View Article PDF

As doctors we are often faced with trying to fix damage done to our patients by other people, whether it be car crash survivors, or the multiple victims of the tobacco industry. We might also get involved in stemming the damage at its source through road safety or tobacco control activism. But what if the harm being done is by government? This is the issue faced by Australian doctors concerned for the well-being of children in the Australian prison camps on Nauru and elsewhere.Conditions in these camps, and the very fact of being interned there for an indeterminate period, are bad for the health and well-being of children. This being so, do you as a loyal citizen of a country with a democratically-elected government accept that this is their business and not yours to question, and is perhaps too complex for you to understand? If you feel strongly enough about it, how is your dissent to be expressed? In an open society it is possible to complain directly to government or to the public through the news and social media in the hope that change can be brought about. Doctors and their organisations have done just this.Or you can go further and encourage a boycott of medical staffing of the camps, believing that anything less makes you complicit in the government s ill-treatment of these children. The alternative view is that taking up the medical care of children in the camps might at least mitigate some of the harm, and, despite gagging clauses in contracts and draconian punishments threatened in the law, you can be a witness and whistle-blower in time. Further, by working in the camps you might limit the chances of an even more brutal regimen being imposed by people with fewer scruples than your own.Many Australians have spoken out. In 2014, an Australian Human Rights Commission inquiry condemned conditions in the camps.1 Children are exposed to danger by their close confinement with adults who suffer high levels of mental illness. Thirty percent of adults detained with children have moderate to severe mental illness. The numerous reported incidents of assaults, sexual assaults and self-harm involving children indicate the danger of the detention environment. (p.30) A survey of general and community paediatricians reported over 80% of respondents agreed with a statement by the Australian Medical Association that mandatory detention of children constitutes child abuse.2The Royal Australasian College of Physicians has issued a strong statement that concludes:3 Held [locked] detention presents an extreme and unacceptable risk to children s development and mental health, especially for unaccompanied children. The Australian government s response was to introduce a law that forbids doctors and others from reporting publicly on what happens in the camps.4 Reporting child abuse, while mandatory in Australia, became an offence in the camps. In June 2015, Dr John-Paul Sanggaran, and 40 others who had worked in detention centres, sent an open letter to the Australian Prime Minister protesting at the gagging provisions.4,5On 3 July, 40 senior New Zealand child health workers sent a letter to the Australian Prime Minister and Leader of the Opposition as follows:6 We, the undersigned are senior New Zealand paediatricians and child health workers experienced in the care of children and their protection from ill-treatment. We are concerned for the children detained by the Australian Commonwealth Government in the immigration detention centres on Nauru and elsewhere. The circumstances in which there is no prospect of appeal or release are inevitably detrimental to many of the children s development and mental health because of the impact on them of the depression, anger and desperation of their parents and other adults in the camps. Further, it is the world-wide experience that children in institutional circumstances such as these are unsafe. Some will suffer abuse. The secrecy provisions in Part 6 of the Australian Border Force Bill 2015 which came into effect on 1 July will exacerbate these effects by severely limiting public oversight of conditions in the camps. In this respect, we support the open letter to yourself of 1 July, 2015 from our Australian colleagues, Dr John-Paul Sanggaran and forty others. Our plea is that your Government should take steps to mitigate the plight of the children in its custody on Nauru and elsewhere. We respectfully suggest these initial actions: Provision for detainees of a realistic hope of resolution through processing as refugees. Without this, children are in the position of hostages in a policy aimed at deterrence which has some of the features of collective punishment, condemned in human rights instruments such as the Geneva Convention. Permitting public oversight of the conditions and effects on children of life in the camps through removal of the tight secrecy provisions in the Australian Border Force Bill and provision for independent monitoring and review. No reply to this letter has been received.When doctors speak up, we risk the ire of the authorities. We may attract unwanted attention, not only to ourselves but also to our colleagues. We have to decide carefully if and when it is worth it, or whether behind the scenes advocacy and negotiation or silent appeasement might be in the best interests of those we serve.Modern medical, and other health practice, is much more than prescribing pills for individuals. We find ourselves with a wider professional duty to act and speak for patients and populations, current and future, here and elsewhere.7 Doctors professional roles include not only clinical care and the care of populations within day-to-day practice, but also support for wider movements for social change. This aligns with the long tradition linking medicine with politics and political action (Virchow s Medicine is a social science, and politics is nothing but medicine at a larger scale8,9), where having effective public health policies/interventions has often needed some political action.9As doctors, we are in a strong position to advocate. Health professionals are citizens; as citizens we have no less right to comment than others. We are privileged by our education, access to power, and a professionally compassionate role in society. We can assimilate