Advocacy and Education

Resources to guide your efforts to educate and influence your campus, community, and domestic and national policy.

How To Contribute To The Asylum Network

Creating an Asylum Clinic at Your School!

Physicians for Human Rights’ Asylum Network is a community of hundreds of health professionals who offer pro bono physical and psychological evaluations to document evidence of torture and persecution for men and women fleeing danger in their home countries. Survivors of human rights abuses are entitled to seek safe haven in the United States, but often find themselves immersed in lengthy and complex legal procedures that could ultimately result in deportation— resulting in further abuse, torture, and even death.

The Asylum Network at Physicians for Human Rights conducted 317 evaluations during academic year 2010-11. These evaluations aided survivors of female genital mutilation, LGBT persecution, gang violence, government sponsored torture, and a number of other forms of persecution. 10% of these evaluations were shadowed by medical students and residents through student run asylum clinics.

PHR has partnered with clinics at Mount Sinai, Cornell, UCSF, and University of Miami, and is now working with students to establish a new clinic at Tufts School of Medicine.  These clinics offer not only direct medical training for students and residents, but provide much-needed forensic evaluations to survivors of egregious human rights abuses. Medical affidavits provide clear evidence of persecution, helping to secure legal status for survivors who deserve the chance to start their lives anew in the US.

PHR forensic evaluations are conducted by licensed physicians and residents, psychologists, and clinical social workers.  However, medical students can play a very active role in conducting forensic evaluations. Asylum clinics run by students are a valuable resource, and PHR is always looking to expand to more medical schools.

Steps for medical students to establish an asylum clinic:

1. If your school has a free clinic, see if it can be reserved for a few hours a week [or month] for forensic evaluations.

2. Locate interested physicians who would be willing to conduct evaluations while teaching medical students. Professors, clinicians, mentors, and residents are all great resources for building a team for your clinic. Once identified, have the physicians join the PHR network [1] directly.

3. Identify a PHR-Student clinic point person. This student representative will be responsible for in-taking clients referred by PHR. When the clinic has openings for client evaluations, the point person will notify PHR, who will then send a list of pending clients.

Throughout the process, PHR will be available to answer any questions, provide training materials and example affidavits, and place you in touch with students and mentors from the already operating student clinics.  Please see the example of the clinic at the University of Miami here. [2]

Student clinics are a wonderful way to gain valuable medical training, while directly helping clients in critical need of medical evaluations.  Students who are involved in their asylum clinics can arrange training sessions for students and residents, host meetings to present their asylum work, and continue to get more students and licensed practitioners alike passionate and motivated about helping this vulnerable population.

If you are interested in establishing an asylum clinic at your school, please contact Kelly Holz, the Asylum Network Coordinator, at kholz@phrusa.org [3].  She will be available to answer any questions, and to provide all of the available resources.

The Asylum Network needs more forensic evaluators— and you can recruit them for us through establishing a student-run asylum clinic. Contact the Asylum Network today!

Creating an Asylum Clinic at Your School! Physicians for Human Rights’ Asylum Network is a community of hundreds of health professionals who offer pro bono physical and psychological evaluations to document evidence of torture and persecution for men and women … Continue reading

Education and Advocacy for Asylum and Detention

Host a discussion: Case studies of asylum seekers The Refugee Protection Act of 2010

The University of Miami Human Rights Clinic: A Model

In 2009, students, residents, and attendings at the University of Miami began working with PHR to plan a Human Rights Clinic.  The intention was to enable asylum-seeking persons/victims of torture and abuse to obtain medial affidavits that document potential physical/psychological human rights violations on a consistent basis. The team drew on an existing academic model in operation at the Mt. Sinai School of Medicine in New York.  The clinic provides a valuable service to the South Florida community while simultaneously providing education to medical students, residents, and fellows in this subject.

On Friday, October 29, 2010, the Human Rights Clinic of Miami [2] is officially opened its doors.  Natascha Chida [1], a PGY-2, said, “Clients will mainly be persons who experienced torture/persecution and are seeking asylum in the United States. We will perform a history and physical that will result in a medical affidavit that the client’s legal representatives can use when advocating for asylum status. Our community partners will refer clients to us; these include Physicians for Human Rights, Catholic Charities, FIAC, and other local organizations.   We will not be providing direct medical care, but clients may follow up at the San Juan Bosco Clinic for services.  At this time PHR students (as the clinic is a project of PHR at UMMSM) and J Weiss residents will be volunteering with our clinic faculty, but as we grow we hope offer the experience to other residents and students.”

