Scavengers at Woolworths in a Remote Mining Town

By the time we disembark in the town we have travelled most of the day. The streets are a desert in the empty way of a Sunday afternoon in the country. We need to buy food supplies but all is quiet. Nothing moves. The air tastes hot. Breathing becomes an effort.

Up and down slow wide streets we prowl, looking for a supermarket. Hello! This is Woolworths. A cluster of cars baking in the carpark. Signs of life. Or recent life.
We tumble out, one grizzled grandfather, two ratty ten-year-old twins. Woolies is open! In the course of the following twenty minutes I load a trolley with fruit, vegetables, cheese, pasta, milk, yoghurt, confectionary bribes, cans of tuna, smoked salmon for the sybaritic grandsons.
The boys have disappeared. All other customers have disappeared. Someone turns off a lot of lights. I wrestle the trolley to the check-out where the twins lie face down, arms outstretched, fingers groping in the narrow cracks beneath the checkout counters, Their long curly hair wears a diadem of dust. Their once-clean shirts from long ago – this morning – are grimy. Their faces are coated in dirt. They wear expressions of intense concentration. When I call their names they do not respond. They pay no heed. Business as usual.
I pay a distracted-looking checkout person who asks me whether the boys are mine.

Technically they are not. But I admit to the connection. 

Checkout person says: ‘That money doesn’t belong to them.’

‘What money, I wonder?’
I call the boys and advise them I am about to leave, the store is about to close, and I will collect them at opening time tomorrow. If I remember.

The boys surface, faces aglow with dirt and triumph, their hands full of coins. ‘Look Saba! We found all this money under the checkouts.’

‘That money doesn’t belong to you’ – checkout person again.  

‘It doesn’t belong to you either’, says one cheeky voice.

‘Who does it belong to?’ – challenges another.


‘No it doesn’t.’ – two voices in chorus.

‘It can’t belong to the shop, Saba. The people paid the shop. The people dropped the coins. It’s not the shop’s money.’

‘Whose is it, do you think?’ – asks the grizzled grandfather, who isn’t really too clear on the legalities or the morals here.
The boys have an answer: they’ve spied a tin chained to the checkout counter. The tin has a slot for coins in its top.

The boys are busily feeding the coins into the tin, counting as they go. ‘Twenty two dollars and thirty-three cents, Saba! All for charity.’
The boys were unerring in their reading of the moral landscape: the label on the tin reads: HELP DISADVANTAGED CHILDREN.

The Last Refugee

Imagine this. A disaster at sea, a lifeboat adrift, full of survivors, now despairing, now in hope, as land takes form through the mists ahead. A form is seen in the water. The boat comes alongside, the form is human and alive. The human extends an arm in supplication. Weary survivors take the limb and heave. The lifeboat, already heavily laden, tilts, takes water. The heavers persist in their heaving and the boat takes more water. A murmur within the boat swells to a cry: “Let him go!”

But the human is already aboard. The boat rights itself, the shouting subsides to a murmuring. The boat drifts on.

Imagine this: a second story. Australia prospers, confidence surges and trust becomes the settled order of things. Somehow Australia’s peoples lose their fears of difference, neither Sharia nor Tjukurrpa nor Kosher is imposed by any person upon any other person, but all are respected and all thrive. The leaders of the government decide to lead opinion rather than to follow it. They declare, “We who have plenty can take in those who have nothing more their need and their stories. Let us welcome them, let them come in!”

And so it comes to pass. Australia booms, its empty lands are claimed, cultivated and nurtured under the guiding hand of the first inhabitants. Australia feeds its peoples, feeds Asia, and prospers greatly. The seekers for asylum fulfil the promise that every newcomer brings. Australia accepts scores of thousands, who succeed in the new land and become part of the community. The community now takes in hundreds of thousands as History smiles upon the land and even the climate shows clemency.

The seekers for refuge are numberless, the land is vast, its resources seem endless. Eventually the land is filled. The flow of seekers for refuge slows to a trickle. It stops. All now are saved, all are safe. But wait! A boat. Aboard the boat are two persons. They extend supplicating arms. The peoples of Australia, accustomed to rescue, habituated and drenched in its ethos, wish to help. But their land is full. There is no room for newcomers. Australians squeeze up together, they wish to rescue those people who extend those arms. They make room, a little room: just one, one alone can be squeezed in. But there are two humans in the boat.