complex evidence and advocate for health, making us potential leaders.10The New Zealand Medical Association s landmark 2011 statement on health equity11 mandates doctors to talk about what determines health. The longstanding ethic to First do no harm extends, we believe, to speaking out against policies and practices that harm whether by damaging child health, widening health gaps, escalating climate risk, or ignoring harm. Such ideals are embodied in professional codes and mores. For instance, the NZMA s Role of the Doctor consensus statement12 and Code of Ethics13 (see Appendix) have doctors as scientists, leaders and public health advocates, with health advocacy a formal role in itself.Despite opposition,14 doctors need, we believe, to become politically active, to speak out when things are wrong.7,15,16 If we don t, divergent views will certainly be promoted within that vacuum to the detriment of public health and the public good. Doctors have spoken out before on a range of issues, often against the tide: tobacco; nuclear war; fenoterol; climate change. We have made a real difference the International Physicians for the Prevention of Nuclear War was even awarded the Nobel Peace Prize and we must continue.In the early days of the discovery of child abuse, a common and understandable response of many doctors to the question of whether or not to report to the authorities was that, if they did, they would lose any chance of influencing the family and protecting the child. As we went on to learn that intervention by individual doctors in the clinical setting was ineffective, that position became untenable. It amounted to complicity. Our situation in relation to an abusive government is somewhat similar. We may argue that we are better able to make changes by remaining friends, but in a government that is clearly hell-bent on stopping the boats by whatever means at its disposal, this seems unlikely.Does public outing of the government do any better? There is no guarantee that it will, but the hope is that the majority of Australians are of course decent people and also voters; and that in time these two facts, together with our efforts as a profession and the efforts of others in drawing attention to the plight of asylum seeker children, will end the serious abuse that is taking place in immigration detention. We are reminded of the famous saying of the sage Hillel:17 If I am not for myself, then who will be for me? And if I am only for myself, then what am I? And if not now, when? To which can be added, And if not me, who? Appendix: Some statements by the New Zealand Medical Association on doctors roles in public health advocacyFrom the NZMA Role of the Doctor consensus statement12https://www.nzma.org.nz/publications/role-of-the-doctor-consensus-statement(our emphasis)Key statements Doctors accept their ethical responsibilities to act in the best interests of their patients, and the population as a whole, and undertake this in a caring, compassionate, competent, and trustworthy manner. Doctors are advocates for improved population health and health equity for all people. Doctors are committed to the spirit and principles of The Treaty of Waitangi, particularly as it relates to the attainment of health equity for M\u0101ori. Doctors as scientistsDoctors have the ability to access, interpret and assimilate new knowledge critically, have strong intellectual skills and grasp of scientific principles, and are capable of effectively managing uncertainty, ambiguity and complexity. They have the capacity to work out solutions from first principles when patterns do not fit, and the ability to work outside guidelines when circumstances demand.Doctors use scientific tools and techniques, including audit and research, to develop new knowledge.Doctors as leadersDoctors have a key role in providing higher level sector leadership, including in leading and facilitating change.Doctors as health advocatesWhen appropriate, doctors use their influence to advocate for increased resources to improve health outcomes for their patients and populations.Doctors have a role in the promotion of population health, including ongoing efforts to achieve health equity. Some doctors will take an increased focus on the health of the population through formal roles in health education or promotion, service improvement, public health and/or health advocacy. This commitment is to the health of all New Zealanders, but it exists alongside a professional responsibility for the health of individuals and communities throughout the world.From the NZMA Code of Ethics13https://www.nzma.org.nz/publications/code-of-ethics(our emphasis)PrinciplesAll medical practitioners, including those who may not be engaged directly in clinical practice, will acknowledge and accept the following Principles of Ethical Behaviour:10. Accept a responsibility to assist in the protection and improvement of the health of the community.11. Accept a responsibility to advocate for adequate resourcing of medical services and assist in maximising equitable access to them across the community.RecommendationsDoctors in a just and caring society68. Doctors should accept a share of the profession s responsibility toward society in matters relating to the health and safety of the public, health promotion and education, and legislation affecting the health or well being of the community.69. Doctors have a role in ongoing efforts to achieve health equity. This includes working collaboratively with public health and other colleagues to shape services and programmes that address health inequities and the broader social and environmental factors that influence health and well being.70. While doctors have a primary responsibility to individual patients, they have a concurrent responsibility to all other patients and the community. Doctors therefore have an ethical responsibility to manage available resources equitably and efficiently. Wherever possible, doctors should use their influence to advocate for appropriate resources to improve health outcomes for their patients and populations.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Ian Hassall, paediatrician, Auckland; Scott Metcalfe, public health physician, Wellington; Alison Blaiklock, public health physician, Auckland.

