When I worked on Nauru as a medical officer for refugees and asylum seekers, I never saw myself as part of the problem. But since I returned to Australia I have increasingly come to question my role in a system that is antithetical to medical ethics.

The ongoing human rights travesty that is indefinite mandatory detention and the treatment of asylum seekers there never seems to be far away from the news. Since returning I’ve watched the Australian Medical Association, the United Nations, the Royal Australian College of General Practitioners and all the other major medical colleges and charities speaking out against the system.

The time came to take a long, hard look to see if I was actually part of the solution or accept that, after this long, doctors are increasingly being forced, by the way the systems on Nauru have been set up by the government, to be a major part of the problem.

Facebook Twitter Pinterest Dr Nick Martin while working on the Pacific island of Nauru.

I recall when working on Nauru the doctors, nurses, social workers and other staff stating they simply could not treat a patient any longer. Often that was the trigger for the evacuation of the patient to a suitable country.

Now there are systems in place that further allow the Australian government to distance itself – handing over care to ostensibly Nauruan organisations that are ill-prepared to deal with these complex, deeply traumatised and vulnerable people. There is an argument that the health professionals involved are in danger of breaking their own professional codes of ethics. They are being used as complicit agents in what is now widely seen as an inhumane and vicious program that shames Australia on the world stage.

No administration comes across as blameless in recent times; the Coalition government is quick to remind us that it was Labor’s Kevin Rudd and then Julia Gillard who reopened the camps, the Greens and Liberals who vetoed a Malaysian solution and, if we are to believe the home affairs minister, Peter Dutton, he would bring every child on Nauru to safety tomorrow if he could.

The role doctors and other healthcare professionals play on Nauru has largely escaped the glare of all the vitriol and anger that is directed at the government. This is in part due to the widely held view that they are doing their best in incredibly trying circumstances, and the ongoing advocacy and recent declarations by bodies such as the AMA and other medical colleges would support this.

Health professionals are being used as complicit agents in what is now widely seen as an inhumane and vicious program that shames Australia.

After more than five years of detention – and, semantics aside, being stuck on an island smaller than Tullamarine airport is detention, no matter what a carefully worded statement from the government would have you believe – the situation has progressed to such a perilous state that I feel it is worthwhile to revisit of the role of the doctors Australia pays to work there.

At medical school I was taught that the four principles of medical ethics are autonomy, justice, beneficence and non-malfeasance.

Autonomy requires that the patient makes decisions about his or her health without coercion or coaxing. The situation that has been manufactured on Nauru means this is simply not the case. Refugees are forced by their increasingly desperate situation to make decisions about their health that have huge impacts on their lives.

Children as young as six are attempting self-harm as they are despairing and believe this is the way to get their families off Nauru. As more of their cases come before the Australian courts – and are invariably won by advocates, and fought to the end by the government – this vile spectre of little children feeling that they hold the key to their family’s freedom is a horrifying sight.

Patients are being pushed to submit to treatments in the Republic of Nauru hospital, which is acknowledged to be substandard, poorly staffed and ill-equipped, despite millions being thrown at it by the Australian government.

The idea of justice, that benefits of treatments must be distributed equally to all patients, is challenged and defied on Nauru. Frequently, patients would be denied recommended overseas treatment if they refused to be separated from their families. Instead of allowing family members to travel with them, the consistent approach by Australian Border Force has been to deny this right, and thus the treatment itself.

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Beneficence, or the requirement that the procedure be provided with the intent of doing good for the patient involved, is thrown out the window especially in psychiatric cases, where the specialists have time and again recommended their patient be evacuated to another suitable country. To then prescribe increasing dosages of antipsychotic medications, even to young children, ostensibly to help treat them but realistically to dope them up so that they become less likely to display “protesting behaviour”, challenges the view that the doctor is acting in the best interests of the patient.

Non-malfeasance, which requires that a procedure does not harm the patient or others in society, would seem to be undercut by doctors knowingly referring people into a healthcare system that is woefully under equipped to deal with them, let alone the local Nauruan community it already serves.

Each of these principles is increasingly being breached, simply as a completely avoidable outcome of the practice of indefinite offshore detention.