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APHA Scientific Session and Event Listing

Recorded presentation

Leslie London, Professor, Health and Human Rights Programme, School of Public Health and Family Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town, 7925, South Africa, Laurel Baldwin-Ragaven, Trinity College, Henry R. Luce Professor of Health and Human Rights, 300 Summit St., Hartford, CT 06106, 27-21-406-6524, laurel.baldwinragaven@trincoll.edu, and Leonard Rubenstein, JD, Physicians for Human Rights, 1156 15th St NW, Suite 1001, Washington, DC 20005.

Background. Underlying many ethical dilemmas in the assessment and care of refugees is the problem of Dual Loyalty where health professionals may have simultaneous obligations, explicit or implicit, to a third party, typically the state, who may be resistant to according foreign refugees any legal status. Methods. A literature review was undertaken of case studies of dual loyalty conflicts relating to refugees, international human rights and ethical codes and strategies for managing dual loyalties, complemented by iterative discussions in an international working group. Results. Violations of refugees' human rights may arise in the course of care or assessment because of (1) Incompatibility of simultaneous obligations; (2) Pressure on the professional from the third party; and (3) Separation of the health professional's clinical role from that of a social agent. The practitioner's contractual relationship with the third party is often the underlying problem, and may encourage a social identification at the expense of a practitioner's professional identity. The particular vulnerability of refugees exacerbates power imbalances between practitioner and patient. Conclusions. Because existing ethical guidelines lack specificity on managing Dual Loyalty in such circumstances, guidelines that draw on human rights standards have been developed by the working group. These guidelines, which propose standards for individual professional conduct and complementary institutional mechanisms to address the problem will be explored for their applicability to the refugee context.

Learning Objectives:

• To understand the concept of dual loyalty facing health professionals
• To identify the potential violations of human rights that can occur in situations of dual loyalty dealing with refugees seeking care or asylum
• To explore the applicability of guidelines and institutional mechanisms to address the problem of Dual Loyalty facing health professionals working with refugees

Keywords: Human Rights, Refugees

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation