Fear and Hypocrisy in Australia: Immigration Detention and Free Speech

It was not long ago that the Abbott government vowed to champion free speech, pledging to amend Section 18C of the Racial Discrimination Act, a section of the act that made almost completely useless speech illegal. This commitment was re-affirmed a number of times, including again in early 2015 after the Charlie Hebdo massacre. It seems however the government’s commitment to free speech is largely selective, actively working to keep the marginalised and powerless out of the debate, happy to gag and attack those who dissent.

The recently introduced Border Force Act has raised the ire of a number of individuals and professional bodies, gaining significant media attention with a possible two year prison sentence for speaking about the conditions in immigration detention. Much has been said about how this will impact on the ability of health professionals to report abuse and advocate for patients, however less has been said about how this will only further silence those who are genuinely voiceless.

Silencing the Silenced

The stories we hear from within detention centres are often told through third parties, with many former employees feeling compelled to speak on behalf of those who could not. For all the noise surrounding immigration detention policies, how many of those voices are refugees or asylum seekers?
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Hannah Arendt explored this powerlessness in The Origins of Totalitarianism, she argued that even though human rights are proclaimed to be universal, asylum seekers and stateless persons were left with nothing to protect their rights, effectively in limbo, no longer a member of a community where their rights could be enforced. This precarious situation has often been referred to as “the right to have rights”.

“… but it turned out that the moment human beings lacked their own government and had to fall back upon their minimum rights, no authority was left to protect them and no institution was willing to guarantee them.”

She emphasised how this stripped away the right to make oneself heard and opinions matter.

“The fundamental deprivation of human rights is manifested first and above all in the deprivation of a place in the world which makes opinions significant and actions effective… They are deprived, not of the right to freedom, but of the right to action; not of the right to think whatever they please, but of the right to have an opinion”

Managing and processing the powerless

Immigration detention in Australia compounds this powerlessness by further limiting asylum seekers ability to control their own lives and speak candidly about their circumstances. Andre Dao reminds us that this powerlessness can manifest in asylum seekers gambling on their bodies, a symbolic way to regain some control, to be heard. As Dao puts it “you are no longer a human being with free will. Instead, you’re a problem to be managed, an object to be processed.” Few better statements sum this up than these words recalled by an ex-detainee on a hunger strike who was being spoken to by a department employee.

“You understand that your life is in our hands. Your death is also in our hands because we won’t let you die.”

Although a number of asylum seekers have spoken out over the years, their voices rarely make it to the mainstream. Furthermore there remains the expectation of silence both during and after detention, it is not until permanent residency has been gained and families reunited that many feel safe to speak about their experiences.

Silenced subjects and misinformation

Maintaining this silence is key to maintaining our current approach to asylum seekers. The system has been built around rhetoric and misinformation, from children overboard to the present day. Most people can bark back three word slogans, but fewer could tell you what percentage of the world’s asylum seekers arrive on our shores or begin to explain the trauma and torture many have faced before finding safety.

The voices we most need in our debates around asylum seeker policy in Australia are absent, not only that, they are actively excluded. So as well as threatening professionals with gaol time, the Border Force Act only further ensures that that we never get to hear these stories, it ensures that we don’t know who we are locking up or for what reason.

It’s not obvious how the Border Force Act serves to “stop the boats” or “smash the people smugglers business model”, taking into account the boats stopped a long time ago. In attempting to justify this legislation however, the rhetoric has boiled down to a very familiar means justifying the ends rationale, something we should all be careful of and something where it seems appropriate to leave the last words with Hannah Arendt.

“The crimes against human rights, which have become a speciality of totalitarian regimes, can always be justified by the pretext that right is equivalent to being good or useful for the whole in distinction to its parts.”

Ryan Essex

PhD Candidate, The University of Sydney.

Policing parenting: is the Family Court going to punish you for having a drink?

