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Health services administration Ethics Child health Mental health Social determinants of health Global health
Volume 202 - Issue 1

Ethical challenges for doctors working in immigration detention

Authors:  Michael J Dudley and Louise K Newman, on behalf of the J'Accuse Coalition and Doctors for Refugees*

Med J Aust 2015; 202 (1): 16-17. || doi: 10.5694/mja14.01388
Published online: 19 January 2015
The case against immigration detention is irrefutable
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To the Editor: As psychiatrists and physicians working with adults and children in mandatory, often prolonged, immigration detention, we confirm Sanggaran and colleagues' account.1

Quality evidence from diverse, independent, multinational sources, including legal and medical investigations over two decades, finds that immigration detention:

  • contravenes multiple international conventions that Australia has signed;2
  • harms mental health of detained children and adults, and detention employees, in a process likened to torture;3
  • incurs vastly greater financial and legal costs than alternatives, and makes profits for multinational companies from desperate, traumatised people;4
  • fails to deter people from seeking asylum and is unnecessary to prevent their absconding (because they rarely abscond);2
  • compromises ethics, through mandating secrecy, neutralising advocacy and destroying independent oversight;5 and
  • fosters conditions for systematic institutional child abuse and its lifelong consequences.6

Immigration detention fails every standard of medicine — science, ethics, health economics, pragmatics and human rights (including freedom from abuse and the right to highest attainable health standards). Yet despite accumulated evidence and established opposition from national professional bodies — including medicine, paediatrics, psychiatry, public health, psychology, nursing, social work and medical students — successive governments deny or rationalise inveterate harms, arguably implicate professionals in legitimating abuses the professionals cannot prevent, and deflect needed policy change.7 The case against immigration detention is irrefutable.

As immigration detention's damages are unmitigated by any (mental) health intervention, and immigration detention renders clinicians ineffectual, a strong clinical and ethical argument exists for withdrawing services. Rather than health care for asylum seekers and detainees remaining with the Department of Immigration and Border Protection or being outsourced, federal or state health departments should provide and manage services and monitor standards independently. This will not resolve the problem of immigration detention, but it may attenuate some of its worst effects.

Authors

  • Michael J Dudley AM, MB BS, FRANZCP1,2
  • Louise K Newman AM, MB BS(Hons) PhD, FRANZCP3
  • 1. Prince of Wales and Sydney Children's Hospitals, Sydney, NSW.
  • 2. University of New South Wales, Sydney, NSW.
  • 3. Royal Women's Hospital and University of Melbourne, Melbourne, VIC.

Correspondence: m.dudley@unsw.edu.au

Competing interests

No relevant disclosures.

*Author doctors in the J'Accuse Coalition and Doctors for Refugees

Dr Michael Dudley
Dr Jon Jureidini
Dr Richard Kidd
Dr Nick Kowalenko
Dr Sarah Mares
Professor Louise Newman
Dr Barri Phatarfod
Professor Alan Rosen
Dr Choong-Siew Yong
Dr Karen Zwi

References

View this article on Wiley Online Library

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