Dual loyalty, medical ethics and healthcare in offshore asylum seeker detention

A/Prof. Deborah Zion1

1Victoria University, Footscray, Australia

Environments devoid of human rights, such as asylum seeker detention, bring with them serious ethical issues when it comes to delivering care. These conflicts that ensue are referred to as “dual loyalty” conflicts. They are defined as situations where physicians and other healthcare providers are required to subordinate the interests of patient to those of the employer or the state. In the context of asylum seeker detention, in itself injurious to both physical and mental health, it might be argued that such conflicts are unavoidable.

In this presentation I will examine healthcare providers try and reconcile such ethical conflicts, drawing on a model developed with Linda Briskman. I will examine four responses to dual loyalty conflict; namely, complicity, subversion, retreat, or advocacy. To do so I will draw on published accounts and interviews with healthcare providers who have worked on Manus Island, Nauru and Christmas Island.


Deborah Zion has taught ethics in medicine and in public health for more than twenty years in Australia, Malaysia and Vietnam. She currently teaches research ethics at Victoria University where she also chairs the HREC. She has written extensively about human rights and bioethical issues concerning vulnerable populations, including persons with HIV/AIDS, refugees and those seeking asylum. She has been interviewing health care providers who have worked in asylum seeker detention since 2005.