Here is an example of UMHRC’S structure [3] (PDF).

Here is an example of UMHRC’S algorithm [4] (PDF).

Here is an example of UMHRC’S Intake Form [5] (PDF).

Here is an example of UMHRC’S Initial Proposal [6] (PDF).

In 2009, students, residents, and attendings at the University of Miami began working with PHR to plan a Human Rights Clinic.  The intention was to enable asylum-seeking persons/victims of torture and abuse to obtain medial affidavits that document potential physical/psychological … Continue reading

An Introduction To Asylum

What is asylum?

Asylum is the process by which a person fleeing persecution in his or her country of origin can seek protection in another country. Every year, thousands of individuals who have suffered violence, injustice, and torture, seek asylum in the United States. When granted, asylum within the US can eventually lead to permanent residency. This legal status also allows an asylee to work legally, to apply to bring family members into the country, and to enter and exit the country freely.

Who can apply for asylum?

Those who flee their country of origin and reach the United States can apply for protection in the form of asylum due to persecution based on race, religion, nationality, political opinion, or membership in a particular social group. The US also recognizes women who have undergone forced abortion, involuntary sterilization, and who have suffered persecution for resistance to a forced birth control program, as eligible for asylum.

For those whose experiences may not fit the stringent requirements for asylum, the following forms of relief from deportation are also available:

  • The Violence Against Women Act (VAWA): This 1994 US Federal Law can serve as a basis of protection for victims of domestic violence.
  • Withholding of Removal: Often applied for simultaneously with the asylum application, this process prevents deportation in the case that a person is “more likely than not” to face persecution if forced to return to his or her home country.
  • Convention Against Torture (CAT): Although more difficult to obtain than asylum, CAT status allows those who fear torture that is not necessarily based on race, religion, nationality, membership in a particular social group, or political opinion, to apply to remain in the US.
  • U-Visa: A U-Visa gives up to four years of legal status and work eligibility to victims of certain crimes who cooperate with law enforcement.
  • T-Visa: A T-Visa allows certain human trafficking victims to remain in the US if they agree to testify against perpetrators.

What happens when a person applies for asylum?

The process of seeking asylum is controlled by complex US immigration law. It has become increasingly difficult to gain asylum since the passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996. Among other things, this law established requirements for the expedited removal and detention of any asylum seeker who arrives in the US without valid permission to enter the country, and has led to the detention of many asylum seekers who have no criminal record.

The detention system is based on the punitive model of criminal incarceration, and many asylum seekers suffer poor living conditions, high psychological stress, and inadequate access to health services while in detention. The lack of appropriate mental health and other health services has led to an unacceptable number of avoidable deaths within the detention system. Being incarcerated makes it extremely difficult for individuals to seek evidence, correspond with attorneys, and otherwise prepare successful asylum applications.  Additional barriers to successful asylum petitions include language differences between asylum seekers and immigration officials, the lack of social and financial resources, and a general lack of understanding of how to seek asylum.

To evaluate an affirmative asylum case, an asylum officer will conduct a detailed interview in which the asylum seeker must demonstrate that he or she cannot return to his or her country of origin due to past persecution or a reasonable fear of future persecution. If an asylum seeker already has an order to appear before an immigration judge, they must prepare a defensive asylum application, which means a judge will hear the case in an adversarial setting.  The interview and court proceedings are often extremely difficult and traumatizing for the asylum seeker, as they are forced to recount the details of experiences which may include torture and other severe forms of persecution.

The medical documentation of an asylee’s suffering is hugely influential; in some cases medical professionals who have conducted forensic evaluations may be brought in to testify on the asylum seeker’s behalf so that their findings can have maximum impact on decision-makers. Although 90% of asylum cases with a medical evaluation are approved, the lack of qualified volunteer physicians means that the majority of asylum seekers do not receive this important, potentially life-saving, assistance.

Eventually, the asylum seeker will receive a decision on his or her case, and depending on the circumstances, might have a few legal options left, or may be immediately ordered back to his or her country of origin. Those who receive asylum can immediately begin work and petition to bring their family members into the country.

How long does it take to be granted asylum?

With few exceptions, the 1996 Law requires that applications for asylum be filed within one year of arrival within the United States. However, detained asylum seekers can remain in detention anywhere from months to years while they await decisions on their cases.