Acknowledgements

Correspondence

Ian Hassall, 18 Corbett-Scott Ave, Epsom, Auckland 1023.

Correspondence Email

i.hassall@yahoo.co.nz

Competing Interests

-- Australian Human Rights Commission. The forgotten children: national inquiry into children in immigration detention. Canberra: The Commission; 2014. Available from: www.humanrights.gov.au/sites/default/files/document/publication/forgotten_childre

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

As doctors we are often faced with trying to fix damage done to our patients by other people, whether it be car crash survivors, or the multiple victims of the tobacco industry. We might also get involved in stemming the damage at its source through road safety or tobacco control activism. But what if the harm being done is by government? This is the issue faced by Australian doctors concerned for the well-being of children in the Australian prison camps on Nauru and elsewhere.Conditions in these camps, and the very fact of being interned there for an indeterminate period, are bad for the health and well-being of children. This being so, do you as a loyal citizen of a country with a democratically-elected government accept that this is their business and not yours to question, and is perhaps too complex for you to understand? If you feel strongly enough about it, how is your dissent to be expressed? In an open society it is possible to complain directly to government or to the public through the news and social media in the hope that change can be brought about. Doctors and their organisations have done just this.Or you can go further and encourage a boycott of medical staffing of the camps, believing that anything less makes you complicit in the government s ill-treatment of these children. The alternative view is that taking up the medical care of children in the camps might at least mitigate some of the harm, and, despite gagging clauses in contracts and draconian punishments threatened in the law, you can be a witness and whistle-blower in time. Further, by working in the camps you might limit the chances of an even more brutal regimen being imposed by people with fewer scruples than your own.Many Australians have spoken out. In 2014, an Australian Human Rights Commission inquiry condemned conditions in the camps.1 Children are exposed to danger by their close confinement with adults who suffer high levels of mental illness. Thirty percent of adults detained with children have moderate to severe mental illness. The numerous reported incidents of assaults, sexual assaults and self-harm involving children indicate the danger of the detention environment. (p.30) A survey of general and community paediatricians reported over 80% of respondents agreed with a statement by the Australian Medical Association that mandatory detention of children constitutes child abuse.2The Royal Australasian College of Physicians has issued a strong statement that concludes:3 Held [locked] detention presents an extreme and unacceptable risk to children s development and mental health, especially for unaccompanied children. The Australian government s response was to introduce a law that forbids doctors and others from reporting publicly on what happens in the camps.4 Reporting child abuse, while mandatory in Australia, became an offence in the camps. In June 2015, Dr John-Paul Sanggaran, and 40 others who had worked in detention centres, sent an open letter to the Australian Prime Minister protesting at the gagging provisions.4,5On 3 July, 40 senior New Zealand child health workers sent a letter to the Australian Prime Minister and Leader of the Opposition as follows:6 We, the undersigned are senior New Zealand paediatricians and child health workers experienced in the care of children and their protection from ill-treatment. We are concerned for the children detained by the Australian Commonwealth Government in the immigration detention centres on Nauru and elsewhere. The circumstances in which there is no prospect of appeal or release are inevitably detrimental to many of the children s development and mental health because of the impact on them of the depression, anger and desperation of their parents and other adults in the camps. Further, it is the world-wide experience that children in institutional circumstances such as these are unsafe. Some will suffer abuse. The secrecy provisions in Part 6 of the Australian Border Force Bill 2015 which came into effect on 1 July will exacerbate these effects by severely limiting public oversight of conditions in the camps. In this respect, we support the open letter to yourself of 1 July, 2015 from our Australian colleagues, Dr John-Paul Sanggaran and forty others. Our plea is that your Government should take steps to mitigate the plight of the children in its custody on Nauru and elsewhere. We respectfully suggest these initial actions: Provision for detainees of a realistic hope of resolution through processing as refugees. Without this, children are in the position of hostages in a policy aimed at deterrence which has some of the features of collective punishment, condemned in human rights instruments such as the Geneva Convention. Permitting public oversight of the conditions and effects on children of life in the camps through removal of the tight secrecy provisions in the Australian Border Force Bill and provision for independent monitoring and review. No reply to this letter has been received.When doctors speak up, we risk the ire of the authorities. We may attract unwanted attention, not only to ourselves but also to our colleagues. We have to decide carefully if and when it is worth it, or whether behind the scenes advocacy and negotiation or silent appeasement might be in the best interests of those we serve.Modern medical, and other health practice, is much more than prescribing pills for individuals. We find ourselves with a wider professional duty to act and speak for patients and populations, current and future, here and elsewhere.7 Doctors professional roles include not only clinical care and the care of populations within day-to-day practice, but also support for wider movements for social change. This aligns with the long tradition linking medicine with politics and political action (Virchow s Medicine is a social science, and politics is nothing but medicine at a larger scale8,9), where having effective public health policies/interventions has often needed some political action.9As doctors, we are in a strong position to