Imagine this: a third story. A lifeboat full of survivors of shipwreck drifts in an uncertain sea. This boat is full. Its gunwhales barely clear the calm surface. Whenever the seas rise all bail mightily to save the boat that saves them, and the boat remains afloat. The boat drifts on.

A shape is seen ahead in the water. As the boat comes alongside, the shape moves, cries, flings human words of thanks, raises an arm in supplication. All aboard the craft can see, all understand: “This lifeboat is barely afloat. If we take in this human his weight will sink us; every one of us – every human person – is lost.”

So much for my little stories. Readers of this blog are well acquainted with my pain, my outrage, my shame. All that old stuff. My eruptions of moral rage have brought a brief pleasure, a relief not unlike the visceral satisfaction of purging. But these explosions achieve nothing, convince no-one who is not already convinced, influence no-one in government.

A couple of years ago I spoke at an awards ceremony for defenders of human rights. I told my lifeboat stories. I pointed out Australia’s lifeboat is not full. I was grand in my flight of brave words and noble ideals. I carried the audience, which, led by two Federal parliamentarians, rose as one to applaud. Afterwards each of the parliamentarians, one a frontbencher in the government, requested a copy of my speech which they’d put up on their websites. One confided: ”You have said what we would like to say but cannot.”

What to do? What more to do? What can we – we powerless people do – beyond voicing our outrage, our shame, our grief? Firstly, we must continue to raise that human voice, to give human words to the suffering of fellow humans. That voice, those words, these are the marks of our being human. These words, the irreducible minimum:

Written in Pencil in the Sealed Railway-Car

By: Dan Pagis

here in this carload
I am eve
with abel my son
if you see my other son
cain son of man
tell him I

But what more? As my little stories suggest, ultimately we persons of good will – and I mean that to refer to my fellow Australians at large – sooner or later must face a terrible choice. At the end of all our rescuing there will always be one more supplicant, one too many for our resources, for our lifeboat. We will face a choice. This is Sophie’s choice, whereby we will chose one to be saved and send another – a human other – to perdition.

But Australia’s lifeboat is not yet full. So, what more, what wiser, what more potent act can we non-governors do? The answer cannot be simple, but our powers of imagination, of thinking hard and speaking softly, have helped in the past. Thus Petro Georgiou of happier memory, with Jozef Szwarc, softened the adamantine policies of John Howard. The image of a dead child floating in the shallows of Lesvos softened the policies of Tony Abbott.

I know of one small group in a faith congregation that has approached leaders of other faiths in an attempt to think hard together and to speak softly together to those who govern. State governors have spoken for their people, saying, give us the children; let them not return to offshore detention. Dr David Isaacs blew a whistle on his return from offshore that mobilised doctors and nurses at Melbourne’s Royal Children’s Hospital and now at Lady Cilento in Brisbane. The RCH refuses to discharge child patients to places of detention. We must understand that for what it is: the RCH is not some Marxist commune, not a place of sedition. It is rather an emblem in the state of Victoria. It stands for the highest skill and care. When the RCH speaks it carries Victoria. None gainsays its voice or its acts.

So, what to do? Think hard, confer, suggest, bring ideas to government. One idea, hardly original, strikes me as promising: let Australia progressively divert funds, currently used for offshore detention, towards a respectable, respectful supra-national staging and assessment process in south Asia. There we would maintain accessible, supportive consular representation. No-one would need to board a leaky boat, no-one would need to jump a queue, no human person would come to Australia and be called by a SIEV number. Our brothers and sisters would arrive with their own names.

We might save money, we might not. Neither governments nor we the governed see these issues in money terms: governments never count the cost when augmenting our cruelties; and we bleeding hearts never count beans. No, these issues are strangely unmonetised. The people of Australia hanker quietly to regain some self-respect.

Respectful policies will save lives. We might save our souls.

Do you have a better idea? Work on it, tell your minister of religion, your minister of the crown, the playgroup mothers, the neighbours. Governments need to follow. It is up to us to lead. We won’t save everyone, but we can hardly do worse than we do at present.

How an intended genius became an accidental terrorist

I’ll tell you how I become a genius. I try to do it six days a week. (The seventh is the Sabbath, when I don’t have to try.) It’s not always easy, this genius business. And dangers lie in wait. Here are the steps that I follow.