What is asylum? Asylum is the process by which a person fleeing persecution in his or her country of origin can seek protection in another country. Every year, thousands of individuals who have suffered violence, injustice, and torture, seek asylum … Continue reading

Creating the University of Miami Human Rights Clinic

An interview with Natasha Chida.

What inspired the asylum clinic?

A combination of things led us to create our human rights clinic in Miami. I had worked with the Asylum Network on a few projects while serving on the PHR Student Advisory Board during medical school and had been speaking with Jenni Balde (the then Asylum Network Director) about doing a training in Miami in 2009.  We then heard about Albert Einstein´s Human Rights Clinic and thought that a similar project may be needed in Miami (in addition to a one-time training). Miami has a large asylum-seeking population but at that time did not have a group of professionals who were consistently documenting, so the need was great.

At the same time that these things were occurring, Dr. Stephen Symes (program director of Jackson Memorial Hospital´s Internal Medicine Residency and also the director of the J Weiss Residency in Social Medicine and Global Health Equity) had been asked by local legal professionals in Miami to evaluate several immigrants who had been detained and were in need of medical care.  Evaluations were thus being done prior to the creation of the HRC.

At this time (fall of 2009) we began speaking with PHR at the University of Miami Miller School of Medicine about starting a clinic; we essentially formed a coalition of students, residents, and faculty to work on the project.  We then contacted the associated program directors of Albert Einstein’s program and they were kind enough to provide us with information about how the clinic is set up and run, etc.  We then began contacting people in Miami who we thought would like to be involved.

What resources did you need to have?

Support from a key faculty member who was willing to serve as medical director (Dr. Symes), support from key medical school faculty, partnerships with local community organizations who deal with these issues, and a group of faculty, residents, and students who were willing to interview and document.  We also made use of PHR´s sample affidavits and the training packet we received during the Miami Asylum Network Training. Lastly, we contacted other similar clinics in the country and obtained information from them. Dr. Ramin Asgary of the Mt. Sinai School of Medicine was particularly helpful.  Based on all of this information we created the structure [1] (PDF). and algorithm [2] (PDF). of our clinic.

What is the first thing you should do when creating a system to provide evaluations for asylum seekers?

Always research what resources are already available to asylum seekers in your community.  It is always a good idea to keep from replicating activities that already exist. In addition, it is preferable to partner with organizations who are already involved in the work you want to do.  Have a good sense of what your community needs before starting a project (essentially, perform a needs assessment).

How much time did it take to start the clinic?  What is the time commitment now?

In the beginning it probably took about 5 hours per week for a few months.  This mainly involved contacting people, communicating (conference calls), meeting with people, creating documents for the clinic, etc.  Now it really depends on how many evaluations we have.  If there are none, then less than an hour a week on average.  If there are, it is a bit different. Each eval takes at least 8 hours in total (including the interview, examination, and then writing the affidavit later) so the time commitment is variable. This is divided amongst members, however, so it isn´t too bad.

How do asylum seekers find your clinic?

Dr. Symes had already formed good relationships with local community organizations such as the Florida Immigrant Advocacy Coalition and Catholic Charities prior to the creation of the HRC.  Both of these organizations have legal wings that serve asylum seeking clients. These organizations contact Dr. Symes directly to ask for evaluations. In addition, we also had pre-existing connections with PHR, through which we are also referred clients. Lastly, we did some research (via the internet and phone calls) on organizations in the state of Florida who serve asylum seekers; we have contacted them and they will also send us clients in the future.

How do you cover your costs?

At this time we do not have costs, but in the future we may apply for grant funding if necessary.

How do you recruit new MDs and med students?  What skills do they need to have?

The student Chapter of PHR officially runs the clinic. We recruited residents through the J Weiss Residency. Once we have more clients we may open it up to other residents, but for now we are focusing on the Social Medicine Residents. In terms of attendings, we have a group of core faculty. We essentially knew people who would be interested and contacted them personally. UM as a human rights community is pretty close-knit so we already had relationships with people who we knew would be interested.

When we need more attendings in the future we´ll send out emails to other people who we know are interested in these issues but also ask our existing members to contact people directly.  In terms of skills, students and residents need commitment and an interest in this type of work. Attendings need to be able to perform a thorough history and physical/psychological exam.  It isn’t absolutely necessary for students/residents/attendings to have attended a PHR Asylum Network Training, but it is very helpful. Everyone should at least read PHR’s handbook on documenting for asylum seekers.  People really become experts at doing the evaluations with practice.