Sascha Callaghan, University of Sydney

News outlets have pounced on a Family Court “order” for parents of a six-year-old boy to not smoke around the child and to limit their alcohol consumption while caring for him. Readers commented that the case represents an unacceptable “intervention by the courts into the personal space of the individual”, and that it was an attempt at “social engineering”.

The idea of a court intervening in family life to prevent what might seem like fairly ordinary activities, such as occasional tobacco smoking or having a glass of wine or two, might seem like evidence of an overreaching “nanny state”. And perhaps it would be if that’s actually what happened – but it didn’t.

It is true, though, that the “right to parent” according to one’s own values and proclivities isn’t actually unfettered. The state can and will intervene in family life in various circumstances.

A definite jurisdiction

State Supreme Courts have powers to make orders under their protective jurisdiction to allow important medical treatment to go ahead if parents won’t consent, for instance. The NSW Supreme Court did exactly that in a 2013 case where a Jehovah’s Witness parent refused a life-saving blood transfusion on behalf of their child.

State agencies can also intercede in family life under child protection laws when a child is at risk of significant harm. This kind of coercive intervention is reserved for serious cases where the child’s basic needs are not being met. And it generally requires much more than a parent who smokes or drinks too much from time to time to trigger intervention.

But child protection laws have also been invoked when parents of a severely overweight boy didn’t go to hospital for treatment, or appropriately manage his diet (the ten-year-old boy later died from heart failure associated with obesity). And when a father, who believed HIV was an invention of pharmaceutical companies, refused to give his child the antiretroviral medication prescribed by doctors.

Not everyone will agree on the limits drawn around decisions parents are allowed to make. But most will agree that the public interest in protecting children means limits must be placed somewhere. And “risk of significant harm” doesn’t seem like a bad starting point.

In addition to child protection laws, the Family Court will intervene in the parenting of children when asked to do so by parents who cannot agree on the relevant decisions themselves. In settling these disputes, the guiding principle is that the court will act to protect the “best interests of children”.

But how do courts interpret this rather wide concept, and where do the limits of personal parental prerogatives lie when a court tries to strike a balance between the strongly held views of parents who bitterly disagree?

The particular case

In the case that has provoked so much comment, the Family Court decided that despite the fact the child’s mother was his primary carer and was “utterly dedicated to the child’s needs”, it would be in his best interests to live with his father.

The Family Court will make parenting decisions when asked to do so by parents who can’t agree on the decisions themselves.
from shutterstock.com

The orders were influenced by the mother’s preference for the advice of her naturopath over an accredited medical practitioner, which the court found was to the detriment of the child; her “conscientious objection to vaccination”; and her “clear and unwavering belief that the child obtains nothing from an ongoing relationship with his father”.

The father, on the other hand, appeared to the court to have a better view of the child’s medical needs and was “the parent more likely to support [the child] in his relationship with his mother”.

Among the 45 orders the court made were two proposed by the mother – that both parents be “restrained from smoking in the presence of the child” and that they will refrain from consuming alcohol “to excess”, or at least to the point of being unable to drive, while the child is in their care. The father agreed to these, in a suite of orders in which his interests mostly prevailed.

These are known as “consent orders” – and they’re quite different to coercive interventions under child protection laws. In fact, health-related agreements are becoming a common feature of consent orders in a culture that increasingly values health and wellness, and in which many parents are likely to want assurances from the other that their child will be in a “healthy” environment when not in their care.

These kinds of concessions are negotiated in families every day of the week – “take Harry to the physio”, or “please can we not have pizza again because last time Sam got sick”. In this sense, consent orders reflect familiar family compromises and the parents’ own values – rather than an out-of-control nanny state imposing orders on passive parents.

It’s just that these fairly unremarkable agreements have been written down and stamped by the court because goodwill has evaporated and parents no longer trust each other to honour everyday deals.

The long arm of the law?

Indeed, the most interesting aspect of this case is perhaps not the agreement by both parents not to smoke in front of their child or get so drunk that they can’t drive, but that in determining a child’s best interests, the overriding priority for the court was securing “the benefit to the child of having a meaningful relationship with both of the child’s parents”.