advocate. Health professionals are citizens; as citizens we have no less right to comment than others. We are privileged by our education, access to power, and a professionally compassionate role in society. We can assimilate complex evidence and advocate for health, making us potential leaders.10The New Zealand Medical Association s landmark 2011 statement on health equity11 mandates doctors to talk about what determines health. The longstanding ethic to First do no harm extends, we believe, to speaking out against policies and practices that harm whether by damaging child health, widening health gaps, escalating climate risk, or ignoring harm. Such ideals are embodied in professional codes and mores. For instance, the NZMA s Role of the Doctor consensus statement12 and Code of Ethics13 (see Appendix) have doctors as scientists, leaders and public health advocates, with health advocacy a formal role in itself.Despite opposition,14 doctors need, we believe, to become politically active, to speak out when things are wrong.7,15,16 If we don t, divergent views will certainly be promoted within that vacuum to the detriment of public health and the public good. Doctors have spoken out before on a range of issues, often against the tide: tobacco; nuclear war; fenoterol; climate change. We have made a real difference the International Physicians for the Prevention of Nuclear War was even awarded the Nobel Peace Prize and we must continue.In the early days of the discovery of child abuse, a common and understandable response of many doctors to the question of whether or not to report to the authorities was that, if they did, they would lose any chance of influencing the family and protecting the child. As we went on to learn that intervention by individual doctors in the clinical setting was ineffective, that position became untenable. It amounted to complicity. Our situation in relation to an abusive government is somewhat similar. We may argue that we are better able to make changes by remaining friends, but in a government that is clearly hell-bent on stopping the boats by whatever means at its disposal, this seems unlikely.Does public outing of the government do any better? There is no guarantee that it will, but the hope is that the majority of Australians are of course decent people and also voters; and that in time these two facts, together with our efforts as a profession and the efforts of others in drawing attention to the plight of asylum seeker children, will end the serious abuse that is taking place in immigration detention. We are reminded of the famous saying of the sage Hillel:17 If I am not for myself, then who will be for me? And if I am only for myself, then what am I? And if not now, when? To which can be added, And if not me, who? Appendix: Some statements by the New Zealand Medical Association on doctors roles in public health advocacyFrom the NZMA Role of the Doctor consensus statement12https://www.nzma.org.nz/publications/role-of-the-doctor-consensus-statement(our emphasis)Key statements Doctors accept their ethical responsibilities to act in the best interests of their patients, and the population as a whole, and undertake this in a caring, compassionate, competent, and trustworthy manner. Doctors are advocates for improved population health and health equity for all people. Doctors are committed to the spirit and principles of The Treaty of Waitangi, particularly as it relates to the attainment of health equity for M\u0101ori. Doctors as scientistsDoctors have the ability to access, interpret and assimilate new knowledge critically, have strong intellectual skills and grasp of scientific principles, and are capable of effectively managing uncertainty, ambiguity and complexity. They have the capacity to work out solutions from first principles when patterns do not fit, and the ability to work outside guidelines when circumstances demand.Doctors use scientific tools and techniques, including audit and research, to develop new knowledge.Doctors as leadersDoctors have a key role in providing higher level sector leadership, including in leading and facilitating change.Doctors as health advocatesWhen appropriate, doctors use their influence to advocate for increased resources to improve health outcomes for their patients and populations.Doctors have a role in the promotion of population health, including ongoing efforts to achieve health equity. Some doctors will take an increased focus on the health of the population through formal roles in health education or promotion, service improvement, public health and/or health advocacy. This commitment is to the health of all New Zealanders, but it exists alongside a professional responsibility for the health of individuals and communities throughout the world.From the NZMA Code of Ethics13https://www.nzma.org.nz/publications/code-of-ethics(our emphasis)PrinciplesAll medical practitioners, including those who may not be engaged directly in clinical practice, will acknowledge and accept the following Principles of Ethical Behaviour:10. Accept a responsibility to assist in the protection and improvement of the health of the community.11. Accept a responsibility to advocate for adequate resourcing of medical services and assist in maximising equitable access to them across the community.RecommendationsDoctors in a just and caring society68. Doctors should accept a share of the profession s responsibility toward society in matters relating to the health and safety of the public, health promotion and education, and legislation affecting the health or well being of the community.69. Doctors have a role in ongoing efforts to achieve health equity. This includes working collaboratively with public health and other colleagues to shape services and programmes that address health inequities and the broader social and environmental factors that influence health and well being.70. While doctors have a primary responsibility to individual patients, they have a concurrent responsibility to all other patients and the community. Doctors therefore have an ethical responsibility to manage available resources equitably and efficiently. Wherever possible, doctors should use their influence to advocate for appropriate resources to improve health outcomes for their patients and populations.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Ian Hassall, paediatrician, Auckland; Scott Metcalfe, public health physician, Wellington; Alison Blaiklock, public health physician, Auckland.

