The current Council for Medical Ethics endeavours to ensure proper health care for migrants who are not legally resident in the country, including in connection with forced returns. However, major challenges arise when doctors provide health services to migrants who are in police custody and are to be forcibly returned. Real independence between the doctor and the police is crucial to maintaining trust in the doctor's role. Professional ethics guidelines provide important guidance for doctors in this role.
Our code of ethics states that the doctor's task is to protect human health, and that the doctor's deeds shall reflect basic human rights (Chapter I, Section 1) (16). The doctor must protect the individual patient's interests and integrity. The patient must be treated with care and respect, and the treatment must, where possible, be based on informed consent (Chapter I, Section 2). Doctors should not assist the police in administering drugs to calm migrants down against their will during deportation. The doctor's task is not to protect the interests of the police. It is particularly problematic if the doctor assists the police in implementing restrictive measures that could be construed as punitive.
Migrants who need medical care have the right to information about their state of health and treatment, in the same way as other patients (Chapter 1, Section 3). A well-functioning, independent interpreting service is a prerequisite for good medical care for migrants. The detention centre's employees should not be used as interpreters at medical consultations.
The doctor must comply with the duty of confidentiality, and information must only be disclosed with the patient's consent or under a legal provision (Chapter I, Section 4). Consequently, doctors should not disclose confidential information to the police or to healthcare personnel employed in the NPIS. Furthermore, medicines for migrants should be distributed by healthcare personnel who have no affiliation with the police.
According to the 2007 recommendation, doctors can assist with 'fit to fly' assessments for migrants who are to be deported. Where possible, the migrant's informed consent should be obtained for conducting such assessments. If the migrant does not give consent, the doctor's assessment should, in principle, be conducted under a legal provision. Like the Parliamentary Ombudsman, the Council finds it concerning that the attending doctor performs the assessment at the request of the police, cf. the Code of Ethics for Doctors, Chapter I Sections 2 and 4. In line with the definition by the International Organization for Migration, the assessment should also take account of information on the access to health services in the destination country.
The Council for Medical Ethics supports the Parliamentary Ombudsman's recommendation for the health service linked to the NPIDC and the processing centre to be organised according to the 'import model'. This will reinforce the independence of the health service from the police. If necessary, legislative changes should be made.
The Council for Medical Ethics questions whether doctors should accompany migrants during forced deportation unless the migrant has requested a doctor to be there. Such a request should have a specific health-related basis. If the migrant has not given consent and forced deportation cannot be carried out in a proper manner without a doctor, it is an indication that deportation is not justifiable.