To many people the idea that a father who had never been in a stable relationship with the mother and had little previous involvement with him should be entitled to a relationship with the child to the extent that his mother’s role as primary carer was lost, would seem ludicrous. But the Family Law Act takes the position that a relationship with both parents will, in the absence of risk of harm to the child, be considered paramount.

With regard to smoking and drinking, there was agreement between the parents with the imprimatur of the court – rather than an order being “imposed”. The most serious issue that remained in dispute was the child’s right to a relationship with both his parents – and this was where the court really did impose the values of the Family Law Act.

Otherwise, unilateral state intervention is reserved for much more serious cases where significant harm is in the offing. So, you can still have a smoko while your child is at home without fear of being touched by the long arm of the law.

The Conversation

Sascha Callaghan is Lecturer in Health Law & Bioethics at University of Sydney.

This article was originally published on The Conversation.
Read the original article.

Politics, Power and Children in Detention

Politics are all around us, playing out in national, local and even domestic governance. Politics have to do with the polis, the people who make up groups of any kind. In that sense, politics are unavoidable. Our relationships with others always contain a political element. Party politics are a subset of politics in its broad sense. Party politics are partisan, ideologically informed patterns of thought and action that suggest how politics should translate into governance in a way that is consistent with a set of underlying values. They condense around different beliefs in power relationships between governors and governed, in the rights and statuses of the different groups that make up the polis, in the control and dissemination of information, and in the responsibilities of government and individuals towards one another.

Accommodation in the Nauru offshore processing facility.

Accommodation in the Nauru offshore processing facility.

Party politics is made up of what Gallie termed ‘essentially contested concepts’. No one, for example, disputes the existence of the multitudes of people fleeing poverty, instability, persecution and fear. Nor do they dispute the reality of the moral and practical problems they pose for the countries to which they try to flee. But the agreements end at about this point. Some interpret this mass movement as a challenge to their sense of humanity and to their obligations to observe human rights. Others, while acknowledging the human problems of displacement, feel that local territorial rights and laws take precedence, and that the welfare of the host countries is paramount. Turning unregistered and unscreened refugees (“illegals”) away is, in that ideology, a better and safer and fairer alternative to dealing with them by taking them in.

Australia has been foremost among western countries in ‘turning back the boats’ and in making off-shore detention inevitable for those who do manage the journey, pointing to the success of that policy in preventing drownings and restricting the numbers of refugees who reach Australian territorial waters. By contrast, Italy has done its best to rescue enormous numbers of people fleeing North Africa, and to find some kind of accommodation for them. Neither side can be said to have found ‘the’ answer to a massive humanitarian crisis. Italy’s resources have been overstretched. The Australian mode of management appears to contravene United Nations conventions on refugees.

Party-Politics & the Report into Children in Detention

Into the middle of this dilemma, which is partly political in the broad sense and strongly party political in a narrower sense, came the Report into Children in Detention, chaired by the Australian Human Rights Commissioner, Gillian Triggs. The Report found more than 200 children to be in off-shore or Australian detention under conditions that harm their development and infringe the UN statements on human rights. The Commission’s findings seem to be supported by doctors who have visited the detention centres, and by various leaks from people who have worked in Nauru and Christmas Island. The Australian Government’s response has been to deny the accuracy of the report, to attack Triggs’s integrity, to accuse her of partisan reporting, and to call for her resignation.

The report calls for the early release of children from detention, and for proper acknowledgement of their rights, particularly their rights to grow into reasonable adulthood, equipped with education and some sense of identity and stability. It makes many comments about the suffering of adults, but its focus is on children and the overwhelming impact that violence, insecurity, uncertainty, heat, lack of space and lack of hygiene will have on their lives.

The report does not deal so much with the original party-political decision to turn back the boats. It does take issue with both political parties’ decisions to enforce mandatory detention, and it does so predominantly in the context of the impact of that policy on children.