Firstly, obtain ‘The Australian’ newspaper. Do not read it unless you want to cry. Turn to the last page of the first section*; here you’ll see the weather map for the entire continent. Below the weather you’ll find the puzzles. Avoid the Sudoku, dodge the cryptic crossword, take a quick peek at the day’s three obscure words (today’s** three are POIKILOTHERMIC, RIEM, KNARRED. I told you they were obscure. Pat yourself on the back if you know any of them. I scored one pat today. Better than average.)

Shun the Mensa puzzle. I hate people showing that they know they are smarter than I am.)

Pass now to the foot of the page. There you’ll see a wordwheel, with one letter in the centre and an additional eight or ten letters disposed in a circle at the perimeter. Our tasks are to find a single word that incorporates all the letters and none others, no repetitions etc etc; and to create as many words as possible of four letters or more.

Next to the wordwheel we find the rankings. Yesterday you’d have seen:

GOOD 23 words




I try to become a genius before bedtime. As a result some nights I need to go to bed very late.

Yesterday’s letters were INATTENTIVE. I got ‘inattentive’ like a shot. Practice makes that easy. But it was not until 22 hours had passed that I became a genius. (Incidentally, it is pretty clear the designer of the rankings is no genius: if one achieves EXCELLENT, that means she excels; none can excel her. But the genius does. What, I wonder, is the designation for one who finds fewer words than 23. “NOT GOOD”?)


So this is my method. I write down as many words as I can. ‘Attentive’ will be the first. Once I run out of words I start to speculate. Would ‘entant’ be a word? I know ‘extant’; perhaps ‘entant’ will be its antonym. I Google ‘entant’ and learn it’s a ridgy-didge word – in French. Spellcheck – or some other pretentious word authority lurking deep in my phone – now diverts me to ‘entertain’, ‘entente’ and other words of no relevance.


I juggle the letters and test other likely or less likely agglomerations for validity. And it is here that Google brings me to the attention of the AUSTRALIAN FEDERAL POLICE, ASIO, THE AUSTRALIAN BORDER FORCE and others. A red flag flies up on a screen in Langley. At Mi6 a man in an expensive grey suit flicks off a message through the dark net. Moments afterward a young woman snoozing before her screen in Canberra is aroused by a nasty chiming sound. Twenty minutes later large men in dark clothing emerge from a large vehicle. They wear bullet-proof vests and they carry semi-automatic weapons. Silently they surround my house. One carries a sledge hammer with which he knocks and they enter. There they find their enemy, an old wordnerd gazing at a screen, writing words on paper. The word he has written is ‘tannite’. ‘Aha!’ – they cry. ‘ Gotcha!’ 


* In the ‘Weekend Australian’ search the last page/s of Review.


** Today is the day of my writing, not of your reading. I write today, February 19, 2016.


Gap Years 

The friendly young man in the bookshop approves of my reading choice*: ‘Good book, I really enjoyed it. It was prescribed in my literature course last year.’He looks young, too young to be a uni graduate: ‘What was your course?’

‘School. I finished last year.’

‘What are you doing this year?’

‘Working here. Saving. I’m going to travel; I’m taking a gap year.’


Everyone takes a gap year nowadays. I never thought of it. No-one did back in 1963. I was keen to get on with becoming a doctor. I couldn’t see a gap and I would not have walked through it if I found one. Tempus was fugit, vita was brevis, gluteus was maximus, so I sat myself down and flogged my humanities brain over the sciences that were the stepping stones to doctoring. I never gave thought to my already clear history of stumbling through the sciences. I entered medical school, I studied the sciences and I stumbled on. If in later years I referred to my undistinguished undergraduate days, patients refused to believe it. They’d look at their trusted doctor and smile, knowing he must be joking; their peace of mind required he have no gaps.


I became a husband, I became a father, once, twice, thrice. I had four new people in my life to love, four more to work for. And I did work. A joyful and fulfilling part of my work was caring for women in pregnancy and childbirth. I became the intimate stranger, the guest at the birth of families. I’d be called to the hospital in the middle of the night, during dinner, at the kids’ bedtime, at quiet times alone with my wife. I’d leave home early in the mornings to visit the mother and her newborn in hospital. I’d leave before the children were awake. I left lacunae in our family, gaps where the dad was elsewhere when a daughter was sick, when our son had asthma, when our youngest cried at bedtime because a classmate at kinder teased her about the warts on her fingers. After twenty years I bade farewell, a long farewell to obstetrics, and hoped I’d mend the gaps.


