Recognition, referral, diagnosis, and management of adults with autism: summary of NICE guidanceBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4082 (Published 27 June 2012) Cite this as: BMJ 2012;344:e4082
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Re: Recognition, referral, diagnosis, and management of adults with autism: summary of NICE guidance
One would take it as a prerequisite of any member of the medical profession, that we aim to uphold the highest standards of human rights. The treatment of vulnerable members of society is of particular importance, given that these individuals may have anything from a range of psychological or neuropsychiatric conditions co-existing with a complex social background.
As a proud member of this caring profession I am distressed at two particular cases of apparent human rights abuse conducted by our government in our name.
I would like to express disappointment at the profession’s silence on the cases of Gary McKinnon and Talha Ahsan, both young British men diagnosed with Asperger’s syndrome, who face extradition to the USA. These are two cases often hidden from mainstream media and society.
Mr Mckinnon’s case is somewhat familiar to most, whilst Talha has been detained for 6 years without charge or trial and is currently held in a high security facility in HMP Long Lartin. He has been described as an exceptional student with a mental illness that will render him a vulnerable individual in prison. The harsh reality of solitary confinement in the USA would daunt any human being, and with a disability affecting both communication and information processing (as described by the National Autistic Society) this would be unbearable for Talha . Whilst supporting the right for a fair trial I find it unacceptable that British law not be applied to a British citizen who was on British soil during the period of time in which the USA allege cyber-crime.
Given the BMA’s claims to advocate “the highest standards of human rights in healthcare” http://bma.org.uk/working-for-change/improving-and-protecting-health/hum..., and given its recent, and admirable, stance on the human rights abuses in Bahrain and Syria, we are extremely surprised at its silence on human rights abuses when they occur closest to home yet accept that this is partly due to the hidden nature of the abuses and often misrepresentation in the media.
Gary and Talha still face extradition to the USA, despite debates and promises in Parliament and government. Caroline Lucas’ (Brighton MP) Early Day Motion 128 in the House of Commons has created cross party support for Extradition Reform although often hers seems like a lone voice in the wilderness.
Whilst the extradition process is prejudicial to all British citizens we are particularly concerned by the effects it will have on those with existing mental health problems due to their vulnerable nature. The psychological distress and trauma of extradition and trial and possible imprisonment abroad will be detrimental to most individuals let alone those with a condition such as Asperger’s.
Patients with autistic spectrum disorders are likely to be particularly traumatised by changes of routine which an extradition process would involve; and critically they are known to be susceptible to victimisation and bullying. Talha is expected to be held at the notorious Florence ADX Supermax facility, further isolated from family support with possibly immense psychological distress. Effects on routine and the psycho-social pressure on such an individual may render them susceptible to further illness and psychiatric disorders.
Given the USA’s recent record with use of procedures such as water-boarding (2007) and solitary confinement for extra-judicial prisoners, it is worrying that this country is prepared to send over two of our most vulnerable citizens without concrete assurances. In the case of Gary McKinnon, previous psychiatric assessment has designated him to be at high risk of committing suicide should he be extradited. In common law and society we take into account extenuating circumstances with patients at high risk of self-harm and both these individuals will be at high risk if the process completes.
We would like to see the BMA and the medical profession call for an end to inhumane treatment of vulnerable prisoners in this country. We demand an immediate end to extended periods of detention without trial and to the threat of extradition of our citizens and patients no matter what their race, religion, creed or colour.
Competing interests: No competing interests