Medicine

Against Our Oath

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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.

‘Lines to Dr Walter Birk on his Retiring from General Practice’, by W.H. Auden

When you first arrived in Kirchstetten, trains had
long been taken for granted, but electric
light was still a surprise and as yet no one
had seen a tractor.

To-day, after forty-five years, as you leave us,
autobahns are a must, midwives are banished
and village doctors become museum pieces
like the horse-and-buggy.

I regret. The specialist has his function, but
to him we are merely banal examples of
what he knows all about. The healer I have faith in is
someone I’ve gossipped

and drunk with before I call him to touch me,
someone who admits how easy it is to misconsider
what our bodies are trying to say, for each one
talks in a local

dialect of its own which can alter during
its lifetime: so children run high fevers on
slight provocation, while the organs of old men
suffer in silence.

When summer plumps again, our usual sparrows
will phip in the eaves of the patulous chestnuts
near your old home, but none will ask: “Is Dr.
Birk around to hear me?”

For nothing can happen to birds that has not
happened before: we though are beasts with a sense of
real occasion, of beginnings and endings,
which is the reason

we like to keep our clocks punctual, as Nature’s
never is. Seasons she has, but no Calendar:
thus every year the strawberries ripen
and the autumn-crocus

flares into blossom on unpredictable
dates. Such a Schlamperei cannot be allowed an
historian: with us it’s a point of honor
to keep our birth-days

and wedding-days, to rejoice or to mourn, on
the right one. Henceforth the First of October
shall be special for you and us, as the Once when
you quit the Public

Realm to private your ways and snudge in a quiet
you so deserve. Farewell, and do not wince at
our sick world: it is genuine in age to be
happily selfish.

– Wystan Hugh Auden, ‘Lines to Dr Walter Birk on his Retiring from General Practice’, in Epistle to a Godson, and Other Poems (New York: Random House, 1972), 10–11.