It was a bit easier for us to find faculty to be involved because we already knew several people who would be interested because we’ve been involved with Miami’s human rights community for some time. If students who are new to a med school are seeking faculty, the best thing to do is always meet with a few key players on campus and get names of people who have an interest in human rights.  Once you have the names you can directly contact them.

An interview with Natasha Chida. What inspired the asylum clinic? A combination of things led us to create our human rights clinic in Miami. I had worked with the Asylum Network on a few projects while serving on the PHR … Continue reading

An Introduction To Immigration Detention

US Immigration Detention and Alternatives: An Overview

Why are Noncitizens in Immigration Detention?

Those without US citizenship, even green card holders, may be deported from the US under certain circumstances.  In most cases, deportation requires a judge’s order.  Deportation hearings take place in immigration courts, where immigrants do not have the same protections afforded to criminal defendants. A lawyer is not provided by the government, even if a person is unable to understand or participate in legal proceedings, and impartial determinations of mental capacity are unavailable.

Immigration detention was formerly used only for those with the most serious criminal convictions or those who posed national security concerns. However, strict immigration laws passed in 1996 drastically expanded the list of crimes that warrant detention, and also implemented mandatory detention for most people caught arriving in the US without valid permission to enter. Any noncitizen accused of being deportable or under a deportation order may be held in a prison, jail, or jail-like detention center until the case is decided.

As a result, immigration detainees are today the fastest growing segment of the incarcerated population in the US.

Detention of Asylum Seekers in the US

Asylum seekers very often flee their homes in acute danger and try to avoid official detection until they reach a country where they hope to find refuge. Because many asylum seekers escape from their countries hastily, many arrive in the US with without adequate identification and are therefore particularly likely to find themselves subject to mandatory immigration detention while awaiting resolution of their cases.

Detention is severely damaging to the health and well-being of Asylum Seekers

United Nations treaties and international laws strongly advise against detaining asylum seekers because detention damages the physical and mental well being of asylees who may have experienced severe persecution or torture. The US government’s plan for health care of detainees has historically focused on “mak[ing] sure [detainees] are medically able to travel and medically able to return to their country,”[1] [1] as opposed to maintaining or improving health.

In a landmark 2003 survey by PHR and the Bellevue/NYU Program for Survivors of Torture, many respondents reported that they had significant difficulty in accessing care while in detention, and nearly half reported that their physical health had declined while in detention. The survey also found that 90% percent of asylum seekers in detention suffered one or more of the conditions of anxiety, depression, and PTSD, and more than 90% of these individuals reported that detention had substantially contributed to worsening their mental health. There is significant variation between different detention facilities, and a lack of comprehensive oversight. Although conditions in some detention facilities have improved since 2003, poor conditions and human rights violations continue in many others due to the lack of standardization and oversight of detention facilities. Between October 2003 and January 2010, a shocking 107 detainees died in immigration detention, many due to documented substandard care or severe neglect of their medical conditions.

Alternatives to Detention

Programs that offer alternatives to detention have proven successful both in ensuring that asylum seekers appear for immigration hearings, and in avoiding incarceration of innocent individuals. In the late 1990’s the Vera Institute of Justice created a pilot program called the Appearance Assistance Program (AAP). Immigrants selected by the government were diverted from detention, received help with establishing community ties and finding “sponsors,” and were required to meet regularly with program staff about their rights and duties in the legal process.  Ninety three percent of formerly detained asylum seekers in AAP appeared for all of their hearings, compared to 78% of a control group who received no special services. Detention is justified only when an individual is determined through individualized review to pose a danger to the community.  Otherwise, asylum seekers should be released into effective alternative community supervision plans.


[1] [2] Caitlin Weber, “ICE Officials’ Testimony on Detainee Medical Care Called into Question,” [3]CQ Politics [4], June 16, 2008,  (accessed February 25, 2009).

US Immigration Detention and Alternatives: An Overview Why are Noncitizens in Immigration Detention? Those without US citizenship, even green card holders, may be deported from the US under certain circumstances.  In most cases, deportation requires a judge’s order.  Deportation hearings … Continue reading

Background

How asylum and detention affect health and human rights.

How asylum and detention affect health and human rights. An Introduction To Asylum An Introduction To Immigration Detention Dual Loyalty: Should Physicians Always Prioritize The Patient? Conditions Of Detention: The Use Of Isolation And Segregation Respect Medical Neutrality

Using Your Medical Expertise For Human Rights

How To Contribute To The Asylum Network The University of Miami Human Rights Clinic: A Model

Planning and Leading an Event

A successful event takes planning, organization, timing, and follow-up. Use this guide for tips on how to produce an effective event.