Acknowledgements

Correspondence

Ian Hassall, 18 Corbett-Scott Ave, Epsom, Auckland 1023.

Correspondence Email

i.hassall@yahoo.co.nz

Competing Interests

-- Australian Human Rights Commission. The forgotten children: national inquiry into children in immigration detention. Canberra: The Commission; 2014. Available from: www.humanrights.gov.au/sites/default/files/document/publication/forgotten_childre

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

As doctors we are often faced with trying to fix damage done to our patients by other people, whether it be car crash survivors, or the multiple victims of the tobacco industry. We might also get involved in stemming the damage at its source through road safety or tobacco control activism. But what if the harm being done is by government? This is the issue faced by Australian doctors concerned for the well-being of children in the Australian prison camps on Nauru and elsewhere.Conditions in these camps, and the very fact of being interned there for an indeterminate period, are bad for the health and well-being of children. This being so, do you as a loyal citizen of a country with a democratically-elected government accept that this is their business and not yours to question, and is perhaps too complex for you to understand? If you feel strongly enough about it, how is your dissent to be expressed? In an open society it is possible to complain directly to government or to the public through the news and social media in the hope that change can be brought about. Doctors and their organisations have done just this.Or you can go further and encourage a boycott of medical staffing of the camps, believing that anything less makes you complicit in the government s ill-treatment of these children. The alternative view is that taking up the medical care of children in the camps might at least mitigate some of the harm, and, despite gagging clauses in contracts and draconian punishments threatened in the law, you can be a witness and whistle-blower in time. Further, by working in the camps you might limit the chances of an even more brutal regimen being imposed by people with fewer scruples than your own.Many Australians have spoken out. In 2014, an Australian Human Rights Commission inquiry condemned conditions in the camps.1 Children are exposed to danger by their close confinement with adults who suffer high levels of mental illness. Thirty percent of adults detained with children have moderate to severe mental illness. The numerous reported incidents of assaults, sexual assaults and self-harm involving children indicate the danger of the detention environment. (p.30) A survey of general and community paediatricians reported over 80% of respondents agreed with a statement by the Australian Medical Association that mandatory detention of children constitutes child abuse.2The Royal Australasian College of Physicians has issued a strong statement that concludes:3 Held [locked] detention presents an extreme and unacceptable risk to children s development and mental health, especially for unaccompanied children. The Australian government s response was to introduce a law that forbids doctors and others from reporting publicly on what happens in the camps.4 Reporting child abuse, while mandatory in Australia, became an offence in the camps. In June 2015, Dr John-Paul Sanggaran, and 40 others who had worked in detention centres, sent an open letter to the Australian Prime Minister protesting at the gagging provisions.4,5On 3 July, 40 senior New Zealand child health workers sent a letter to the Australian Prime Minister and Leader of the Opposition as follows:6 We, the undersigned are senior New Zealand paediatricians and child health workers experienced in the care of children and their protection from ill-treatment. We are concerned for the children detained by the Australian Commonwealth Government in the immigration detention centres on Nauru and elsewhere. The circumstances in which there is no prospect of appeal or release are inevitably detrimental to many of the children s development and mental health because of the impact on them of the depression, anger and desperation of their parents and other adults in the camps. Further, it is the world-wide experience that children in institutional circumstances such as these are unsafe. Some will suffer abuse. The secrecy provisions in Part 6 of the Australian Border Force Bill 2015 which came into effect on 1 July will exacerbate these effects by severely limiting public oversight of conditions