The children grew, graduated, went to work, married, became parents. Became busy. Their time cramps them, crowds them in. The gaps that open in our children’s lives allow my wife and me in and enrich us.


The friendly young bookseller-bookreader will head off into his gap. He’ll travel towards his Ithaka and become rich with all he learns.


The truth is, life is full of gaps. As Leonard Cohen teaches us, that’s how the light gets in.





*Brenda Walker’s ‘Reading by Moonlight’. A gift for a friend with a couple of cancers.


The Tooth

In his last decade Dad and I drove every year to the Gippsland Lakes for a few days of sailing. Those lakes are plenished by rivers that flow down from the Great Dividing Range on their way to the sea. In the course of the drive of four hours we had time enough to evoke time remembered. Passing through the township of Trafalgar we’d sight the turnoff to Bruthen, a small town nestled high in those hills. Dad and I remembered Bruthen for our separate reasons, I for the Snowy River – mighty in verse, a miserable trickle in its reduced reality when I found it in 1968. Dad remembered Bruthen for the tooth.
‘I did a locum in Bruthen. It would have been 1935. I was a year or so out of medical school, wandering around the country, working in little towns – like you do, Howard.
I remember the drive up into the hills. I was driving a Sunderland. I remember that car for its unusual transmission: in those days manual transmission was all we had, but the Sunderland had something unique: you pre-selected a gear manually and it would change itself. Strange at first, unfamiliar, but just the thing as I wound up those hills and around those bends.’
Dad smiled as he remembered: ‘Bruthen was a one-doctor town. On my first day there a man came in with a toothache. His face was swollen and he pointed to his upper jaw on the right side. This was the 1930’s; we had no antibiotics the: the man needed a dentist. “Doc,” he said, “I’ve got a tooth for you to pull.”

(I pictured my Dad as I was at that stage – green, keen, torn between the need to be a proper locum tenens, literally, ‘holding the place’ of his absent Principal, while untrained for the task. Where I was timorous and trepid, Dad was fearless as an aspiring surgeon, aware of his solitary state – no colleague to consult, no training beyond seeking and accepting responsibility – and rising to the challenge. Dad would believe he could do the job and he must do so.)

Dad continued: ‘“I’m not a dentist. I can’t do that.”
“Why not, Doc? The regular doctor always pulls teeth.”
“I don’t have any instruments…”
“Yes you do, Doc. In the cupboard, up there.”

He pointed. Hoping he was incorrect I went to the cupboard. He was quite right. I found two pairs of steel dental forceps, half-familiar instruments, a bit sinister-looking.
“See, Doc? You use this pair for lower teeth, and this one for uppers. Mine’s an upper.”
The handles felt alright in my palm. Usable, not impossible…
“Doc, you know the trick to this tooth-pulling business? You have to push downwards to pull a lower tooth and you push upwards for an upper.”’
Dad said: ‘I didn’t know the trick.
The man pointed to the tooth. I applied the forceps, closed my palm, gripping the tooth hard, then I pushed up as the man advised. Nothing happened. I squeezed harder and pushed harder. A crunching sound then all resistance fell away. I looked down at the forceps: the tooth, a molar, sat beneath its roots, which were long and stout, like antlers on a stag.
“See, Doc? Nothing to it.”
The man fingered the cavity where his molar used to sit. He withdrew his finger, bloody and slippery with spit: “Wrong tooth, Doc. It’s this one.” He pointed again.
I said I was sorry: “You really need a dentist”, I said.
“No dentist in Bruthen, Doc. You do it.”
“Are you sure?”
“Yeah. You’re good at it. Go ahead.”
It was easier the second time. I looked down at the tooth feeling satisfied with myself.
“Good work, Doc!…but… it’s the wrong tooth.”
Feeling miserable I washed the forceps and placed them in the sterilizer.
The man said: ‘What are you doing, Doc? You haven’t finished.” He pointed to the next tooth along. 
“Are you sure this is the one?”
He was sure.
I removed that tooth like its predecessors. Like its predecessors it too was the “wrong one.”

