Ethical dilemmas in supporting drug detention centers

Organizations that seek to provide health care, food, and other services to people held in drug detention centers in developing countries often face ethical dilemmas: Are they doing more good than harm? Are they helping detainees or legitimizing a corrupt system and ultimately building its capacity to detain and abuse more people?

Such dilemmas are explored in an article coauthored by Nancy Berlinger and Michael Gusmano, research scholars at The Hastings Center, along with Roxanne Saucier and Daniel Wolfe of the Open Society Institute, and Nicholas Thomson of Johns Hopkins Bloomberg School of Public Health. The article appears in the current issue of the International Journal of Prisoner Health.

The article focuses on the drug detention centers that have proliferated over the last decade in China, Cambodia, Vietnam, and other parts of Asia. Although the centers say that they provide drug treatment and rehabilitation, in reality people inside receive no effective drug treatment, little medical care, and insufficient food. Indeed, they are more likely to face what amounts to torture, cruel, inhuman, and degrading treatment. Unlike prisons, detention centers have no judicial process or right of appeal. More than 400,000 people are detained each year.

Some nongovernmental organizations attempt to provide care and services to the detainees, but center administrators and their governments sometimes seek these relationships to legitimatize the detention centers. "In 2008, many were alarmed when a large U.S.-funded health organization sent an announcement saying that they were going to help make a notoriously abusive drug detention center in Cambodia a 'Center for Excellence,'" the authors write. "This same center was widely viewed by most health and human rights organizations as beyond redemption."

The goal of providing health services to detainees is ethically sound, the article says. However, it presents an ethical dilemma - a situation in which no option is clearly right, and that can be resolved only by determining which option is less wrong than others under particular circumstances. "It would be incorrect to assume that doing something in this setting - in this case, undertaking health-related goals - is better than doing 'nothing,'" the authors write. Doing nothing may be preferable if engaging with drug detention centers amounts to what the authors call a "rotten compromise."

They conclude that leaders of health-related organizations should evaluate how their programs can promote health in drug detention centers, and also how or whether their work might make conditions much worse. Given that health-related resources are limited, the authors suggest that the leaders ask themselves, "might the resources in this instance be better served by efforts to keep individuals out of detention centers in the first instance?"