Brainstorm

Events are most effective when they advance your chapter’s overall strategy; they provide great opportunities to recruit members, raise awareness, educate, promote advocacy, and raise funds or materials for the specific issues your chapter has chosen as a focus. Events can also be effective ways of attracting media attention, influencing policymakers, and promoting dialogue on your issue. Agree on your objectives before planning an event.

  • After agreeing on your objectives, establish SMART goals.  The outcome of your event should be:

Specific
Measurable
Achievable/Ambitious
Relevant
Time-bound (fit to deadlines)

  • Events can lead to direct action aimed at a social or policy change. If you intend to incorporate an action component, establish specific success objectives.

Examples of Success Objectives:

  • Written letter from each chapter member
  • Published letter to the Editor, Op-Ed (or other publicity)
  • Action by Member of Congress (or other elected official)
  • Formation of a coalition

Letters to the Editor

Writing a letter to the editor is a simple but effective way to make your voice heard in the public dialogue about current events and to influence public opinion. Beyond this, policy makers and legislators review their local papers’ letters to the editor to gauge their constituents’ priorities. Letters to the editor should be concise and well-written; state your main assertion in the first few lines of the letter, and be sure to proofread your letter. The letter is more likely to be published if it is written in response to a recent news item, which you should refer to in your letter.  Submission guidelines differ, so be sure to follow the guidelines set by the specific publication you wish to publish your letter. To find out how to submit a LTE for your local paper visit their website. The excitement of seeing your name in print and the ability to influence decision makers’ opinions make writing a letter to the editor well worth your while.

Successful events require resources.

What resources may be in reach? Here are a few possibilities (see Develop Resources [3] for more information):

Within your PHR chapter In your community From PHR
  • Computer, writing, or art skills
  • Media contacts
  • Connections with businesses
  • Commitment to the issue
  • Personal knowledge and/or experiences with the issue
  • Local relevant institutions
  • Local businesses
  • Supportive faculty
  • Nearby NGOs and other organizations
  • PHR Toolkit
  • PHR videos & reports
  • PHR staff
  • Nearby PHR chapters

Build Coalitions/Work With Others

Build power in numbers. Other groups may be happy to work with your chapter on an event and just require a specific ask about how they can help.

  • Coalition partners can help with planning, publicity, and participation.  Be clear on what type of assistance you need.
  • Consider partnering with groups such as: the student council, academic departments, faculty associations, other student organizations from your campus or other schools, community groups and NGO’s.

Assign Tasks

  • Create a timeline with a breakdown of tasks (recruitment, materials, publicity, media, general, etc). Work backwards from the due date of each task to ensure all the components come together in timely fashion.
  • Plan out your volunteer needs.  You will need people to cover the program, recruitment, registration, set-up, folder-stuffing, copying, greeting media, audio-visual set-up, photographer, etc.
  • Delegate responsibilities clearly.  If you have enough volunteers, set up work teams. Make event planning fun and express the importance of each person’s contribution.
  • Check in regularly with your event team to provide support and ensure they meet their goals and timelines.

Build an Audience & Publicize Your Event

  • Set a target number of people you hope will attend the event. Make it an ambitious but reachable goal. Consider whether you are looking for sheer numbers and/or certain people, e.g., health professional students, policymakers, the general public.
  • The law of halves: Consider that you will reach about half of the people you call or email. Of the people you talk to or reach by email, about half of those will express interest, and about half of those people will actually come. This means that if you want 100 people, 200 have to say yes. For 200 to have said yes, you must have reached 400 people, and sent out emails or tried calling about 800.

Consider the Four C’s when recruiting prospective attendees: Connect with people in a friendly way; provide the Context of the event and importance of issue; ask for a Commitment; and Common ground (relate the issue or event to the invitee.)

  • Start wholesale (group emails/mailings), and end up retail (individual emails, calls, and meetings). Nothing beats individual contact!
  • Recruit others to recruit for you. Utilize links from other websites and include event notices in others’ newsletters and emails.
  • Publicize your event widely!

Consider: fliers, listservs, tabling, announcements in class, Facebook & Myspace, banners in public spaces, letters to the editor of school paper, announcements in publications, Evite.com, presentations at club meetings, advertising on T-shirts, public service announcements on your local radio station, and asking faculty to announce your event during class.

