Regular Features / Uncategorized Sandpit December 10, 2018 John Quiggin71 Comments A new sandpit for long side discussions, conspiracy theories, idees fixes and so on. Share this:TwitterFacebookLike this:Like Loading... Related
71 thoughts on “Sandpit”
Harry: “whether or not doctors would abuse this”
By using the word “abuse”, you are accusing doctors of lying. Hugo’s comment – that it is allegedly easy for doctors to lie without consequence – is also very much accusing doctors of lying.
You even went so far in your first post as to claim a panel of eminent doctors will lie about the condition of *all* asylum seekers, in order to bring them *all* to Australia. Do you realise how paranoid and delusional that sounds?
@nick. Every single statement (except for the last) you make is false. The last statement draws on a series of falsehoods to draw a wrong conclusion. But. apart from that, thanks for your thoughtful remarks.
“By using the word “abuse”, you are accusing doctors of lying.”
Explain why this is a false statement.
“Hugo’s comment – that it is allegedly easy for doctors to lie without consequence – is also very much accusing doctors of lying.”
I never said doctors are lying. I said:
I also pointed out that unless a good reason exists for not doing so, doctors generally accept patients faithfully report symptoms. For instance, if you go to a doctor for a medical certificate for a day off work because you claim to have severe diarrhoea, a doctor is unlikely to ask you to drop your pants and shine a torch up your ass. Instead, he or she will take your word for it.
Since you lack elementary comprehension skills and/or intellectual honesty, I’m not sure I will bother with you in future.
“unless a good reason exists for not doing so”
You mean like suspecting an asylum seeker might be inventing their distress in order to gain access to the mainland?
Doctors weren’t born yesterday, Hugo. It’s a bit different to trying to get a signature for a day off work. People who have died in detention centres had obvious medical conditions – severe infections etc – that Peter Dutton and his department chose to ignore or dismiss.
For the life of me, I can’t understand why you would trust his honesty over that of an expert panel of doctors.
@Nick: “You mean like suspecting an asylum seeker might be inventing their distress in order to gain access to the mainland?”
Nauru wouldn’t work as a deterrent if it wasn’t objectively miserable and distressing. I don’t see why you think a doctor would need much convincing that an apparent manifestation of distress was genuine. Get a grip.
And will undoubtedly do so whenever he feels like it.
There’s plenty of evidence that harsh policies don’t deter boat arrivals.
“June 1989 – Prime Minister Hawke introduced changes that included mandatory deportation, and allowed for the recovery of funds from asylum seekers to pay for the costs of their detention and deportation. The number of boat people continued to increase after these changes were introduced.
December 1992 – Prime Minister Keating introduced limited mandatory detention. The number of boat people remained unchanged afterwards.
April 1994 – Keating expanded mandatory detention. The number of boat people increased afterwards.
October 1999 – Prime Minister Howard introduced temporary visas (TPVs). Instead of getting a permanent protection visa, refugees were instead given only temporary protection (a 3 year protection visa). After that, their case would be reviewed. Also, their protection could be revoked if they left Australia during the 3 years, and it didn’t allow their families to settle in Australia. The number of boat people continued to increase afterwards.
September 2001 – Howard introduced the ‘Pacific Solution’. This involved offshore processing and detention, and turning back of boats. Again, some people claim this policy slowed the arrival of boats, but the data show the numbers were already dropping by the time he introduced the Pacific Solution. Plus, the introduction of the Pacific Solution (Sept 2001) coincided with the removal of the Taliban from power in Afghanistan (Oct 2001). Leading up to this point, Afghanistan had been one of our major sources of asylum seekers (17% in 2001-01). Also, from 2001 to 2002 there was a 45% drop in refugee numbers worldwide.
August 2012 – Prime Minister Gillard reintroduces the Pacific Solution. It didn’t slow the boats. In fact, the number of boat more than doubled.” – The AIM Network.
“Nauru wouldn’t work as a deterrent if it wasn’t objectively miserable and distressing.”
