, risk eroding fairness and trust.
Victoria’s pending Treaty legislation adds another layer of political complexity, but health policy must remain rooted in evidence and ethics, not symbolism. True equity in healthcare is achieved through structural reform—better resourcing, cultural competence, and removal of systemic bias—without undermining the core principle that medical treatment is a human right, not a racial privilege.
In attempting to correct past wrongs, St Vincent’s may inadvertently violate both ethical and legal frameworks designed to protect fairness. As Professor Wilson emphasises, impartiality in medicine is not optional—it is a duty. Policies that compromise this principle threaten both public trust and the integrity of Australian healthcare.