Media/Publicity

  • Prepare a news advisory to be released ahead of the event and a news release for the day of event (see media training for how to write and distribute these and then do follow up pitch calls).
  • Utilizing strong visuals will increase chances of getting media coverage and will provide a visual record of your event.
  • Consider preparing and distributing a press kit (see PHR online advocacy toolkit).
  • Contact PHR [2] if you need help getting media attention, and send PHR any media coverage you receive.
  • See the guides on Publicizing your Event [1] and Working with the Media to Raise Awareness [4] for more information.

Reserving Sites and Preparing Materials

  • Reserve a venue well in advance; try to find a good fit for your event (parking and/or public transportation, price, size, neighborhood, convenience).
  • Ask everyone presenting at the event what they need ahead of time (slide or LCD projector, etc).
  • Be sure the message and appearance of any materials reflect your objectives and are appropriate for your audience. (Very important: contact PHR [5] regarding guidelines for using the PHR logo before producing materials!) Give yourself enough time for design, printing, distribution, and transporting materials to the venue prior to the event. Do a separate plan/timeline just for materials.
  • Have a sign-in sheet [7] (pdf) to collect names and contacts of the attendees. Send a copy to PHR [6].

Evaluate & Celebrate

  • In a following meeting, have an open Q & A to evaluate the event [What went well?  What would you change for the next event?]
  • Update contact information.
  • Have a post-event celebration with the event team and volunteers.
  • Send thank-you cards to all people involved in the event.
  • Report your event to PHR [8]. Send pictures and summary paragraph for possible use on the PHR student website.

A successful event takes planning, organization, timing, and follow-up. Use this guide for tips on how to produce an effective event. Brainstorm Events are most effective when they advance your chapter’s overall strategy; they provide great opportunities to recruit members, raise … Continue reading

Dual Loyalty: Should Physicians Always Prioritize The Patient?

The health of my patient shall be my first consideration

— World Medical Association (WMA) Declaration of Geneva

A physician shall owe his patients complete loyalty and all the resources of his science.

— WMA International Code of Medical Ethics

Although these principles are grounded unmistakably in both ancient and modern texts across the globe, there is growing recognition that doctors are too often placed in situations where it is difficult for them to fulfill loyalty obligations to their patients.  Opposing and competing obligations to third parties, such as employers, governments, and insurers, often test the devotion that health professionals are required to give to their patients.  Such conflicts are generally identified as “dual loyalty” issues because the health professional is torn between two different players which often have different or competing aims and objectives.  In many cases, health professionals who succumb to the pressure to fulfill third party needs at the expense of their patients needs end up violating the human rights of the very person who is entitled to the health professional’s strongest loyalty.

An army doctor is charged with managing the care and well-being of a unit under enemy attack. Although all doctors, including military doctors, are required to treat the health of their patients as their primary concern, the battlefield commander places immense pressure on the doctor to return men to combat before they are mentally and/or physically fit. The doctor recognizes that many of the men are still suffering from painful and debilitating wounds as well as PTSD, but he fears that keeping them from battle could jeopardize the safety and survival of the entire unit because the enemy is numerous. The doctor is unsure of whether to abide by his loyalty obligation to provide the best possible care to his patient or to obey the orders of his military commander, who represents both his employer and the government.

Closed environments, such as prisons, jails, detention centers, mental health facilities, and the military, are the most susceptible to breeding dual loyalty conflicts because security concerns tend to run high while transparency and monitoring mechanisms are generally lacking or altogether absent. Additionally, there is often ambiguity, sometime deliberately, about the health professional’s role in closed institutions. Health professionals working in these environments often find it difficult to provide the best possible care for their patients because they feel pressure to participate in institutional security, cost cutting, and helping to meet other institutional objectives.

The loyalty conflicts resulting from third party pressure may be express (e.g. the military commander orders the doctor to clear patients for battle) or implied (the commander frequently reminds the doctors that the enemy outnumbers them), and they may be real (the commander is indeed putting pressure on the doctor), or perceived (the doctor feels it is his responsibility to get the soldiers back on the battleground, even though the commander has not communicated with him at all).  However, regardless of the form the pressure takes, and even if it is only perceived to be real by the doctor, it still has the potential to distract him from providing the best possible care to his patients.  Situations like the one described above frequently draw health professionals into a moral and ethical maelstrom, where they end up second-guessing what they know to be their first and primary duty: giving patients the best possible care.

The health of my patient shall be my first consideration — World Medical Association (WMA) Declaration of Geneva A physician shall owe his patients complete loyalty and all the resources of his science. — WMA International Code of Medical Ethics … Continue reading