Clearly and openly, you advocate the placing of men, women and children in concentration camps. I really don’t need to say any more.
Doctors diagnose medical conditions on the basis of signs and symptoms. Sometimes the single word ‘symptoms’ is used to cover both categories, but there is a significant distinction. Signs can be observed by people other than the patient; symptoms can’t. A rapid pulse is a sign: people other than the patient can measure it. Discolouration of the skin is a sign: people other than the patient can see it. On the other hand, pain, dizziness, and fatigue are symptoms: the only way doctors know whether a patient is feeling any of these things is by the patient’s report. (There are visual aids sometimes shown to patients as a way of getting them to rate their pain on a scale: the reason this is done is because pain isn’t something measurable by people other than the patient.) Spots in front of the eyes are a symptom (unlike spots on the skin, which are a sign), and hearing voices is a symptom. Feeling sick, in the sense of nauseated, is a symptom; being sick, in the sense of vomiting, is a sign.
In general, doctors accept what patients report about their symptoms (as opposed to signs), and rightly so. People do have symptoms–if a patient reported never feeling pain, that would also be a symptom, indicating a rare and dangerous medical condition–and they are of enormous value to doctors in diagnosing the conditions which cause them. The capacity to practise medicine would be crippled if doctors disregarded patients’ reports of their symptoms.
Obviously malingering does happen, and doctors will sometimes suspect it, and sometimes rightly so. But it is ridiculous, and also vicious, to expect doctors to practise medicine in a way which involves starting every case by investigating the possibility of malingering and not considering other treatment until the possibility of malingering has been excluded.
Sometimes doctors diagnose medical conditions so serious that they can only be effectively treated in a particularly advanced medical facility, and the reason this happens is because there really are medical conditions so serious that they can only be effectively treated in a particularly advanced facility. I don’t believe, however, that there is any one (reported) symptom (or, for that matter, any one observed sign) which by itself would result in a diagnosis like that. A doctor in a remote location in Australia is not, for example, going to respond to a patient’s report of severe pain by saying ‘Your condition can only be treated in the most specialised facility in the country’; nor would that happen if a patient reported grievous emotional distress, or any other single symptom a patient is likely to report. Severe pain and grievous emotional distress are both real symptoms associated with real medical conditions, but mostly those conditions do not require the most highly specialised forms of treatment, because mostly medical conditions in general do not require the most highly specialised forms of treatment–obviously, by definition.
If a doctor says, ‘This is not something I can treat here, you need to be transferred to a specialist facility’, it’s going to be on the basis of a combination of signs and/or symptoms of the kind which I do not believe is readily faked. If you want me to believe that there are things you could say to a doctor which would let you fake your way into referral to a specialist facility of the kind that’s only found in a few locations, you are going to have to tell me just what it is you would say. If you think something like, for example, ‘I’m feeling suicidal’ would do the trick, you’re mistaken. Suicidal ideation, as it’s referred to clinically, is another example of a real symptom associated with real medical conditions, at least some of them (unsurprisingly) dangerous, and yet people are regularly diagnosed with these and treated for them without even necessarily being hospitalised.
harryclarke and hugo visit the doctor, in some pain. He tells them they have an illness and yes, it is easily curable but first refers them to an economist. The economist determines, after careful consideration of all the implications, that it would reduce overall suffering if harry and hugo are not treated but instead paraded about the city with placards around their necks. The deterrence effect will, he assures them, lead to much less pain than any medical treatment…..
That’s kinda funny. Thanks Peter 🙂
Hugo said “In regards to asylum seekers we are in broad agreement; a strong deterrent condemns a few to misery but saves the lives of many and is thus more compassionate.”
We need to reread “condemns a few to misery but saves the lives of many and is thus more compassionate.”. Is it in law, Constitution, torts? Or is this a bit like a ‘belief’.
Would you say this if it was your child was condemned to misery?
