After finishing our Brain and Behavior course, my second-year class launched into our third InFocus week— a time to come together as a class to reflect on an aspect of medicine outside the realm of typical medical education.
InFocus 3 is all about human rights: from understanding the legal and ethical framework of human rights, to the physician’s role in maintaining human rights, to how to conduct a medical evaluation for asylum. Led by Dr. Holly Atkinson, a physician leader in human rights and former president of Physicians for Human Rights, the week was interspersed with talks from renowned leaders in human rights, including Ken Roth, the executive director of Human Rights Watch.
Dr. Ross MacDonald, from the Division of Correctional Health Services of NYC Health and Hospitals, spoke about the issue of dual loyalty, particularly in the context of providing health care in prisons. Dual loyalty refers to the conflict that can exist between the ethical obligation of a physician to their patient and their obligation to another party, such as the state, an employer, or an insurer. In the context of jail, Dr. MacDonald pointed to the many and often non-overlapping interests of physicians, patients, jail security, executives, and others.
For mental health providers in jails and prisons, solitary confinement is a key issue of dual loyalty. Physicians are often placed as gatekeepers of who is fit to withstand such an environment, despite the knowledge of the ill effects solitary confinement can have on mental health. In this conversation, two important aims of advocacy arose:
- Improve the day-to-day lives of current inmates.
- Dismantle the system of mass incarceration.
Next, we broke into small groups to discuss specific issues of physician dual loyalty. My group, led by Dr. Schuyler Henderson, Assistant Professor of Child and Adolescent Psychiatry at NYU Langone, discussed physician participation of force feeding hunger strikers in prison.
Many questions arose in the context of this discussion:
- What role do hunger strikes have for prisoners in asking for their own human rights?
- What does it mean for a prisoner to die on the watch of the state?
- Is it ever acceptable for physicians to participate in torture, even if this form of torture would keep someone alive?
We discussed the conflict of loyalties doctors in Israel are currently experiencing: while the State of Israel has legalized force-feeding Palestinian hunger strikers, Israeli doctors have refused to follow through with such measures.
The second segment of InFocus 3 focused on how to conduct various medical examinations for asylum seekers: the physical exam, the gynecologic exam, and the psychiatric exam, with special sessions on considerations for LGBT asylum seekers and on the spectrum of violence perpetrated against women, including female genital mutilation (FGM).
Dr. Makini Chisolm-Straker, Assistant Professor of Emergency Medicine at the Icahn School of Medicine, presented about the various forms of human trafficking and what it might look like in a clinical setting. Her talk gave us practical skills as we depart to our clinical years that included being alert to red flags that a patient may be the victim of human trafficking and how we can report it.
— Icahn School of Med (@IcahnMountSinai) October 28, 2016
One of the most memorable talks of the week was the last: Aissata Camara, co-founder of the There is No Limit Foundation, herself a survivor of FGM, talked about her advocacy work to end FGM within her community and other communities around the world. Aissata spoke eloquently about the role of culture in FGM, and how culture can continue to be celebrated in the absence of such practices.
Her work shows the exciting promise of the upcoming generation in starting conversations and changing the norm around FGM to protect the rights and bodily autonomy of women and girls worldwide.
Hazel Lever is a second-year MD/MPH student at the Icahn School of Medicine at Mount Sinai. A native of Spartanburg, SC, she graduated from Harvard University in 2013 majoring in History and Science, and worked after graduation in HIV and public health. Outside of medicine, she dances and choreographs.