The University of Greenwich, London, UK.
Barts Health NHS Trust, London, UK.
BMC Med Ethics. 2019 Jul 23;20(1):52. doi: 10.1186/s12910-019-0392-8.
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.
澳大利亚的移民拘留被称为国家批准的虐待和反人类罪。澳大利亚医疗保健界一直密切关注这些政策，呼吁对其进行改革，并在拘留中心内提供医疗服务。移民拘留不仅对健康造成了破坏性影响，还改变了医疗保健的范围和性质，其提供的医疗服务被描述为一项西西弗斯式的任务。在本文中，我将探讨在拘留中心工作的临床医生所获得的指导，并认为规范、准则和立场声明在伦理决策方面几乎没有帮助。首先，我将概述职业道德准则和立场声明中可以找到的指导，重点关注特别相关的原则，如倡导、临床独立性以及临床医生与人权的关系。然后，我将通过引用以前在这些环境中工作的临床医生的证词，突出这种指导与拘留中心医疗服务之间的差距。虽然这种差距应该引起警惕，至少应该质疑规范和立场声明的使用方式（如果有的话），但在这些情况下，规范和立场声明未能提供指导还有更根本的原因。我将概述对道德规范的更普遍批评，并以此提出一种前进的方式，包括超越规范和立场声明，指导澳大利亚移民拘留中的行动。