Triggs & the Ruin of Party-Politics

It makes disturbing reading. Presumably that is why it has provoked such extreme responses from both sides of party politics.

On the right, party politicians and right-wing newspapers have belittled Triggs and accused her of bias against them, of dishonesty and inaccuracy. They question the timing of the inquiry, which began soon after the election of the LNP in 2013. They have recommended imprisonment for anyone who leaks relevant information to the media, such as those who supplied some of the information that Triggs relied upon.

On the left (and in the centre), politicians, commentators and media have called for the report to be taken seriously, for secrecy to be lifted and for legislation to protect refugee children. For these people, the timing of the report is irrelevant because its contents demand some major response. At the same time, those who oppose the present government’s theories and practices have used the report as a lever to destabilise the government’s refugee policies more generally, pointing out that what happens to the children is a consequence of what happens to “illegal” refugees at large.

All these conflicts of interpretation and accusations of dishonesty signal the presence of an essentially contested concept. The big concerns for us are:

  1. That politics in the broad sense have been confused with a much narrower party politics;
  2. That the present government’s refusal to allow access to the detention facilities effectively disables any public debate;
  3. That the punishments threatened against anyone who reveals ‘classified’ information about the centres are Draconian;
  4. That the government’s vigorous attacks on the report and its author suggest that they had a pre-formed notion of what the report should say.

Essentially contested concepts make up a significant part of our ‘political’ lives – they always have and they always will. What is important is the way in which these contests are handled. A totalitarian government will settle them one way; a liberal democracy will try to find another.

Ignoring the Real Issue

What is at stake in this confrontation is not Gillian Triggs’s credibility, but the public perception of its preferred mode of government. Apparently, more than 50% of the population approve the present government’s approach to refugees or believe that it should be more extreme. We can only hope that they understand that Triggs, in her appointed role as Human Rights Commissioner, was writing about children in detention, and that government decisions to discredit her well-supported findings by political force majeur raise serious concerns about the reality of our much vaunted participatory democracy.

Emeritus Professor Miles Little, University of Sydney

Miles was the Founding Director of the Centre for Values, Ethics and the Law in Medicine (1996-2003). He was also the Foundation Professor of Surgery at Westmead Hospital in 1978 and a Co-Founder of the World Association of Hepatic, Pancreatic and Biliary Surgeons (1987). Since 1996, Miles is an Emeritus Professor of Surgery at the Sydney Medical School. At the VELiM, he continues to teach and is directing the Cancer Survivorship Project. Miles interests include Medical Sociology and Biomedical Ethics. He is also a published poet.

Let’s stop the bullying of trainee doctors – for patients’ sake

Kimberley Ivory, University of Sydney and Karen Scott, University of Sydney

Size matters. At least, that seems to be the media’s belief when it comes to analysing social problems. The grimmer the stories, the uglier the experience, the more bodies at the bottom of the cliff, the better.

And last night’s episode of ABC TV’s Four Corners didn’t disappoint, with its expose on bullying among surgeons and the devastating consequences this entrenched practice has for its victims, both in the short and long term.

Despite casting their net wide, the show’s producers found only three medical professionals who haven’t spoken out about this issue before, and only two chose to be identified. Imogen Ibbett and Vyom Sharma have now joined the growing ranks of doctors, such as Dr Caroline Tan and Dr Talia Steed, in breaking the silence around the destruction of careers and health that doctors cause among their own.

But noticing the growing pile of bodies at the bottom of the cliff is only helpful if it triggers the essential questions – who or what is pushing them off and what can be done to stop it?

Not just surgeons

The program notes that this is not just a problem for women, or surgeons or even just the medical profession; it’s a public health issue that demands action. Indeed, women can also be perpetrators as Imogen Ibbett’s allegations against Helen Maroulis clearly demonstrate.

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But most significantly, the show highlights the risk bullying, scalpel-throwing surgeons, misogynist physicians, and harassed and cowered trainee doctors pose to the lives of patients.

