Abstract
Australian immigration detention has been called state sanctioned abuse and a crime against humanity. The Australian healthcare community has been closely involved with these policies, calling for their reform and working within detention centres to provide healthcare. As well as having a devastating impact on health, immigration detention changes the scope and nature of healthcare, with its delivery described as a Sisyphean task. In this article I will explore the guidance that is available to clinicians who work within detention centres and argue that codes, guidelines and positions statements provide little help in relation to ethical decision making. First I will outline guidance that can be found in codes of ethics and position statements, focusing on particularly relevant principles, such as advocacy, clinical independence and the clinicians’ relationship to human rights. I will then highlight the disparity between this guidance and the delivery of healthcare within detention by drawing on the testimony of clinicians who formerly worked in these environments. While this disparity should be cause for alarm and at a minimum call into question how codes and positions statements are being used (if at all), there are more fundamental reasons why codes and position statements fail to provide guidance in these circumstances. I will outline a more general criticism of codes of ethics and use this to suggest a way forward, including looking beyond codes and position statements to guide action within Australian immigration detention.
Highlights
Codes of ethics Below I will discuss four codes of ethics: The Australian Medical Association’s (AMA) Code of Ethics [45], the Australian Psychological Societies’ (APS) Code of Ethics [46], the International Council of Nurse’s Code of Ethics [47] and the Royal Australian and New Zealand College of Psychiatrist’s (RANZCP) Code of Ethics [48]
These codes represent the overwhelming majority of clinicians who have worked within the system and have been produced by professional bodies who have been active in discussions related to health and healthcare within Australian immigration detention
What are the alternatives? While many practical questions remain unanswered, the disparity between codes of ethics and the delivery of healthcare in Australian immigration detention speaks to larger, more fundamental issue related to codes of ethics and the guidance they provide
Summary
Australian immigration detention Immigration detention has been one of the most contentious contemporary political issues in Australia for over two decades. In October 2015, the Nauru government announced that they would be processing all remaining asylum seekers who would no longer be confined within the detention centre This was announced only days before an Australian. As can be imagined with these conditions Australian immigration detention violates or impinges upon almost all human rights and international legal instruments to which Australia is signatory [11] including the right “to be free from torture or cruel, inhuman or degrading treatment.” [12] The impact of these policies on health and wellbeing has been well established, with all studies, testimony and evidence from inquiries suggesting that detention has a devastating impact on the health of detainees [13,14,15]. I will outline a more general criticism of codes of ethics and use this to suggest a way forward, including looking beyond codes and position statements to guide action within Australian immigration detention
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