‘We continued, tooth following tooth, until I had cleared all the upper teeth on the right side. Then we agreed to call a halt.’

The Clinician and Detention

Recently Dr David Isaacs, a courageous Australian paediatrician, returned from a working visit to one of Australia’s offshore immigration centres with distressing reports of the suffering and what he considered to be torture of the detained asylum seekers. He called publicly for doctors and nurses to question whether it is ethically permissible for them to accept employment in such settings. Since Dr Isaacs spoke out doctiors and nurses at Melbourne’s Royal Children’s Hospital have refused to discharge asylum seeker p[atients to island detention where they believe the children would be unsafe.
Dr Isaacs risked imprisonment for speaking out and he donated his earnings to asylum seeker relief. He then published an essay in The Journal of Medical Ethics, whose editor – an Australian medical graduate – asked me to respond. This is what I wrote. It is published here with the kind consent of the editor of the Journal of Medical Ethics, British Medical Journal.
ABSTRACT: An examination of ethical issues encountered in the author’s clinical work with detained patients. The author seeks to clarify in which ways, if any, the detained patient might differ from the generality of patients, and hence to identify any distinct ethical duty of the clinician. Also addressed is the broader question: how – if at all – do medical ethics vary from universal ethics? The author reflects on the distinctive duties of a free human towards a detained one. And finally addresses the topical suggestion that a doctor or a nurse should positively refuse to serve in an immigration detention facility on the grounds that to do so would be to condone or facilitate torture.


