Steel Zachary, Silove Derrick
School of Psychiatry, University of New South Wales, UK.
Monash Bioeth Rev. 2004 Oct;23(4):93-103. doi: 10.1007/BF03351424.
Despite a strong historical record of resettling and providing care for refugee populations, the Australian Federal Government has increasingly implemented harsh and restrictive policies regarding the treatment and management of asylum seekers. Most controversial of these has been the mandatory detention of asylum seekers, a policy applied indiscriminately and without discretion where individual cases have not been subject to judicial review or time constraints. From the outset health professionals have raised concerns about the possible adverse mental health impacts of prolonged detention. In contrast, government representatives have characterized conditions in detention as benign and comfortable, and have consistently contested criticism of detention, often citing a lack of scientific evidence as tacit support for the continuation of the policy. Nevertheless, requests for access to the detention centres to undertake rigorous scientific investigations have gone unheeded. In this context we argue that the Australian Government has failed to uphold its commitment to good governance by allowing transparency, openness and a willingness to have the impact of its policies scrutinized by scientists. The manifest conflict of interest in the government position leads to a breach in the normal social contract between mental health researchers and those responsible for the policy of detention. There is, we argue, a legitimate moral imperative in such situations for clinical researchers to breach the walls of enforced silence and give a voice to those who are afflicted. This imperative, however, must be carefully balanced against the risks that may face detainees agreeing to participate in such research.
尽管澳大利亚联邦政府在安置和照顾难民群体方面有着良好的历史记录,但它在寻求庇护者的待遇和管理方面越来越多地实施严厉和限制性政策。其中最具争议的是对寻求庇护者的强制拘留,这一政策不加区分且毫无酌处权地适用,个别案件未经司法审查或时间限制。从一开始,卫生专业人员就对长期拘留可能对心理健康产生的不利影响表示担忧。相比之下,政府代表将拘留条件描述为良性和舒适的,并一直对拘留的批评提出异议,经常以缺乏科学证据作为继续实施该政策的默许支持。然而,进入拘留中心进行严格科学调查的请求却被忽视了。在这种情况下,我们认为澳大利亚政府未能履行其对善治的承诺,未能做到透明、开放,也不愿意让其政策的影响接受科学家的审查。政府立场中明显的利益冲突导致了心理健康研究人员与拘留政策负责人之间正常社会契约的破裂。我们认为,在这种情况下,临床研究人员有合理的道德义务打破强制沉默的壁垒,为那些受苦的人发声。然而,这一义务必须与同意参与此类研究的被拘留者可能面临的风险仔细权衡。