Ethical and professional considerations providing medical evaluation and care to refugee asylum seekers/torture survivors

Significant number of asylum seekers live in the US but there are only a few programs that provide them with medical evaluation during asylum process. Additionally, only limited training is available for practitioners who evaluate asylees. Asylees have complex social and medical problems with significant access to healthcare issues. When evaluating and providing care for survivors, both medical providers and their respective institutions face important challenges in regard to medical ethics and professional codes that should not be overlooked. We explore these potential concerns in different categories: accountability toward patient versus clients, competing professional responsibility toward society and judiciary system, inconsistency in survivors claims and risk of fabrication, and ethical concerns in involving trainees in caring for and researching this vulnerable populations. We briefly discuss risk factors including inadequate and insufficient provider training and preparation, varying and often inadequate institutional commitment, asylees significant pre-existing medical and social problems and lack of information, and the broader health and social system issues. We review existing resources to address these concerns and offer suggestions.