The author is a general practitioner of wide experience, having worked in Australian urban, suburban and country practices over greater than four decades; and having spent about eight weeks a year for the past twenty years working in remote clinics. These ‘outback’ postings have been predominantly in Aboriginal communities, while (in 2009) the writer worked for a time In Alice Springs Correctional Centre, and (in 2010) in an Australian Government Immigration Detention Centre offshore.
1. I worked in Alice Gaol for lower than average wages; I worked offshore for inflated wages; I banked all proceeds and I paid tax on them.
2. I tutored the editor of this journal in general practice. Our conversations ran particularly to ethics. I became your editor’s friend, his referee, his failed marathon running mentor.
3. As a result of the foregoing I must accept partial responsibility for any ethical errors in your editor’s writing and in his clinical work.
4. I have written and published elsewhere on these themes and continue to do so. They constitute a substantial element in my forthcoming book, ‘Burned Man’ (in press, Hybrid Publishers, for release in August 2016), to be marketed with mercenary intent (and with the opposite expectation).
5. I signed a confidentiality agreement with my employer prior to working in the island Detention Centre. 
6. I worked in Torres Strait (2008) on behalf of the Department of Customs, charged with medical assessment and initial treatment of illegal fisherman captured in Australian waters.
I read with interest and admiration ‘Are health professionals working in Australia’s immigration detention centres condoning torture?’ The paper addresses a number of important issues explicitly as well as raising equally significant questions implicitly. As I read that valuable paper I found myself wondering whether any distinction actually exists between medical ethics and human ethics generally. An alternative way of formulating my question runs something like this: Why, and in what ways, should a nurse or a doctor – or any clinician – be answerable differently from any other moral agent?
At first blush there would seem to be no difference: in the encounter between any two humans who find themselves respectively in need of help and in a position to help, their inequality mandates a response. That one is sick and the other is skilled in healing is an accident, a detail. This is the bedrock ethic of the Good Samaritan.
However, if among a number of willing passers-by there be one who is a nurse or a doctor, the twin facts of clinical training and of vocation, demand that person in particular step forward and help.
Similarly, the training of the Surf Life Saver selects her to rescue one washed out to sea; and the paramedic is the one who should commence CPR in case of roadside cardiac arrest; and the infectious diseases physician respond to the Ebola outbreak.
Common to all these is a degree of risk to the rescuer; the life saver risks drowning, the paramedic risks injury from passing vehicles or hostile lawyers, the physician risks contracting infection and the asylum-seeker’s clinician risks criminal penalties should she reveal official wrongdoing. Traditionally society expects its ‘rescuer class’ to accept those personal risks. In entering our professions we who are clinicians have implicitly accepted – indeed embraced – those risks. So much so that it was with shock that I first heard the suggestion – made in 1969 – that a doctor should not stop to help a road victim, lest the doctor be sued for an adverse outcome. (That advice was given to doctors in litigious America. The advice was ethically wrong, and in many jurisdictions laws have been passed that protect a clinician who responds ethically.)
My detained refuge-seeking patients resembled all patients in that they were variously unhappy and anxious; their understanding of their condition was inadequate; and they were sometimes unwell, although not in the way they understood themselves to be.
These were patients (although my employers insisted they were ‘clients’); their complaint, their pathos, was the detained condition, to which more familiar clinical entities were superadded.
To a man – and the great majority in my care happened to be adult and male – patients in immigration detention suffered from a spiritual malaise, an affliction I have not seen described and which I struggle to categorise. Its features include an inversion of belief such that the detained person replaced trust in fellow humans with mistrust, an expectation of mendacity and malignity of purpose. Thus the clinician, ostensibly present to help, was felt to be the adversary, present only to frustrate and harm the detained one. Our method of harm was supposed to destroy sanity, literally to drive mad the supplicant for our help. The two protagonists became respectively the anti-patient and the anti-doctor. The inversion of belief was pervasive. Hope, the constitutional belief in life and its goodness, were alien, felt to be elements of the fabulous, not congruent with life as it was now known. In a community of almost one thousand believers the mosque was largely unattended.
This inversion of the spiritual substrata of life reminded me of Primo Levi’s descriptions of that distinctive moral universe, the Nazi concentration camp, where the SS intentionally destroyed a world of hope, faith, kindness. I do not suspect any such intent on my island. But the outcomes here are as certain as they are unintended. 
An unanticipated hazard was experienced by carers, both among the guards and the clinicians. The hazard was moral in nature. Quickly many came to sense wrongness in the system. The wrongs included treating as criminals persons who had broken no law; imprisoning persons who had shown every desperation to be free; humiliating our patients with a dehumanizing system of identification by boat number rather than by name. All who worked in the Centre understood we were functioning parts of an unkind system: while we were to do no harm we were to delimit our own capacity to do good.
Evidence of the moral hazard, the sense of our violence against our own values, emerged in the behavior of the captors. Doctors drank every night, smoked heavily, suffered nightmares. More than one guard attempted suicide, one successfully.
In one more than one instance my medical superior refused my referrals for imaging, apparently on the unspoken grounds such would have to take place outside the Detention Centre. In one case, evidence of acute lumbar disc herniation indicated urgent CT scanning. This would require transfer to the mainland. My boss said: ’No. That can’t be done.’ Knowing that it could be done and it should be done, I asked, ‘Why can’t it be done?’
Displeased by my insubordination she stepped forward, stopped half a pace from me and shouted, ‘You can’t ask that question!’
For months following my return to the mainland, my reunion with friends and family, my resumption of normal medical work, I experienced nightmares. In those dreams I was a member of a tribunal, sitting in judgement on refugees’ pleas for asylum. In those dreams no voice was heard; supplicants argued mutely; mutely, we judges refused their pleas. The whole was an accusation against my implicated self, against my silent self.
The author of ‘Condoning Torture?’ refers to both criminal detention and immigration detention. I have worked in both categories as well as in compulsory detention for Customs. In all three cases detained persons are held inside locked areas behind high fencing in locations beyond view of the public. These arrangements serve to ensure ‘security’, an idea with more than one understanding: ‘security’ has evolved from the safety of the detained person and of the community to security of secrets. Briefly put, locked behind a series of heavy steel doors, detained persons remain invisible to outsiders and hence vulnerable to abuse. These are the settings which some refer to as Black Sites.
In the case of my island Detention Centre, the detained resided in their quarters, out of reach and sight of clinicians, who saw and treated them only when they were admitted to the Clinic located in a second secured area. The communicating door between the broader compound and the clinic was manned by the bulkiest of the male guards, charged with selecting and admitting our patients according to acuity of need. In practice these selections were opaque; we clinicians could never know who was excluded from our view and on what basis.
Offshore detainees manifest a critical and unique pattern of behaviour which distinguishes them from the great majority of patients of my clinical experience in other settings: they see it in their interest to achieve, demonstrate and maintain the worst health possible. The purpose – or the function – of this ‘poor health’ is to qualify for urgent transfer to ‘the mainland’, a location endowed with a mythic access to liberty in Australia proper. Thus the asylum seeker will exaggerate or fabulate to save himself. The clinician is mistrusted (like all in authority, for all have ‘lied’, and lied maliciously to drive the poor patient mad); in turn the clinician is unable to take symptoms at face value. Trust, the substrate of every decent clinical encounter, is shattered. For the clinician and the imprisoned person have opposite objectives.
Quite different are the assumptions in Alice Springs Correction Centre where eighty percent of prisoners are Aboriginal. Here transparency is a cardinal virtue. Prompted by blackfella outrage and whitefella shame, and by the political hazard of failing to care well for imprisoned indigenous people, authorities hasten to identify risk of harm to their charges and to act upon it. Often warders and clinicians over react, such are the anxiety and the dread of misreading need through the clinician’s cultural subliteracy.  
This question arises because of the apprehended possibility that a doctor will participate in or facilitate wrongdoing; and having witnessed harm to patients will be constrained from ‘whistleblowing’ against that wrong. The apprehended risks are real. Under new Australian legislation a clinician who speaks out is open to prosecution and if convicted, to imprisonment for up to two years, for revealing secret information. An additional constraint is the Confidentiality Agreement employees are required to sign as a condition of employment.
The author of “Condoning Torture” suggests Australia’s treatment offshore of detained refugees constitutes torture. The writer adduces evidence for that suggestion but stops short of declaring categorically that such treatment is torture. At the same time he acknowledges the clinical needs for care of the refugees. He writes: Australian health professional thus face a major ethical dilemmas. Individual health professionals need to decide whether or not to work in immigration centres. If they do so, they need to decide for how long and to what extent restrictive contracts and gagging laws will constrain them from advocating for closing detention centres.
I find the author’s formulation of those questions helpful in pointing a clear ethical path. He authorizes each individual to forge a personal response. This seems to recognize the moral autonomy of the individual practitioner, as well as the individual responsibility of the individual. As the Mishnaic sage Hillel taught: if not me, then who? If not now, then when?
The author breaks the decision into two or three parts:
1. Will I work there? (Do I have the right to do so? Do I have the right to decline?)
2. If I do accept that work, I must do so provisionally, ceasing when I form a judgement that to continue more offends ethically than to desist.
3. In answering the second question I must consider how much my gags prevent me from doing needed good?

