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Essex R. The psychometric properties of the strengths and difficulties questionnaire for children from refugee backgrounds in Australia. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Essex R, Isaacs D. Responding to mandatory immigration detention: lessons for the health care community. Med J Aust 2019; 211:390-391.e1. [PMID: 31606901 DOI: 10.5694/mja2.50366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Essex R, Ocloo J, Rao M. The need to establish sustainable public and patient involvement in research in low and middle income countries. J R Soc Med 2019; 112:456-458. [PMID: 31347947 DOI: 10.1177/0141076819865867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Essex R. Do codes of ethics and position statements help guide ethical decision making in Australian immigration detention centres? BMC Med Ethics 2019; 20:52. [PMID: 31337376 PMCID: PMC6652001 DOI: 10.1186/s12910-019-0392-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/12/2019] [Indexed: 11/30/2022] Open
Abstract
Australian immigration detention has been called state sanctioned abuse and a crime against humanity. The Australian healthcare community has been closely involved with these policies, calling for their reform and working within detention centres to provide healthcare. As well as having a devastating impact on health, immigration detention changes the scope and nature of healthcare, with its delivery described as a Sisyphean task. In this article I will explore the guidance that is available to clinicians who work within detention centres and argue that codes, guidelines and positions statements provide little help in relation to ethical decision making. First I will outline guidance that can be found in codes of ethics and position statements, focusing on particularly relevant principles, such as advocacy, clinical independence and the clinicians' relationship to human rights. I will then highlight the disparity between this guidance and the delivery of healthcare within detention by drawing on the testimony of clinicians who formerly worked in these environments. While this disparity should be cause for alarm and at a minimum call into question how codes and positions statements are being used (if at all), there are more fundamental reasons why codes and position statements fail to provide guidance in these circumstances. I will outline a more general criticism of codes of ethics and use this to suggest a way forward, including looking beyond codes and position statements to guide action within Australian immigration detention.
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Essex R. How should the health-care community respond to human rights violations? Lancet 2019; 394:26. [PMID: 31282358 DOI: 10.1016/s0140-6736(19)30495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/26/2019] [Indexed: 11/26/2022]
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Essex R. Should clinicians boycott Australian immigration detention? JOURNAL OF MEDICAL ETHICS 2019; 45:79-83. [PMID: 30463934 DOI: 10.1136/medethics-2018-105153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/01/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
Australian immigration detention has been called state sanctioned abuse, cruel and degrading and likened to torture. Clinicians have long worked both within the system providing healthcare and outside of it advocating for broader social and political change. It has now been over 25 years and little, if anything, has changed. The government has continued to consolidate power to enforce these policies and has continued to attempt to silence dissent. It was in this context that a boycott was raised as a possible course of action. Despite discussions among the healthcare community about the merits of such action, a number of questions have been overlooked. In this article, I will examine whether a boycott is both ethical and feasible. Taking into account the costs and benefits of current engagement and the potential impact of a boycott, more specifically the potential it has to further harm those detained, I conclude that under current circumstance a boycott cannot be justified. This however does not mean that a boycott should be dismissed completely or that the status quo should be accepted. I discuss potential ways forward for those seeking change.
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Essex R, Isaacs D. The Ethics of Discharging Asylum Seekers to Harm: A Case From Australia. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:39-44. [PMID: 29368170 DOI: 10.1007/s11673-017-9833-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 08/31/2017] [Indexed: 06/07/2023]
Abstract
In February 2016 a twelve-month-old asylum seeker, who came to be know as Baby Asha, was transferred from Nauru and hospitalized in Brisbane. This case came to public attention after Doctors refused to discharge Asha as she would have been returned to detention on Nauru. What in other circumstances would have been considered routine clinical care, quickly turned into an act of civil disobedience. This paper will discuss the ethical aspects of this case, along with its implications for clinicians and the broader healthcare community.
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Daien V, Nguyen V, Essex RW, Morlet N, Barthelmes D, Gillies MC, Gillies M, Hunt A, Essex R, Dayajeewa C, Hunyor A, Fraser-Bell S, Younan C, Fung A, Guymer R, Louis D, Arnold J, Chan D, Cass H, Harper A, O’Day J, Daniell M, Field A, Chow L, Barthelmes D, Cohn A, Young S, Lal S, Ferrier R, Barnes R, Thompson A, Vincent A, Manning L, Lake S, Phillips R, Perks M, Chen J, Landers J, Niladri, Banerjee G, Swamy B, Windle P, Dunlop A, Tang K, McLean I, Amini A, Hunt A, Clark G, McAllister I, Chen F, Squirrell D, Ng C, Hinchcliffe P, Barry R, Ah-Chan J, Steiner H, Morgan M, Thompson C, Game J, Murray N. Incidence and Outcomes of Infectious and Noninfectious Endophthalmitis after Intravitreal Injections for Age-Related Macular Degeneration. Ophthalmology 2018; 125:66-74. [DOI: 10.1016/j.ophtha.2017.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/19/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
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Essex R, Govintharajah P. Mental health of children and adolescents in Australian alternate places of immigration detention. J Paediatr Child Health 2017; 53:525-528. [PMID: 28485531 DOI: 10.1111/jpc.13538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/26/2016] [Accepted: 01/09/2017] [Indexed: 11/29/2022]
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Abstract
Australian immigration detention has received persistent criticism since its introduction almost 25 years ago. With the recent introduction of offshore processing, these criticisms have intensified. Riots, violence, self-harm, abuse and devastating mental health outcomes are all now well documented, along with a number of deaths. Clinicians have played a central role working in these environments, faced with the overarching issue of delivering healthcare while facilitating an abusive and harmful system. Since the re-introduction of offshore processing a number of authors have begun to discuss the possibility of a boycott. While taking such action may lead to change, further discussion is needed, not only in relation to the impact of a boycott, but whether it is possible for clinicians to engage with this system in more productive, ethical ways. This article utilises a framework proposed by Lepora and Goodin (On complicity and compromise, Oxford University Press, Oxford, 2013) that provides a structured approach to examine complicity and seeks to explore how clinicians have engaged with Australian immigration detention and ultimately whether they should continue to do so.
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Jerome SM, Carney K, Essex R, Fassbender ME, Goldberg S, Kinlaw M, LaMont SP, Mackney D, Morrison JJ, Nortier FM. Reference materials for neptunium determination. Appl Radiat Isot 2017; 126:44-48. [PMID: 28089269 DOI: 10.1016/j.apradiso.2016.12.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/05/2016] [Accepted: 12/24/2016] [Indexed: 11/17/2022]
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Essex R. Torture, healthcare and Australian immigration detention. JOURNAL OF MEDICAL ETHICS 2016; 42:418-419. [PMID: 26902475 DOI: 10.1136/medethics-2016-103387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/26/2016] [Indexed: 06/05/2023]
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Essex R. Children in Australia's immigration centres. Lancet 2016; 387:1903. [PMID: 27203645 DOI: 10.1016/s0140-6736(16)30412-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Essex R. Ethics, Foreseeability, and Tragedy in Australian Immigration Detention. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:537-539. [PMID: 26626066 DOI: 10.1007/s11673-015-9676-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 11/01/2015] [Indexed: 06/05/2023]
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Arnold JJ, Campain A, Barthelmes D, Simpson JM, Guymer RH, Hunyor AP, McAllister IL, Essex RW, Morlet N, Gillies MC, Gillies M, Hunt A, Hunyor A, Arnold J, Young S, Clark G, Banerjee G, Phillips R, Perks M, Essex R, McAllister I, Constable I, Guymer R, Guymer R, Lim L, Harper A, Chow L, Wickremansinghe S, Wickremasinghe S, Wickremasinghe S. Two-year outcomes of "treat and extend" intravitreal therapy for neovascular age-related macular degeneration. Ophthalmology 2015; 122:1212-9. [PMID: 25846847 DOI: 10.1016/j.ophtha.2015.02.009] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report 24-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) using a treat and extend treatment regimen in routine clinical practice. DESIGN Database observational study. PARTICIPANTS