Ethical challenges for doctors working in immigration detention

To the Editor: Sanggaran and colleagues starkly illustrate the ethical dilemmas of doctors contracted to an organisation delivering substandard medical care to asylum seekers.1 They pose the question of whether doctors should boycott the system.

The same ethical dilemma sometimes faces doctors working in the limited-resource environment of public hospitals in Australia. The following example illustrates how boycotting the system can achieve results.

In May 2003, medical administrators at Sir Charles Gairdner Hospital (a tertiary referral public hospital in Perth) were alerted to looming problems with provision of prostate biopsies, including failing equipment and unacceptable waiting times for urology patients. In April 2006, amid ongoing administrative inaction despite repeated meetings and correspondence, a patient was diagnosed with metastatic prostate cancer while still on a waitlist for a prostate biopsy.2 Four of five urologists consequently resigned, arguing that they could no longer be part of a system that presided over this sort of substandard care. Their en-masse resignations were widely reported in the media, prompting the direct intervention of the then Western Australian Minister for Health. Only by boycotting the system were their concerns properly addressed.

The American Medical Association Code of medical ethics advocates use of ethically appropriate criteria when allocating limited medical resources.3 Most importantly, the treating physician must remain an advocate for patients.

When we find ourselves involved in organisations delivering substandard medical care, all of us must take the lead of Sanggaran et al and continue to speak out — and sometimes boycott the system — to effectively advocate for our patients.