The argument allows me to approach the questions as follows: Here, in the offshore ‘facility’ – a black site or a blackish site or at the very least a grey site – we have sick human beings. Our government, their custodians, seeks to employ doctors, nurses, psychologists, mental health nurses, to attend to clinical need. The employer presents the qualified clinical professional with a contract to perform professional duties and to treat the conditions of the workplace confidentially. The government does not stipulate, ‘You must agree to torture your patient’.
On the basis of my own experiences, where I was not required to do positive harm but I was constrained from doing some needed good, I could sign the contract and enter upon my employment in good faith and in the assumption of my employer’s good faith. After all, I was employed a medical professional. That profession implies first and foremost a refusal to do no harm. If and when I form the belief my employment required me to do harm, I must refuse and make clear my reasons for doing so, both to my superiors and to my peers. Where possible I must make this clear also to the detained person. Should my employer dismiss me I must make public my employer’s wrongful instruction and my actions and the circumstances of my dismissal. I run a risk in doing this, the risk of incarceration. That is my lifesaver, my paramedic, my infectious disease specialist moment, my moment of familiar medical hazard. A hazard, yes, but in our relatively non-totalitarian system, a hazard without risk of death. Safer far than the ebola risk. Safer than the choices of a psychiatrist in the Soviet Union, safer than those of doctors under the Third Reich. A hazard but not a mortal hazard. 
On the other hand if no objectionable command requires me to take a self-sacrificial stand I remain free to work, to watch, to listen and to consider. And upon making my judgement I should speak out. If all is kosher, if detained persons are treated with full human dignity and compassion, then I must cry it from the rooftops. And conversely, if I find my hypothetical centres to be objectionable I must call for their improvement or their closure.
Those are equally clear ethical imperatives – not matters of narrow medical judgement but the call of every citizen. In the end the doctor, the nurse, the guard, the journalist, the therapist, the pharmacist, the interpreter, the public servant all answer to an ethic which is universal. Medical ethics represents but one corner of that wide universe.