The Impossible Position: The medical profession’s struggle of power and politics in Australia’s immigration detention system

The medical profession engaging with Australia’s immigration detention system experience what is known in bioethics as a dual loyalty. The government-constructed system of immigration detention is proven to cause harm to the people it incarcerates, and the profession are under pressure to conform to the ideology of that system. At the same time, the profession must uphold their legal and ethical duties to their incarcerated patients. Existing scholarship on the profession’s experience in this context focuses on conflicts within the clinical relationship. However, the struggles faced by the profession are manifold and extend past the clinical setting. This thesis seeks to broaden understandings of the position of the medical profession involved with the detention system by going beyond discussions focused on the clinical setting. It performs an interdisciplinary, theoretical and empirical analysis of publicly available statements made by medical professionals and organisations in relation to the detention system between 2012 and 2017. By interrogating the systemic and contextual aspects of the profession’s struggles, which are fuelled through the politics and power dynamics that shape the detention system, this research becomes a deeper inquiry into the complex relationship between the medical profession and the Australian Government. This scholarship develops a new theoretical framework labelled the impossible position which exposes and explains the role that politics and power play within dual loyalty situations. Medical professionals engaging with the detention system find it impossible to perform their professional role because of ideological and power struggles, which are generated at the systemic level through politics and power. The framework exposes practical recommendations for the profession in navigating this struggle. As the causes of the conflicts are systemic, they are impossible for an individual professional to resolve, which necessitates and justifies action from the wider medical profession. To navigate the impossible position, the profession must act collectively to engage in the ideological and power struggle, by implementing systemic mechanisms aimed to preserve professional ideology and maximise the profession’s access to technologies of power.