Sometimes as part of medical practice we provide an intervention that is intended to help not the person we are providing it to, but someone else. For example, we encourage new parents and grandparents to have a pertussis immunisation booster, not to protect themselves as much as to protect the new arrival in their family.
The provision of pertussis immunisation to older people in order to protect a neonate is ethically sound practice because there is:
- Benefit – pertussis immunisation of caregivers has been demonstrated to reduce risk to the infant they are caring for.
- Lack of harm – the immunisations provided are known to be extremely safe.
- Autonomy – though we encourage the caregivers of neonates to receive the booster, ultimately whether they do so is up to them.
- Justice – the resources put into the immunisation program don’t impede access to care for those in need of even more beneficial interventions, and we do not have a less invasive way of achieving the same benefit.
Some of our colleagues from the Royal Children’s Hospital in Melbourne have been in the news recently as they have called on the Federal Government to end the practice of keeping children in detention.1 RCH paediatrician Dr Tom Connell described seeing children who are living in detention with a range of problems including nightmares, bed-wetting, anxiety and depression. He also described how RCH clinicians are finding it almost impossible to treat these children while they remain in detention (Tessa has previously described some of the health problems experienced by children in detention here).
Australian immigration minister Peter Dutton’s response was quoted as “I understand the concern of doctors, but the Defence and Border Force staff on our vessels who were pulling dead kids out of the water don’t want the boats to re-start”, a sentiment that pretty much everyone will agree with.
Though these are my words not his, Mr Dutton appears to essentially be implying that keeping children in detention is acceptable because it is preventing lives being lost at sea. Effectively we are applying an intervention (detention) to one group of people (those in detention) in the hope of reducing harm to another group of people (those who may be deterred from attempting to reach Australia by boat). While acknowledging the complexity of immigration policy and the real tragedies that have occurred while people try to reach Australia we must consider the ethical basis of applying that intervention.
Using the same format as above:
- Benefit – we do not have evidence that keeping children in detention has any benefit to anyone. Certainly the advocates of the policy hope it does and circumstantial evidence may link Australian immigration policy as a whole with reduced numbers of known deaths at sea, but there is no evidence that specifically the detention of children reduces deaths at sea.
- Lack of harm – on the contrary as our colleagues in Melbourne have described in the media, the harm to children in detention is evident. The Australian Medical Association and the Royal Australasian College of Physicians have made statements against the practice of keeping children in detention based on the evidence of harm that is done to them, with longer periods of detention having been linked to more severe mental health outcomes.2
- Autonomy – clearly those children in detention or their guardians are not given any choice.
- Justice – detention is a relatively resource intensive practice and there are multiple conceivable alternatives. There is no evidence that the cost to detained children in terms of health and developmental outcomes (as well as the financial cost to the Australian taxpayer though that is not the focus of our argument) is offset by a benefit to other groups.
DFTB exists for the purpose of medical education not politics, however the editors are all doctors and feel an obligation to advocate for their patients. We believe the detention of children is unethical and should be stopped as soon as possible.
- http://www.abc.net.au/news/2015-10-11/royal-childrens-hospital-doctors-children-detention/6844458 accessed 12/10/15
- Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B, & Susljik I 2006. Impact of immigration detention and temporary protection on the mental health of refugees British Journal of Psychiatry 188(4):58-64