Australia’s law to gag doctors with concerns about asylum seekers is a failure of democracyBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3256 (Published 17 June 2015) Cite this as: BMJ 2015;350:h3256
- David Berger, district medical officer, emergency medicine, Broome Hospital, Robinson Street, Broome WA 6725, Australia
“If you have nothing to hide, you have nothing to fear.” So runs the mantra of Western governments when they want us to accept mass surveillance of phones, email, and messaging.1 The script changes, however, when the boot is on the other foot. At the slightest chance of embarrassment or an awkward question to a minister governments do their utmost to control the flow of information to prevent disclosure, irrespective of any real implications for national security.
Recently we saw a typical manifestation of this dark art when Australia passed, with bipartisan support, the Border Force Act 2015.2 3 This regressive legislation will have the effect of gagging doctors working in Australia’s notoriously harsh onshore and offshore detention centres for people seeking asylum. Contravening the act, even by revealing the absence of basic sanitary conditions, may result in a two year prison sentence.4 5 6
Only because of disclosures to the press was the broken arm of a boy detained on Nauru properly reduced and internally fixed, after more than a month of pain for him and anguish for his parents; nothing was done until the situation was leaked.7
Avoiding embarrassing revelations
Australia’s general position when asked to comment on its operations regarding asylum seekers is to say, “Every time we comment on operational matters we give information to our enemies. We give information to people who want to do the wrong thing by our country.”8 However, it is hard to concoct even a specious argument that national security could be compromised by revealing details of the substandard medical care accorded to innocent people who have sought Australia’s protection. We must conclude, therefore, that the only reason to suppress doctors in this way is to avoid embarrassing revelations about how Australia is flouting its international humanitarian obligations towards refugees and is subjecting them to treatment that violates the United Nations Convention Against Torture.9
Doctors worldwide are bound by strong ethical codes. These govern every aspect of our practice and have evolved over at least 2000 years, placing the patient’s interests at the heart of our endeavours to the exclusion of almost all else. Most people would agree that this is right.
To submit to a gagging order such as the Border Force Act 2015 places doctors in direct opposition to our professional duty to promote the best interests of our patients at all times. It is a moral travesty of the Australian government to put healthcare workers in this invidious position simply to safeguard its own blushes and to further its inhumane policy initiatives. Allegations in October 2014 by Scott Morrison, Australia’s then minister for immigration, that Save the Children’s staff working on Nauru may have been fabricating and even coaching allegations of child sexual abuse, were thoroughly discredited in March 2015 by the investigation that Morrison himself commissioned.10 11
If this new law had been in force then, those 10 Save the Children staff might have been imprisoned for disclosing this information, not just expelled from the island. It is hard, therefore, to see this act as anything but a dangerous precedent, in Australia and globally, for suppressing legitimate voices of conscience and dissent.
All governments, whether democratic or not, hate whistleblowers and leakers (although governments themselves are addicted to leaking). Time and time again, however, when courageous people bring matters to light that governments would rather see buried, the public demands action. Nowhere is this better illustrated than in the recent news that the US senate has passed the USA Freedom Act, repealing the right of the US National Security Agency to collect telephone and message data in bulk from the country’s population.12 This resulted from disclosures by Edward Snowden and the consequent outrage among US citizens of all political persuasions at what they saw as unjustifiable intrusion into their privacy. Ironically, and as testament to the hatred governments have towards whistleblowers, Snowden still faces charges under the Espionage Act and life in prison if he returns to the United States.13
Democracy requires openness
Holding governments to account through the conscience of the people is democracy in action. Without information this cannot happen, and democracy must fail. This is why, except when the reasons not to are absolutely overwhelming, information must be open.
Embarrassment at policy failure is not a good enough reason to conceal information; even less so when innocent lives are at stake. By shackling the conscience of doctors the Australian government is leading the way for others to follow if they have something embarrassing (and possibly lethal) to hide, be they governments, hospitals, healthcare organisations, or other bodies with responsibility for people’s lives. We can only reflect ruefully that Stephen Bolsin, the courageous whistleblower at the heart of the Bristol paediatric cardiac surgery scandal who fled the UK for Australia in the 1990s, should now find himself living in a country where the government can actually imprison doctors for advocating in their patients’ interests.14
I call on all right minded people, people of conscience, and lovers of democracy and accountability to petition the Australian government to repeal this repressive legislation and to promote openness, accountability, and protection for whistleblowers everywhere.
Doctors are not the only people with a conscience, but our work makes us well placed to identify when power is being abused. If Australia now has a law that may be used to silence doctors or imprison them for two years for doing their best to safeguard their patients’ interests, what will it do to everyone else?
Cite this as: BMJ 2015;350:h3256
Competing interests: I am a non-executive director of BMJ. I am an employee of Western Australia Country Health Service (WACHS). These opinions are my own and do not in any way represent the views of WACHS.