Ethical challenges for doctors working in immigration detention

The perspectives of Sanggaran and colleagues accurately highlight many of the ethical dilemmas facing doctors working at the front line in immigration detention.1

The current arrangements for health services in immigration detention create irresolvable ethical difficulties for health practitioners that conflict with the Australian Medical Association’s position statement on medical ethics in custodial settings.2 Fundamentally, the problems are of working for a government department whose policies are known to cause harm to health, where the scope for health advocacy is severely restricted, and where independent scrutiny has been eliminated. The recent introduction of the Australian Border Force Act 2015 further extends and entrenches these conflicts in legislation.

This situation of working within the immigration detention system differs significantly from doctors working with non-government organisations to provide health care for asylum seekers in refugee camps overseas. Instead, it is analogous to health services in prisons, where the need to separate the governance of health from corrective services is well recognised.3 In all Australian states and territories, with the exception of Western Australia, the responsibility for care of prisoners’ health is independent of each department of corrective services and is placed with the relevant department of health or, in Victoria, with an independent section of the Department of Justice.4

The spectre of a medical boycott in immigration detention raises the consideration of changes necessary to ensure that health professionals are able to work in these facilities without compromising medical ethics. At a minimum, this must include establishment of an independent monitoring and advisory group composed of nominated representatives of peak health bodies, and the transfer of responsibility of health care in detention from the Department of Immigration and Border Protection to an independent body such as the federal Department of Health.