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I have worked in Australian urban, suburban and country general practices for more than four decades, and spent about 8 weeks a year for the past 20 years working in remote clinics. These ‘outback’ postings have been predominantly in Aboriginal communities, while in 2008 I worked in Torres Strait on behalf of the Department of Customs, charged with medical assessment and initial treatment of illegal fisherman captured in Australian waters. In 2009, I worked for a time in Alice Springs Correctional Centre, and in 2010 in an Australian Government Immigration Detention Centre offshore.

I therefore read with interest (and admiration) the paper titled ‘Are health professionals working in Australia's immigration detention centres condoning torture?’ in this issue. The paper addresses a number of important issues and questions. In this short commentary I will draw on my personal experience 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 towards them. I outline my personal response to the 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.

Are detained patients different from other patients?

Perhaps the essential difference of an involuntarily detained patient from other patients is in relation to their clinical attendants: their would-be helpers are, inescapably, also their captors.

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’); however, their complaint, their pathos, was the detained condition, to which more familiar clinical entities were superadded.

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