Do codes of ethics and position statements help guide ethical decision making in Australian immigration detention centres?

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

Resistance in health and healthcare

In this article I will introduce and outline the concept of resistance as it relates to health and healthcare. Starting with a number of examples of action, I will then turn to the broader literature to discuss some conventional definitions and related concepts, outlining debates, controversies and limitations related to conceptualising resistance. I conceptualise resistance broadly, as any act, performed by any individual (or collective) acting as or explicitly identifying as a healthcare professional, that is a response to power, most often in opposition to contentious, harmful or unjust rules, practices, policies or structures. Practically this could account for any public action, marches, sit-ins and civil disobedience, but also forms of ‘everyday resistance’, such as working slowly, feigning sickness, or even providing care for marginalised groups that would otherwise not have access. Such action could go unrecognised by those in power and perhaps more contentiously, those resisting needn’t even recognise their actions are resistance. I will then apply this conceptualisation to explain action which has been undertaken by healthcare professionals, identifying the key features of this action. In many respects this conceptualisation of resistance is a first step in better understanding what is remarkably common form of action pursued by healthcare professionals. I will briefly discuss future directions for inquiry that appear particularly pressing. These including ongoing conceptual development, identifying the functions of resistance in healthcare along with what makes it distinct from healthcare as usual and other forms of resistance and finally, the range of normative questions resistance raises

Contentious politics, human rights and Australian immigration detention

Australian immigration detention has been a contentious political issue for over two decades. While Australia is signatory to all major human rights instruments, immigration detentions' status as administrative detention, the bipartisan political support it receives and the open hostility the government has expressed for human rights have ensured few avenues for political reform and progress toward the realisation of these rights. While this has challenged more traditional legal and institutional means of pursuing change, human rights can be (and have been) defended in other ways. In this article I will show how human rights shape and are shaped by contentious political action, offering a powerful means to pursue change where traditional political and legal structures have failed. I will first discuss grassroots action that has occurred in response to these policies, outlining action that has been relatively impactful. I will then consider how human rights could be understood as contentious. I argue that such an approach is particularly well positioned to explain how human rights have been used to challenge these policies and discuss the importance in of ongoing research and action in this area

Psychology and its response to major human rights abuses: the case of Australian immigration detention

Australian immigration detention has been criticized both domestically and internationally for the harm that it creates and promotes and for violating human rights and international law. Psychologists have worked within centers and have thus been central to their operation, but have also long called for reform of these policies. Despite this and despite broader criticism from all corners of Australian society, the government has continued to consolidate power in relation to the administration of these policies and has actively attempted to shut down dissent. How should Psychologists respond? This article will argue that current approaches are inadequate and more adversarial action is needed. Supporting such an approach, social movement theory will be introduced and applied to examine how it may inform future action. Psychologists have an obligation to protect human rights and health, and while more adversarial action may not typically fit in traditional repertoires, there are few other professionals who are better skilled to begin to deal with these questions. In light of this, Psychologists in Australia and across the globe should carefully consider their roles in social change and whether they can do more in the face of major human rights abuses.Abstract. Australian immigration detention has been criticized both domestically and internationally for the harm that it creates and promotes and for violating human rights and international law. Psychologists have worked within centers and have thus been central to their operation, but have also long called for reform of these policies. Despite this and despite broader criticism from all corners of Australian society, the government has continued to consolidate power in relation to the administration of these policies and has actively attempted to shut down dissent. How should Psychologists respond? This article will argue that current approaches are inadequate and more adversarial action is needed. Supporting such an approach, social movement theory will be introduced and applied to examine how it may inform future action. Psychologists have an obligation to protect human rights and health, and while more adversarial action may not typically fit in traditional repertoires, there are few other professionals who are better skilled to begin to deal with these questions. In light of this, Psychologists in Australia and across the globe should carefully consider their roles in social change and whether they can do more in the face of major human rights abuses

Australian Immigration Detention: How Should Clinicians Respond?

Australian immigration detention violates human rights and international law. Clinicians and professional healthcare bodies have been central to its operation, both providing healthcare within detention centres and protesting its consequences. Since its introduction over 25 years ago and despite ongoing protest the government has continued to implement increasingly opaque and punitive policy. How should clinicians respond? This thesis sets out to challenge over 20 years of thinking on this topic, calling for a shift in how clinicians and professional bodies engage with Australian immigration detention. I argue that current responses to the health and healthcare needs of those detained are inadequate. I reject a boycott but call for such action to be seen within a broader strategy aimed at bringing about social and political change. I propose a theoretical base to inform such a stance, by appealing to social movement theory and other theories of social change. I demonstrate how such theory can be applied to inform systemic, social and political change, and I argue that clinicians and professional bodies should embrace this approach which includes employing forms of political action such as protest, disruption and civil disobedience

Resistance in response to Australian immigration detention: lessons learnt after three decades of advocacy

Australian immigration detention was introduced almost four decades ago. Since its introduction it has been condemned domestically and internationally, recognised as uniquely cruel and draconian in its approach toward asylum seekers and refugees. While for the most part, these policies have become increasingly punitive, advocates for change can also count a number of victories. This presentation will briefly discuss the history of advocacy and activism in response to Australian immigration detention and focus on the developments in response to the more recently introduced (and subsequently repealed) “Medevac” legislation; legislation which gave doctors greater power to evacuate unwell refugees from offshore locations to mainland Australia. While this legislation was repealed shortly after it was introduced, over 192 refugees were transferred to Australia. Almost all of those who were transferred had been detained for over seven years and were facing indefinite detention offshore. By March 2021, most of those who were transferred to Australia were given visas and moved to the Australian community. This presentation will outline the actions of lawyers, the healthcare community and the general public in demanding change, from protest to litigation and even civil disobedience, along with what lessons can be learnt from this action

Health and healthcare in Australian immigration detention: a comparison between onshore and offshore data

The study compares the impact of Australian onshore and offshore immigration detention centres on detainees' health and healthcare events. It utilises data extracted from the Australian government’s quarterly health reports, from 2014-2017. These reports contain a range of data about the health and wellbeing of detainees, including complaints/presenting symptoms and number of appointments and hospitalisations. To compare onshore and offshore datasets, we calculated the rate of health events per quarter against the estimated quarterly onshore and offshore detention population. We ran a series of two-proportion z-tests for each matched quarter to calculate median z and P values for all quarters. These were used as an indicator as to whether the observed differences between onshore and offshore events were statistically significant. The results suggest that both people onshore and offshore have substantial health needs, however, almost all rates were far higher offshore, with people more likely to raise a health related complaint, access health services and be prescribed medications, often at two to three times the rate of those in onshore detention. This paper adds to a modest body of literature that explains the health of people detained in Australian immigration detention centres. It is the first paper to our knowledge to explore health service utilisation and a range of other variables found in the Australian government’s quarterly health reports. These findings bolster the evidence which suggests that detention, and particularly offshore detention is particularly harmful to health

Give incivility a chance

While it is nice to be nice, we should be careful in dismissing incivility entirely as is argued by McCullough, et. al. (2023). In this article we will argue that incivility, when conceptualised politically as a form of resistance has democratic value. That is, some types of incivility are not only justified, but can serve important ends, especially for oppressed groups. Several historical examples as they relate to health and healthcare speak to this point. The uncivil behaviour by Emma Goldman, imprisoned after publicly promoting birth control, to those challenging racism in healthcare are two of many examples that highlight the instrumental and symbolic value of incivility, in both forcing political change and saying something that could not otherwise be said ‘civilly’

Health care worker strikes and the Covid pandemic

Despite having been warned for decades, many countries were unprepared for the Covid-19 pandemic. Though some have managed to contain the virus, in most countries, the pandemic response has been poor at best; in some countries, it’s been disastrous. As of mid-March 2021, nearly 2.7 million deaths had been attributed to SARS-CoV-2, and many more aspects of the health and social impact are likely to come to light over the long term. Though there are no official global figures, among the casualties are likely to be tens of thousands of health care and other frontline workers; in late 2020, Amnesty International estimated that more than 7000 health care workers had died from Covid. Beyond risking their lives, such workers have had a challenging year, to put it mildly. Many continue to work in underresourced systems, with inadequate personal protective equipment (PPE), dealing with a situation that was both unprecedented and completely foreseeable. While the heroics of health care workers have been celebrated and we’ve gained a renewed appreciation of the risks that many frontline workers face while providing fundamental services, less attention has been paid to those who have refused to work under such dangerous conditions and those who have pointed out that no health care workers needed to be placed at such high risk. Many have rightly argued that heroics were required only because of government neglect, underfunding, and lack of preparation for a pandemic that we knew was coming. Many workers are justifiably angry. Although there are no official figures, Covid-19 appears to have led to a substantial uptick in strike actions by health care workers