in the camps. In this respect, we support the open letter to yourself of 1 July, 2015 from our Australian colleagues, Dr John-Paul Sanggaran and forty others. Our plea is that your Government should take steps to mitigate the plight of the children in its custody on Nauru and elsewhere. We respectfully suggest these initial actions: Provision for detainees of a realistic hope of resolution through processing as refugees. Without this, children are in the position of hostages in a policy aimed at deterrence which has some of the features of collective punishment, condemned in human rights instruments such as the Geneva Convention. Permitting public oversight of the conditions and effects on children of life in the camps through removal of the tight secrecy provisions in the Australian Border Force Bill and provision for independent monitoring and review. No reply to this letter has been received.When doctors speak up, we risk the ire of the authorities. We may attract unwanted attention, not only to ourselves but also to our colleagues. We have to decide carefully if and when it is worth it, or whether behind the scenes advocacy and negotiation or silent appeasement might be in the best interests of those we serve.Modern medical, and other health practice, is much more than prescribing pills for individuals. We find ourselves with a wider professional duty to act and speak for patients and populations, current and future, here and elsewhere.7 Doctors professional roles include not only clinical care and the care of populations within day-to-day practice, but also support for wider movements for social change. This aligns with the long tradition linking medicine with politics and political action (Virchow s Medicine is a social science, and politics is nothing but medicine at a larger scale8,9), where having effective public health policies/interventions has often needed some political action.9As doctors, we are in a strong position to advocate. Health professionals are citizens; as citizens we have no less right to comment than others. We are privileged by our education, access to power, and a professionally compassionate role in society. We can assimilate complex evidence and advocate for health, making us potential leaders.10The New Zealand Medical Association s landmark 2011 statement on health equity11 mandates doctors to talk about what determines health. The longstanding ethic to First do no harm extends, we believe, to speaking out against policies and practices that harm whether by damaging child health, widening health gaps, escalating climate risk, or ignoring harm. Such ideals are embodied in professional codes and mores. For instance, the NZMA s Role of the Doctor consensus statement12 and Code of Ethics13 (see Appendix) have doctors as scientists, leaders and public health advocates, with health advocacy a formal role in itself.Despite opposition,14 doctors need, we believe, to become politically active, to speak out when things are wrong.7,15,16 If we don t, divergent views will certainly be promoted within that vacuum to the detriment of public health and the public good. Doctors have spoken out before on a range of issues, often against the tide: tobacco; nuclear war; fenoterol; climate change. We have made a real difference the International Physicians for the Prevention of Nuclear War was even awarded the Nobel Peace Prize and we must continue.In the early days of the discovery of child abuse, a common and understandable response of many doctors to the question of whether or not to report to the authorities was that, if they did, they would lose any chance of influencing the family and protecting the child. As we went on to learn that intervention by individual doctors in the clinical setting was ineffective, that position became untenable. It amounted to complicity. Our situation in relation to an abusive government is somewhat similar. We may argue that we are better able to make changes by remaining friends, but in a government that is clearly hell-bent on stopping the boats by whatever means at its disposal, this seems unlikely.Does public outing of the government do any better? There is no guarantee that it will, but the hope is that the majority of Australians are of course decent people and also voters; and that in time these two facts, together with our efforts as a profession and the efforts of others in drawing attention to the plight of asylum seeker children, will end the serious abuse that is taking place in immigration detention. We are reminded of the