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.

中文翻译：

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道德准则和立场声明是否有助于指导澳大利亚移民拘留中心的道德决策？

澳大利亚移民拘留被称为国家批准的虐待行为和反人类罪。澳大利亚医疗保健界一直密切参与这些政策，呼吁进行改革并在拘留中心内开展工作以提供医疗保健。移民拘留不仅对健康造成破坏性影响，还改变了医疗保健的范围和性质，其交付被描述为一项西西弗斯任务。在本文中，我将探讨在拘留中心工作的临床医生可以使用的指南，并认为守则、指南和立场声明对道德决策几乎没有帮助。首先，我将概述道德准则和立场声明中的指导，重点关注特别相关的原则，例如倡导、临床独立性以及临床医生与人权的关系。然后，我将利用以前在这些环境中工作的临床医生的证词，强调本指南与拘留期间提供医疗保健之间的差异。虽然这种差异应该引起警惕，并至少引起人们对代码和立场声明的使用方式（如果有的话）的质疑，但还有更根本的原因导致代码和立场声明未能在这些情况下提供指导。我将概述对道德准则的更普遍的批评，并以此提出前进的方向，包括超越准则和立场声明来指导澳大利亚移民拘留中的行动。