We included treatment-naïve eyes receiving predominantly ranibizumab for nAMD in routine clinical practice treated using a treat and extend regimen that were tracked in the Fight Retinal Blindness observational registry. METHODS A cohort of eyes treated by practitioners using exclusively a treat and extend regimen was extracted from the Fight Retinal Blindness observational registry. MAIN OUTCOME MEASURES Change in visual acuity (VA) over 2 years and number of injections and visits. RESULTS Data from 1198 eyes from 1011 patients receiving anti-VEGF therapy using a treat and extend regimen for treatment-naïve nAMD between January 2007 and December 2012 and with 24-month follow-up were included in the analysis. Mean VA increased by +5.3 logarithm of the minimum angle of resolution letters from 56.5 letters (20/80+1) at initial visit to 61.8 (20/60+2) letters at 24 months. Mean VA gains improved and number of injections increased with successive years from +2.7 letters for eyes commencing in 2007 after a mean of 9.7 injections in 2 years, to +7.8 letters for eyes commencing in 2012 after a mean of 14.2 injections over 2 years. The proportion of eyes with VA >20/40 increased from 27% when starting treatment to 45% after 24 months; the proportion with vision of <20/200 remained unchanged (13% initial, 11% at 24 months). Of the included eyes, 90.5% avoided a vision loss of ≥15 letters. There was an overall mean of 13.0 injections over the 24 months, 7.5 injections in the first year and 5.5 in the second year, with a mean of 14.8 clinic visits. CONCLUSIONS These data indicate that eyes managed in routine clinical practice with a treat and extend regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.
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Essex R. Human rights, dual loyalties, and clinical independence : challenges facing mental health professionals working in Australia's immigration detention network. JOURNAL OF BIOETHICAL INQUIRY 2014; 11:75-83. [PMID: 24363197 DOI: 10.1007/s11673-013-9493-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/25/2013] [Indexed: 06/03/2023]
Abstract
Although Australia has comparatively few individuals seeking asylum, it has had a mandatory detention policy in place since 1992. This policy has been maintained by successive governments despite the overwhelmingly negative impact mandatory detention has on mental health. For mental health professionals working in this environment, a number of moral, ethical, and human rights issues are raised. These issues are discussed here, with a focus on dual loyalty conflicts and drawing on personal experience, the bioethics and human rights literature, and recent parliamentary inquiries. For those who continue to work in this environment, future directions are also discussed.
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Meyer K, Kaplan JT, Essex R, Damasio H, Damasio A. Seeing touch is correlated with content-specific activity in primary somatosensory cortex. ACTA ACUST UNITED AC 2011; 21:2113-21. [PMID: 21330469 DOI: 10.1093/cercor/bhq289] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is increasing evidence to suggest that primary sensory cortices can become active in the absence of external stimulation in their respective modalities. This occurs, for example, when stimuli processed via one sensory modality imply features characteristic of a different modality; for instance, visual stimuli that imply touch have been observed to activate the primary somatosensory cortex (SI). In the present study, we addressed the question of whether such cross-modal activations are content specific. To this end, we investigated neural activity in the primary somatosensory cortex of subjects who observed human hands engaged in the haptic exploration of different everyday objects. Using multivariate pattern analysis of functional magnetic resonance imaging data, we were able to predict, based exclusively on the activity pattern in SI, which of several objects a subject saw being explored. Along with previous studies that found similar evidence for other modalities, our results suggest that primary sensory cortices represent information relevant for their modality even when this information enters the brain via a different sensory system.
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Leggitt J, Inn K, Goldberg S, Essex R, LaMont S, Chase S. Nuclear forensics—metrological basis for legal defensibility. J Radioanal Nucl Chem 2009. [DOI: 10.1007/s10967-009-0293-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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