Can Physicians Working in Detention Facilities Uphold Their Hippocratic Oath?

Berman Institute faculty Nancy Kass and Len Rubenstein, along with Paul Spiegel of the Bloomberg School of Public Health’s Center for Humanitarian Health, have published “Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath?”in the Aug. 30 online edition of JAMA Viewpoint.

The authors state that medical ethics “have been strikingly consistent from Hippocrates to modern-day guidance. Whatever the future of US immigration policy, decent and humane treatment of children, as well as all other detainees, and preservation of the independence of physicians and other health professionals to meet patients’ medical and psychological needs are essential. Now is not a time to change the commitments, reputation, and integrity of physicians and the medical profession.”

The authors put forward a number of concrete steps that should be taken to ensure appropriate treatment of individuals receiving medical care in Health and Human Services (HHS) facilities run by the Office of Refugee Resettlement (ORR). They include:

• “Health care professionals should insist on and adhere to clinical independence to ensure they are able to provide the highest standards of care that are in the best interests of the patient. This independence also demands that physicians and other health care professionals are not subject to retribution for reporting … about their evaluations of conditions of detention that impede their patients’ health and the availability of quality medical care.”
• “There needs to be an independent health oversight body that monitors all aspects of preventive and curative health services, outcomes, and standards in DHS and ORR/HSS immigration detention facilities, assesses health care practitioners’ ability to uphold their primary professional obligations, and issues timely recommendations. The proposed independent oversight body should be completely insulated from government interference and be granted full access to all DHS and ORR/HSS detention facilities, their personnel, and patient medical records at any time.”
• DHS and ORR/HHS should be required to report on a regular basis how they are meeting their own and international standards for each facility for which they are responsible. While Customs and Border Patrol, Immigration and Customs Enforcement, and ORR standards exist, they should be assessed independently to ensure they are sufficient and meet international standards. Furthermore, their responses to the independent health oversight organization should also be made public.”

Nancy Kass is the Phoebe R. Berman Professor of Bioethics and Public Health and the Berman Institute’s Deputy Director for Public Health. Len Rubenstein is core faculty at the Berman Institute and the Director of the Program on Human Rights, Health and Conflict at the Bloomberg School’s Center for Public Health and Human Rights. Paul Spiegel is Director of the Center for Humanitarian Health at the Bloomberg School.