Issue 37 / 6 October 2014

BARRY Haase, the newly appointed administrator of Christmas Island, made his opinion clear last week about who was to blame for the plight of more than 600 people currently held in the island’s immigration detention centre.

Haase told a group of enthralled reporters that the asylum seekers themselves were at fault “for getting on a leaky boat”, neatly encompassing his view that it was a straightforward matter of a poor choice leading to a poor outcome.
    
In medicine we hear a lot about choices: healthy choices, evidence-based choices, shared choices, therapeutic choices, and moral and ethical choices. Making the wrong choices can have disastrous consequences but, as we explore in this week’s MJA InSight, making the right ones is often not straightforward.

Contraception is a case in point. While experts have argued for years that women should be encouraged and enabled to use highly effective long-acting reversible contraception (LARC) such as injectable or implantable progestogens and intrauterine contraceptive methods, uptake in Australia has been disappointing.

Women who have just undergone pregnancy termination should be motivated to choose a reliable contraceptive method. However, an MJA study has found that only one in five women who had an abortion at a Marie Stopes International clinic in 2012 left with a LARC in place, and not many more intended to access a LARC in the near future.

One of our news stories this week looks at the drivers for these choices, including cost, lack of knowledge, barriers to access and unfounded fears.

When buying medication over-the-counter many people rely on labeling to provide them with adequate information to make a good choice. Academic pharmacist Ronald Batagol has argued in a letter to the MJA, rather than just those administered to children, should carry a warning on the label about their potential to worsen renal impairment in susceptible people.

Another of our news stories examines the changes to the labeling so far and the need to extend them so that people can make informed choices.

While it might seem like doctors make the choices about patient care in hospitals a comment this week, from two health services researchers, reminds us that this is never done in isolation. Realising and embracing this reality, they say, is both liberating and invigorating.

In his rationalisation of the poor choices of “people who get on leaky boats”, it would be interesting to ask Barry Haase where the hundreds of children in Australian-run immigration detention centres fit in. In a survey of Australian paediatricians published in the MJA, more than 80% of respondents agreed with a view put forward by the AMA — that detention of asylum seeker children is a form of child abuse.

The survey also found that many paediatricians were unclear about the legalities and practicalities of health and health care for child asylum seekers. The experts contacted for our lead news story said the confusion did not stop here.

The federal government’s recent announcement that children aged under 10 years and their families who arrived before 19 July 2013 will be released into the community on bridging visas has led many to believe that child detention is coming to an end, whereas the new policy only applies to a minority of those currently detained.

The depressing truth behind the smoke and mirrors of government announcements and pronouncements about the numbers of children detained is that up to 1000 child asylum seekers will remain in detention under the new policy.

Who is at fault for the abusive situation in which child asylum seekers find themselves?

The concept of responsibility for one’s own choices is difficult to apply to children, but releasing them into better situations is a straightforward choice that only the Australian Government can make.

 

Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight

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