Torture and doctors’ dual obligation

Support for doctors working in immigration detention centresIn recent years, colleagues and I have examined several hundred asylum seekers giving histories of torture but subjected to immigration detention. Our experience accords with numerous reports by the Prisons Inspectorate.1 We agree with Sheather and colleagues that new approaches are needed to support health professionals confronted with violation of detainees.2

Recent practice has re-traumatised many vulnerable people, who have then needed hospital admission for psychosis. In seven cases, courts have held that detention constituted inhuman and degrading treatment.3

These failures have complex causes. Doctors employed in detention centres have little time or training to document people who should not be detained according to Home Office policy and the law. Such doctors feel conflicting loyalties between their duties to their patients and to their employers. Yet they issued some 1500 or more reports raising concerns last year. Home Office caseworkers who take decisions to detain, formulaically reject these reports as not independent evidence of torture.

When caseworkers reject a report, they must send a response to the detainee and the doctor. According to detention service orders,4 the doctor should respond where appropriate, setting out their reasoning. This rarely happens.

Doctors have a duty to work within their competence or to refer a colleague to deal with patients’ clinical needs. This injunction is one of the General Medical Council’s duties of a doctor.5 It is being universally ignored. In addition to the damage to patients, doctors place themselves at risk.

We owe our colleagues practical help and support in complying with these undoubted difficulties. Medact is establishing a forum for doctors working in immigration detention to interact with colleagues experienced in the documentation of torture. We hope the BMA, GMC, NHS England, and professional indemnity bodies will support this initiative. Confidential inquiries to: ethics@medact.org
Notes

Cite this as: BMJ 2015;350:h1008

 

Footnotes

Competing interests: FA has examined more than 200 survivors of torture during or after their detention in the UK. He is sometimes paid for doing so and for producing expert evidence to the courts.

 

References

  1. Detention Forum. Inspection reports. https://detentionforum.wordpress.com/resources-and-links/resources-and-inspections-overview/
  2. Sheather J, Beynon R, Davies T, Abbasi K. Torture and doctors’ dual obligation. BMJ 2015;350:h589. (3 February.) g
  3. Grant-Peterkin H, Schleicher T, Fazel M, Majid S, Robjant K, Smith G, et al. Inadequate mental healthcare in immigration removal centres. BMJ2014;349:g6627.
  4. Home Office. Detention service order 17/2012. Application of detention centre rule 35. gov.uk/government/uploads/system/uploads/attachment_data/file/300366/17.2012_v2.0_-_Application_of_Detention_Centre_Rule_35_ext.pdf.
  5. General Medical Council. Good medical practice. Apply knowledge and experience to practice. 2013. www.gmc-uk.org/guidance/good_medical_practice/apply_knowledge.asp.

This letter was originally published in the BMJ online on 24.2.15

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