The problem starts early, in medical school; both local and international research persistently show most medical students experience mistreatment during clinical placements in hospitals.

Our recent – about to be published – research found 74% of Australian medical students experienced mistreatment during clinical placements and even more witnessed it. Similarly, a 2014 US study found 83% of medical students experienced some form of mistreatment during medical training in hospitals.

A large number of students reported use of “pimping”, an aggressive form of questioning based on an abuse of the Socratic teaching method, described in Four Corners, which is used to shame students for their lack of knowledge. Studies have also highlighted negative environments involving belittlement, disrespect and being “constantly ignored and told to disappear.”

Although student reports of mistreatment may be interpreted by some senior staff as just over-sensitivity, research shows students perceive negative events in a similar way to physicians and nurses. Unsurprisingly, under-reporting is common.

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Mistreatment of medical students is at odds with the explicit teaching about professionalism in medical training, leaving many confused. But some others become medical teachers who “mete unto others what was perpetrated against them”. The effects of all this “teaching by humiliation” can be profound and enduring.

Medical students’ mental health has been shown to decline throughout medical training. And this can lead to poor self-confidence and burnout, binge drinking, stress and depression, and substance abuse, broken relationships, suicide and early exit from the profession.

Mistreatment can create cynicism and reduce empathy, which may directly affect patient care. Students are also distressed when they see doctors mistreating or being disrespectful to, or about, patients.

Impact on patients

Patients can clearly be directly affected by the way the autocratic medical culture affects working practices and ineffective communication causes health-care errors and poor patient safety outcomes.

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In fact, this kind of culture poses an extreme threat to patient care, like the notorious “Butcher of Bega”, Graeme Reeves. After 35 formal complaints of bullying and harassment were made about Reeves by other doctors, nurses and patients over a 15-year period starting in 1985, he was deemed “a person unfit to remain on the register of medical practitioners” in 2004. Behind him lay a trail of dead and mutilated patients and aggrieved and frustrated doctors and other staff.

But much bullying and harassment is subtle, insidious and harder to prove and act upon. Indeed, Four Corners shows how one doctor’s tormentor can be another’s mentor. Dr Imogen Ibbet finds Dr Tan’s tormentor, Chris Xenos to be professional and respectable, for instance, but feels very differently about Dr Helen Maroulis’ behaviour.

And all the bad behaviour is difficult to police because mistreatment is often so subtle and secretive it can be impossible to deal with, especially when the victim is made to feel both responsible and powerless.

In the program’s attempt to look for solutions, it’s confronted by the apparent buck-passing of responsibility between the Australian Medical Association (AMA), the professional colleges and the workplaces where bullied doctors work.

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Four Corners and BeyondBlue have nailed the problem that’s pushing people over the cliff: workplaces that have allowed a culture of humiliation, bullying and harassment to prosper with inadequate pathways for action. And the fence that’s needed at the top of the cliff to prevent the falls is now also becoming apparent.

If bullying is a workplace issue, and the workplace is funded on the public dollar, then the public needs more say in hiring and firing practices. Nothing can change until young doctors are safe in the knowledge that the people they need to complain about no longer have absolute control over their careers. And there’s an example that can be followed.

Training to become a specialist in general practice is no longer directly under the control of either of the general practice colleges. Rather it’s contracted out to 17 regional training providers. The role of the general practice colleges now is to improve practice quality as a whole, build collegial relationships, and provide continuing education and opportunities for its fellows and members.

This may be a model we need to emulate for all medical speciality training. While it will never be possible to completely remove the apprenticeship model from medical education, it’s possible to ensure progression decisions are made by those at arm’s length from training and that merit, not nepotism, prevails.

The Conversation

Kimberley Ivory is Senior Lecturer, Population Medicine and Sub-dean Student Support, Sydney Medical School at University of Sydney.
Karen Scott is Senior Lecturer, Education, Discipline of Pediatrics and Child Health at University of Sydney.

