Friday, February 14, 2014

Doctors and the health of asylum seekers

No way should we be treating asylum seekers like this

Like many people in Australia, I am deeply concerned about the way we are treating a vulnerable group of human beings who come to Australia because they are persecuted in their own country.

There are many others who can talk about ways of helping, or our international obligations. My field is health, and I wanted to put in one place what I know from news reports about the health of asylum seekers, and the response of doctors to this.

I want to do this because I am angry, and I think you should be too. Doctors are not known for their left-leaning sympathy, but doctors groups across the political spectrum have spoken out about what is happening already. That's because this is not a left-right political issue, though it's often portrayed as such. This is a human issue. Doctors see every day in their practice the consequences of treating people like this. We are the ones who see and deal, often inadequately, with the problems people have arising from violence in the home, from torture in refugees and from physical and emotional abuse as a child. That our government could be deliberately choosing to do this to people is beyond belief.

Apparently, the biggest single cause of death for detained asylum seekers is suicide. This fact alone should make us ask what we are doing to people. The reports of the effect on children - exhibiting signs of depression - would legally oblige doctors to report the carers for suspected child abuse in any other setting.

Back in December, the Immigration department sacked its Immigration Health Advisory Group, which got a bit of coverage in the press. At the time, we were told that this was because the group was too large, and because they needed advice quickly. Good work from the AAP under a Freedom of Information request shows that the real reason was that it was "difficult for some members to provide health advice independent of their other interests." The minute, written by the secretary of the Immigration Department, goes on to say that these conflicts of interest arose from "natural professional interests and obligations." So that's not conflicts of interest like having a partner who parts owns a lobbying company, or receiving money. That sound to me like the conflict of interest is that they have professional obligations to speak out, to do the right thing! The secretary notes that the policy approaches were contentious, and seems to say that "policy and operational activities are becoming increasingly problematic." (It's possible, though less likely on my reading, that he's actually saying it's the potential and actual conflicts of interest, or the present challenges that are getting more problematic.)

My reading of this is that the Department knew that what they were doing was cruel, and they knew that the professional obligation of the doctors on the health panel would be to speak out, so they sacked them. The former panel member interviewed by the Guardian indicates that the advice the group were giving didn't fit with government policy.

You can see that professional obligation in action in the doctors contracted to work in the facility writing 92 pages of their concerns about the treatment of asylum seekers, and the inadequate systems they were asked to work with to manage this.

You can see professional obligations in action when organisations like the Royal Australian College of Physicians, the Australian Medical Association and the RACGP all speak out against our current policies.

You can see professional obligations in action when Michael Gliksman writes a strongly worded opinion piece for the MJA calling what we are doing torture, and calling on all doctors to speak out against it.

I've come across numerous other doctors speaking out on Twitter and on their blogs about what we are doing.

Why would so many want to sepak out? Why not keep our heads down?

It's because the Immigration Department are right in thinking that doctors can't stay silent on behaviour that harms others. The World Medical Association Declaration of Tokyo is pretty clear on this.

"The physician shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures.
The physician's fundamental role is to alleviate the distress of his or her fellow human beings, and no motive, whether personal, collective or political, shall prevail against this higher purpose."
And we can go back to that old Hippocratic maxim understood by doctors the world over, (and even quoted by Tony Abbott)

"Primum non nocere - Above all, do no harm."
If there is one thing we know about the current treatment of asylum seekers arriving by boat, it is that harm is being done. It's why doctors are speaking out both publically and privately.

What you can do