Adolescent decision making in the harsh world of offshore detention

Fiona Owens1, Dr Janine Winters1

1Otago University, Dunedin, New Zealand

Australia’s offshore processing of people seeking asylum has been in the world spotlight for a number of years.  The UN recently visited Nauru and condemned the treatment of people held on the island, especially children.  A clinical case extrapolated from media reports will be used to explore both the unique challenges of consent and decision-making in unusual circumstances and the perennial issues of adolescent’s developing capacity and autonomy. The case presents a 14-year-old adolescent in off-shore detention who sewed her lips shut as part of a hunger strike protest and refused to consent to medical reversal.  Her parents did not agree with each other and mediation was unsuccessful, so the medical team became the final arbiter.

The case sets up exploration of evaluating the adolescent’s capacity and her ability to provide informed consent in a context of probable social coercion. The influence of detention on mental health, autonomy and decisional capacity of both the child and her parents is also discussed. The challenges to the medical team in these types of circumstances is examined as the team members needed to consider cultural differences, potential for causing significant harms, parental capacity, beneficence, and their own professional roles and duties.

The UN described the mental health on the island as ‘shocking’ and is now urging the Australian government to rethink its policy on offshore detention.  If time allows, our discussion can grapple with the complexities of health professionals working in hostile environments, including this setting of current human rights abuses that is on our own doorstep.


Fiona Owens is an experienced social worker who over the past 25 years has worked in a variety of unusual positions including in offshore detention.

Dr Winters is a senior Lecturer at University of Otago Bioethics Department.  Dr Winters is a Medical Doctor. Specialist in palliative medicine, paediatric palliative care, and family medicine.

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