This article was originally published on The Conversation.
Read the original article.

Big Food with a regional flavour: how Australia’s food lobby works

Christopher Mayes, University of Sydney and Jenny Kaldor, University of Sydney

Criticism of the food industry has itself become a niche industry. But the tendency to embrace a US-centric conception of how the industry works risks masking local variants and inhibiting a targeted response in other countries.

Since the 2001 book Fast Food Nation, a spate of books, films and documentaries on the American food industry have helped to shape the popular idea of “Big Food”.

The food industry is depicted as a highly organised set of multinational food and beverage lobbyists peddling the global diet of sugary drinks and highly processed, energy-dense salty foods – akin to tobacco industry lobbyist Nick Naylor in the 2005 film Thank You For Smoking.

But although it is highly globalised, the food industry is far from homogeneous. Big Food in Australia is not the same as the industry in the United States, where much of the popular media has come from.

Still, that doesn’t mean Australian food and beverage lobbying is benign.

Continue reading

Why care about the health and well-being of asylum seekers?

By Stacy Carter, University of Sydney and Ian Kerridge, University of Sydney

A report on the refugee detention centre in Nauru by five independent clinical experts posted online by The Guardian on Friday paints a bleak picture of life on the island, particularly for children. But why should we care about how these people are being treated?

The report describes the now-familiar wretched conditions of refugee detention. Tents that leak in the rain and become unbearably hot and humid by 10am. Burning white rocks underfoot, little natural shade, dust everywhere, only electric fans for cooling in most areas of the camp.

Mosquitoes that prevent sleep and may carry diseases. Overwhelming boredom. And the hopelessness, helplessness, frustration and despair that accompany radical uncertainty about the future.

The authors detail the effects of this environment on the physical and mental health of asylum seekers. And, not unexpectedly, they recommend changes to the detention centre. This implies, of course, that current conditions should change; that the damage we are doing to these adults and children is unacceptable.

But the Australian government disagrees. It claims current policy is justified because it prevents asylum seekers from dying at sea. Let’s assume for a moment that this is truly the purpose of offshore mandatory detention. The goal – preventing deaths – is worthy, but what means are justified to reach it? Continue reading

Abandoning clinical trial safeguards won’t boost local industry

Paul Komesaroff, Monash University; Colin Thomson, University of Wollongong, and Ian Kerridge, University of Sydney

CLINICAL TRIALS – Human clinical trials are an important last hurdle in the development of new drugs and therapies. Today, The Conversation takes a closer look at this vital scientific endeavour with three articles that look at different aspects of the process.


Testing new drugs in clinical trials is a billion-dollar industry in Australia, with most of the money coming from international pharmaceutical companies. But as investment grows in India, China, and other emerging competitors, some people argue we need to make Australia more attractive to such investment. One of their solutions is to water down the ethics approval process.

Responding to these concerns, the Coalition’s election policy on medical research promises to “move swiftly” with reforms to the ways in which clinical trials are conducted, by developing:

a nationally consistent approach to ethical standards to reduce complexity, speed up the process and where possible, rationalise the number of ethics committees to reduce the large number that currently exist.

Before major changes are introduced, however, it is important to remember that ethics committees are the very bodies that ensure the safety of clinical trials and maintain public confidence.

Developed in response to concerns about the untrammelled power of medical institutions in the 1970s, as well as reports of egregious excesses by researchers in the United States and elsewhere, the ethics committee system has become highly refined in both its processes and in the substance of the issues it addresses.

In Australia, it is also remarkably devolved and democratic, drawing in thousands of men and women from different walks of life across the country to engage in conversation, for no personal gain, about ethical issues in health care and research.

Established by hospitals and universities, the panels review research proposals and ensure they’re ethically acceptable. Their deliberations cover potential risks and benefits to both individuals and the wider society and issues relating to consent, confidentiality, privacy, conflicts of interest and protection of vulnerable participants. Continue reading