Medical advocacy in the face of Australian immigration practices: A study of medical professionals defending the health rights of detained refugees and asylum seekers.

Rohanna Stoddart,Paul Simpson,Bridget Haire,Joseph Telfair

doi:10.1371/journal.pone.0237776

Abstract

While medical advocacy is mandated as a core professional commitment in a growing number of ethical codes and medical training programs, medical advocacy and social justice engagement are regularly subordinated to traditional clinical responsibilities. This study aims to provide insight into factors that motivate clinician engagement and perseverance with medical advocacy, so as to inform attempts by policymakers, leaders and educators to promote advocacy practices in medicine. Furthermore, this study aims to provide an analysis of the role of medical advocates in systems where patients' rights are perceived to be infringed and consider how we might best support and protect these medical advocates as a profession, by exploring the experiences and perspectives of Australian clinicians defending the health of detained asylum seekers. In this qualitative study thirty-two medical and health professionals advocating on asylum seeker health in immigration detention were interviewed. Transcripts were coded both inductively and deductively from interview question domains and thematically analysed. Findings suggested that respondents' motivations for advocacy stemmed from deeply intertwined professional and personal ethics. Overall, advocacy responses originated from the union of three integral stimuli: personal ethics, proximity and readiness. We conclude that each of these three integral factors must be addressed in any attempt to foster advocacy within the medical profession. In light of current global trends of increasingly protectionist immigration practices, promoting effective physician advocacy may become essential in ensuring patients' universal right to health.

Highlights

Medical advocacy is increasingly mandated as a core component of medical professionalism and ethical practice, featuring in a number of codes of conduct [1]
The first theme elucidates participants’ professional and personal ethics; the second shows how these were challenged by immigration detention; the third provides insight into initial motivations
Holistic healthcare and engagement with social determinants of health was described as being fundamental to medical professionalism

Summary

Introduction

Medical advocacy is increasingly mandated as a core component of medical professionalism and ethical practice, featuring in a number of codes of conduct [1]. Australian immigration detention and the health of detained asylum seekers Under the Australian Migration Act 1958, asylum seekers can be detained indefinitely in prison-like facilities without judicial oversight [9, 10]. This includes mandatory detention in offshore processing centres, a practice which has been widely condemned as violating both human rights and international law [11]. In the setting of Australian immigration processing, indefinite detention in poor conditions has serious and long-standing impacts on physical and mental health [12,13,14,15,16,17]. Australian immigration policy is as much a public health challenge as a political issue.

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Conclusion