Just a simple decision to heal a person must come with the requisite misery? Or is it just those fleeing? Or just the ones you fear. My barrister has acted for both sides. Compassion weeping out at the bar one day, and then zero compassion in pleadings. Such a career must surely dint compassion.
My fear factor of these persons;
“Under the ASIO Act, security means protection from
politically motivated violence,
promotion of communal violence,
attacks on Australia’s defence system or,
acts of foreign interference.”…
… is seriously aroused even though the people we will be ACTUALLY talking about (not the whole set, just a vanishly small subset) will be so compromised at the point of removal (read Healthcare ) that if we can’t manage them we should just admit we are incapable.
A blind spot? “Tran said he paid the smugglers about $50,000 and said others paid similar amounts.”… “The ABF would not provide a historical breakdown of figures, but it is believed the number of Malaysian unlawful non-citizens has almost doubled since 2015. The ABF said the total number of overstayers has remained “relatively static” at about 63,000.”… yet we worry about the people in detention and doctors doing their job. Not a real figure yet if those 63,000 did pay 50k each we’d have let a $3.1Billion smuggling business thrive. Which pales to insignificance ABOUT 1-2,000 we are currently worried about.
Hundreds of thousands drowned. Mobilise a peacetime effort… send a few more boats to pick them up – we have the tech – neatly bundled into a tender awarded by Peter Dutton. Just before he becomes a director of serco?
Time to read “Snow Crash” again.
“Hiro heads north to where the Raft, a huge collection of boats containing Eurasian refugees, is approaching the American coast.”
So as I mentioned before, if we don’t do it differently misery and costs will surely increase.
I really believe we are able to prevent now, misery. Certainly for the subset and certainly for the PEOPLE on the boats.
Thanks to all commenters. Particularly to jq for allowing this thread. Revealing.
Harryclarke endorses Hugo, who says that doctors believe what patients tell them. And harryclarke says that doctors will ‘gradually identify medical problems in all asylum seekers that justify the entry of all’.
Under the measures passed in the Senate, doctors have to do a clinical assessment finding that people need medical action that isn’t provided where they are held. The reference panel is of the chief medical officer of Home Affairs, the surgeon-general of Border Force, the Commonwealth chief medical officer, and nominees of the major medical specialist colleges.
For many clinical situations, symptoms will be observable. They won’t be a matter of untestable self reporting.
Whether they are or not, the clinical assessment is of a need for medical action that isn’t available where people are held. Nothing stops the Minister ensuring that medical action is available. And successive Ministers have asserted, falsely, that medical action was available which, in fact, they have never ensured or have intervened to withdraw.
To ‘identify medical problems in all asylum seekers that justify the entry of all’, the reference panel has to confirm not only the medical action needed but that it is not being provided where people are held. No-one gets the required clinical assessment without that.
Is it only the needed medical action that Hugo says the reference panel will abuse? Or is it the provision of that action where people are held?
Harryclarke and Hugo say their positions don’t assert the reference panel will lie. Saying medical action is needed when it isn’t, or that medical action is unavailable where it is, seem to me hard to distinguish from lying. Believing what people tell you is, obviously, ordinarily incapable of getting to both elements of the required clinical assessment. If lying is not the word for what will get there for everyone held offshore, do let other commenters know what is the right word.
@chrisod: “Harryclarke endorses Hugo, who says that doctors believe what patients tell them.”
Get off your high horse, peaches. I never said anything so lacking in nuance as that and I don’t think Harry did either. Since the first thing you say is false I didn’t bother reading the rest of your thingie.
How about some Puddles Pity Party? That guy always makes me think of Nauru:
“a strong deterrent condemns a few to misery but saves the lives of many and is thus more compassionate.”
That’s just so silly, it only takes a few of those people with nothing to lose to demonstrate the failure of the deterrent.
Hugo said ‘I wouldn’t give doctors responsibility for transfers off Nauru as a “medical reason” will undoubtedly be found in almost every case and the deterrent will be lost.’ Hugo said ‘A doctor doesn’t need to lie; all they need do is accept that a patient is faithfully reporting their symptoms.’