famous saying of the sage Hillel:17 If I am not for myself, then who will be for me? And if I am only for myself, then what am I? And if not now, when? To which can be added, And if not me, who? Appendix: Some statements by the New Zealand Medical Association on doctors roles in public health advocacyFrom the NZMA Role of the Doctor consensus statement12https://www.nzma.org.nz/publications/role-of-the-doctor-consensus-statement(our emphasis)Key statements Doctors accept their ethical responsibilities to act in the best interests of their patients, and the population as a whole, and undertake this in a caring, compassionate, competent, and trustworthy manner. Doctors are advocates for improved population health and health equity for all people. Doctors are committed to the spirit and principles of The Treaty of Waitangi, particularly as it relates to the attainment of health equity for M\u0101ori. Doctors as scientistsDoctors have the ability to access, interpret and assimilate new knowledge critically, have strong intellectual skills and grasp of scientific principles, and are capable of effectively managing uncertainty, ambiguity and complexity. They have the capacity to work out solutions from first principles when patterns do not fit, and the ability to work outside guidelines when circumstances demand.Doctors use scientific tools and techniques, including audit and research, to develop new knowledge.Doctors as leadersDoctors have a key role in providing higher level sector leadership, including in leading and facilitating change.Doctors as health advocatesWhen appropriate, doctors use their influence to advocate for increased resources to improve health outcomes for their patients and populations.Doctors have a role in the promotion of population health, including ongoing efforts to achieve health equity. Some doctors will take an increased focus on the health of the population through formal roles in health education or promotion, service improvement, public health and/or health advocacy. This commitment is to the health of all New Zealanders, but it exists alongside a professional responsibility for the health of individuals and communities throughout the world.From the NZMA Code of Ethics13https://www.nzma.org.nz/publications/code-of-ethics(our emphasis)PrinciplesAll medical practitioners, including those who may not be engaged directly in clinical practice, will acknowledge and accept the following Principles of Ethical Behaviour:10. Accept a responsibility to assist in the protection and improvement of the health of the community.11. Accept a responsibility to advocate for adequate resourcing of medical services and assist in maximising equitable access to them across the community.RecommendationsDoctors in a just and caring society68. Doctors should accept a share of the profession s responsibility toward society in matters relating to the health and safety of the public, health promotion and education, and legislation affecting the health or well being of the community.69. Doctors have a role in ongoing efforts to achieve health equity. This includes working collaboratively with public health and other colleagues to shape services and programmes that address health inequities and the broader social and environmental factors that influence health and well being.70. While doctors have a primary responsibility to individual patients, they have a concurrent responsibility to all other patients and the community. Doctors therefore have an ethical responsibility to manage available resources equitably and efficiently. Wherever possible, doctors should use their influence to advocate for appropriate resources to improve health outcomes for their patients and populations.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Ian Hassall, paediatrician, Auckland; Scott Metcalfe, public health physician, Wellington; Alison Blaiklock, public health physician, Auckland.

Acknowledgements

Correspondence

Ian Hassall, 18 Corbett-Scott Ave, Epsom, Auckland 1023.

Correspondence Email

i.hassall@yahoo.co.nz

Competing Interests

-- Australian Human Rights Commission. The forgotten children: national inquiry into children in immigration detention. Canberra: The Commission; 2014. Available from: www.humanrights.gov.au/sites/default/files/document/publication/forgotten_childre

Contact diana@nzma.org.nz
for the PDF of this article

Subscriber Content

The full contents of this pages only available to subscribers.
Login, subscribe or email nzmj@nzma.org.nz to purchase this article.

LOGINSUBSCRIBE