Australia’s offshore detention system and the Journal of Medical Ethics

Offshore detentionJulian Burnside has drawn attention to four recently-published articles on Australia’s offshore detention system. They appeared in the Journal of Medical Ethics, and they contribute to a significant and growing body of academic literature on what is a far cry from being a merely academic subject:

ABSTRACT: Australian immigration detention has been identified as perpetuating ongoing human rights violations. Concern has been heightened by the assessment of clinicians involved and by the United Nations that this treatment may in fact constitute torture. We discuss the allegations of torture within immigration detention, and the reasons why healthcare providers have an ethical duty to report them. Finally, we will discuss the protective power of ratifying the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment as a means of providing transparency and ethical guidance.

ABSTRACT: Australian immigration detention centres are in secluded locations, some on offshore islands, and are subject to extreme secrecy, comparable with ‘black sites’ elsewhere. There are parallels between healthcare professionals working in immigration detention centres and healthcare professionals involved with or complicit in torture. In both cases, healthcare professionals are conflicted between a duty of care to improve the health of patients and the interests of the government. While this duality of interests has been recognised previously, the full implications for healthcare professionals working in immigration detention have not been addressed. The Australian Government maintains that immigration detention is needed for security checks, but the average duration of immigration detention has increased from 10 weeks to 14 months, and detainees are not informed of the progress of their application for refugee status. Long-term immigration detention causes major mental health problems, is illegal in international law and arguably fulfils the recognised definition of torture. It is generally accepted that healthcare professionals should not participate in or condone torture. Australian healthcare professionals thus face a major ethical dilemma: patients in immigration detention have pressing mental and physical health needs, but providing healthcare might support or represent complicity in a practice that is unethical. Individual healthcare professionals need to decide whether or not to work in immigration detention centres. If they do so, they need to decide for how long and to what extent restrictive contracts and gagging laws will constrain them from advocating for closing detention centres.

The compromised nature of healthcare has now been well documented along with the pervasive nature of dual agency (or dual loyalty) obligations, between that of patients, the immigration department and other contractors. This has only served to restrict and distort the nature of healthcare and limit clinicians in their roles with healthcare frequently subverted to other policy goals. Accountability is obscured and oversight is limited with arrangements that attempt to divest responsibility from the immigration department. At best clinicians are required to navigate ethically fraught terrain where they frequently have to compromise what may be ideal or even generally accepted treatment, at worst this promotes conduct that is clearly unethical. Along with the detention environment this all serves to curtail what benefits may usually be gained from treatment. These issues have played out in a more acute form in off-shore detention where there has been a number of examples of the immigration department intervening in medical transfers and treatment recommendations.

Sadly and justifiably, regardless of the final results of this past weekend’s federal election, those illegally detained in Australia’s offshore detention centres can expect nothing to change. We are being governed by xenophobic dragons with little regard either for the rule of law or for human decency.

2 thoughts on “Australia’s offshore detention system and the Journal of Medical Ethics

  1. Such sad reading Jason. Asylum seekers mostly have already been tortured prior to reaching our shores. How dare it be repeated. When will they (the powers and principalities) ever learn? And with huge dismay I read in today’s ODT about what Pauline Hanson is thinking about Muslim communities in Australia.

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  2. Indeed it does make very somber reading, Janet. And to state the bleeding obvious about Ms Hanson, while her reemergence is unfortunate, it is largely symptomatic of a shrinking centre in much of the political landscape in the west, even if the current duopoly here in Australia lack any will to really acknowledge and embrace the implications of such a fact in ways that are non self-exploitative. I wonder if this feels a little less the case in NZ where you have the MMP system?

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