Then he said that he never said anything so lacking in nuance as that doctors believe what patients tell them. And so he didn’t bother reading anything else.
Nuance: ‘a medical reason will undoubtedly be found in almost every case’.
But the reference panel will have to find that there’s particular medical action needed that isn’t provided where people are held. That’s the point Hugo didn’t bother reading; or understanding; or responding to.
‘Get off your high horse, peaches.’ As Hugo said.
@chrishod: “But the reference panel will have to find that there’s particular medical action needed that isn’t provided where people are held. That’s the point Hugo didn’t bother reading; or understanding; or responding to.”
That’s because it is silly. Nauru has the population of a small country town and as such very little “medical action” of a complex nature can be done with its meager medical infrastructure.
Moreover, if X claims s/he is depressed and anxious due to being on Nauru and s/he appears to meet the criteria and reports s/he is not responding to medication it is, I believe, unlikely doctors would not want to have X transferred off Nauru. With conditions such as depression, doctors are largely constrained by the symptoms patients report. Moreover, most doctors feel ethically obliged *not* to act as modern-day Witch Finder Generals who view patients with suspicion and distrust.
There is no equivalent of an “objective test”, such as a blood test re diabetes, for anxiety and depression. Having “major depression with generalised anxiety disorder” myself, that is my experience. It is also what I picked in 20 years of medico-legal work in which I must have spent 10,000 plus hours dealing with medical practitioners, reading their reports and witnessing them in cross-examination.
As I see it, the asylum seeker issue a “wicked problem”. There is no solution that doesn’t involve considerable suffering. More specifically, (a) if you try to “fix” the countries that people flee from you risk unattended consequences such as protracted warfare (b) if you open your borders people will die trying to reach those borders and the political centre of gravity in the host country will move to the reactionary right and (c) if you deter asylum seekers some will suffer as a consequence of the deterrent measures.
Having said all that, if someone has a practical and workable plan that means (b) would involve less suffering than (c) I’ll change my opinion in a heartbeat.
This is correct; most doctors do feel such an ethical obligation. So they should. This situation is not a problem, and therefore does not need a solution. In particular, it does not require authorising a minister to act as a modern-day Witchfinder-General who views patients with suspicion and distrust and can, on that basis, override the medical judgement of doctors. I am sure there are many politicians who are not merely prepared to act as Witchfinders-General, but keen to do so; that actually is a problem, and encouraging those politicians is an exacerbation of the problem, not a solution to it.
The biggest driver of refugee crises is wars. The West (and Russia) should stop inflicting wars on under-developed countries. The other problem is the arms trade which sends floods of weapons into many under-developed countries. If people want to stem the refugee crises, policies in favor of wars and the weapons trade need to be curtailed.
Most Western and Russian intervention in conflict zones is counter productive. It widens wars, drags them out and leads to a great many more casualties and refugees in the long run. The best course of action is non-involvement, particularly in the express form of sending no troops, no weapons and no war aid. The upside of this course of action would be the large budgetary savings which would easily pay for refugee assistance to the then reduced refugee problem.
We can note that the most successful modern economy, in terms of growing rapidly from a low base, is that of China. China does not fight foreign wars. It does not waste its people and production (blood and treasure) on foreign interventionism and expeditionary war.
The West could improve its economies greatly by shifting effort from defense (really offense) budgets and weapons production into the renewable energy transition which is the major challenge of our time.
Why is Hugo even bothering with this thread: “There is no solution that doesn’t involve considerable suffering.” … and then says “Having said all that, if someone has a practical and workable plan that means (b) would involve less suffering than (c) I’ll change my opinion in a heartbeat.”
Hugo, you know there are solutions, it is just that your mind can’t get past this: compassion / misery.
I bothered to read your posts, I contained my response and deleted before posting my word for “peaches”.
Don’t bother me please Hugo with such trolling.. “I didn’t bother reading the rest of your thingie.”
And then a video clip. Your trolling. Please stop.