Journal of Medical Ethics
July 2016, Volume 42, Issue 7
http://jme.bmj.com/content/current

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The concise argument
Medical involvement in torture today?
Kenneth Boyd
J Med Ethics 2016;42:411-412 doi:10.1136/medethics-2016-103737
[Extract]
In the ethics classroom, medical involvement in torture is often discussed in terms of what happens or has happened elsewhere, in some imagined country far away, under a military dictatorship for example, or historically in Nazi Germany or Stalin’s Russia. In these contexts, at a distance in space or time, the healthcare professional’s moral dilemma can be clearly demonstrated. On the one hand, any involvement whatever in the practice of torture, countenancing or condoning as well as participating, is forbidden, formally by the World Medical Association 1957 Declaration of Tokyo, but more generally by the professional duty to do no harm. On the other hand, the professional duty of care, and more generally human decency and compassion, forbids standing idly by when no other professional with comparable skills is available to relieve the suffering of victims of torture. In such circumstances, the health professional’s impulse to exercise their duty of care, albeit thereby implicitly countenancing or condoning torture, may be strengthened by the knowledge that to refuse may put their own life or that of a member of their family in danger. But then again, they may also be all too aware that in exercising their duty of care they may simply be ‘patching up’ the victims in order for them to be tortured again.
Ethics classroom discussion of medical involvement in torture can be a productive way of exercising moral imagination in seeking possible ways of resolving or ameliorating apparently intractable moral dilemmas. In discussing such moral dilemmas, moral imagination can a.lso be exercised, and may be enlarged, by trying to understand these dilemmas from the poi

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Asylum
Are healthcare professionals working in Australia’s immigration detention centres condoning torture?
David Isaacs
J Med Ethics 2016;42:413-415 Published Online First: 23 December 2015 doi:10.1136/medethics-2015-103066
Abstract
Australian immigration detention centres are in secluded locations, some on offshore islands, and are subject to extreme secrecy, comparable with ‘black sites’ elsewhere. There are parallels between healthcare professionals working in immigration detention centres and healthcare professionals involved with or complicit in torture. In both cases, healthcare professionals are conflicted between a duty of care to improve the health of patients and the interests of the government. While this duality of interests has been recognised previously, the full implications for healthcare professionals working in immigration detention have not been addressed. The Australian Government maintains that immigration detention is needed for security checks, but the average duration of immigration detention has increased from 10 weeks to 14 months, and detainees are not informed of the progress of their application for refugee status. Long-term immigration detention causes major mental health problems, is illegal in international law and arguably fulfils the recognised definition of torture. It is generally accepted that healthcare professionals should not participate in or condone torture. Australian healthcare professionals thus face a major ethical dilemma: patients in immigration detention have pressing mental and physical health needs, but providing healthcare might support or represent complicity in a practice that is unethical. Individual healthcare professionals need to decide whether or not to work in immigration detention centres. If they do so, they need to decide for how long and to what extent restrictive contracts and gagging laws will constrain them from advocating for closing detention centres.

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Commentary: The clinician and detention
Howard Goldenberg
J Med Ethics 2016;42:416-417 Published Online First: 28 January 2016 doi:10.1136/medethics-2016-103371

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Commentary: Torture, healthcare and Australian immigration detention
Ryan Essex
J Med Ethics 2016;42:418-419 Published Online First: 22 February 2016 doi:10.1136/medethics-2016-103387

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Paper: Is Australia engaged in torturing asylum seekers? A cautionary tale for Europe
John-Paul Sanggaran,
Deborah Zion
J Med Ethics 2016;42:420-423 Published Online First: 22 June 2016 doi:10.1136/medethics-2015-103326
Abstract
Australian immigration detention has been identified as perpetuating ongoing human rights violations. Concern has been heightened by the assessment of clinicians involved and by the United Nations that this treatment may in fact constitute torture. We discuss the allegations of torture within immigration detention, and the reasons why healthcare providers have an ethical duty to report them. Finally, we will discuss the protective power of ratifying the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment as a means of providing transparency and ethical guidance.