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Canadian Journal of Public Health

, Volume 104, Issue 1, pp e45–e51 | Cite as

Contradictions and Dilemmas Within the Practice of Immigration Medicine

  • Laura Bisaillon
Qualitative Research

Abstract

OBJECTIVES: To identify, explore and critique features of how practices associated with immigration medicine are socially organized. Specifically, how the work of designated medical practitioners (DMP) - physicians who conduct immigration medical examinations of prospective immigrants to Canada as contractors to the Canadian government department of Citizenship and Immigration Canada - is organized to occur in interactions with applicants who are diagnosed with the human immunodeficiency virus during the immigration medical examination.

METHODS: Findings from a theoretically informed empirical study using institutional and political activist ethnography inform this article. Data collection and analytic activities spanning 18 months included observational work in institutional settings, textual review, 61 interviews, and 2 focus groups in three Canadian cities.

RESULTS: The medical examination of prospective immigrants to Canada is not organized as a therapeutic relation of care and has little to do with medicine per se. The rationale structuring the work of DMPs is actually administrative responsibilities. The work achieved by the DMP positions her/him as a key figure and important decision-maker within the Canadian immigration system.

CONCLUSION: The work of doctors who practice immigration medicine gives rise to contradictions and ethical problems. These are largely unresolvable because of the way in which the labour process in which the DMP is implicated is coordinated. The social organization of immigration doctoring practices has serious consequences for prospective immigrants to Canada, for doctors themselves, and for the Canadian immigration system more broadly.

Key words

Critical methods designated medical practitioners HIV/AIDS immigration medical examination immigration medicine mandatory HIV screening sociology 

Résumé

OBJECTIFS: Identifier, explorer et critiquer l’organisation sociale des pratiques qui relèvent de la médecine de l’immigration. En particulier, comment le travail du médecin désigné - médecins contractuels au département fédéral de Citoyenneté et Immigration Canada chargés de faire l’examen médical aux fins de l’immigration d’immigrants prospectifs - est organisé lors des interactions avec les demandeurs de résidence canadienne ayant reçu un diagnostic de séropositivité au virus d’immunodéficience humaine lors de l’examen médical de l’immigration.

MÉTHODES: Les résultats d’une étude théorico-empirique qui a employé l’ethnographie institutionnelle et l’ethnographie d’activisme politique comme méthodes d’enquête fondent cet article. Les activités de collecte et d’analyse des données ont eu lieu pendant 18 mois et étaient constituées d’observations dans divers lieux institutionnels; d’analyse de textes; 61 entrevues; et 2 groupes de discussion («focus groups ») dans trois villes canadiennes.

RÉSULTATS: L’examen médical des immigrants prospectifs au Canada n’est pas l’occasion d’une intervention thérapeutique, et a peu de rapport avec la médecine proprement dit. Le raisonnement clinique du médecin désigné est en fait remplacé par des responsabilités administratives. Le travail effectué par ces médecins fait en sorte que cet individu soit une personne clé et un preneur de décision important au sein du système de l’immigration canadien.

CONCLUSION: Les pratiques réalisées par les médecins désignés donnent lieu à des contradictions et problèmes éthiques. Il y a peu de chances à ce que ces derniers soient rectifiés en raison de la manière dont ce médecin est appelé à travailler. L’organisation sociale des pratiques de la médecine de l’immigration a des conséquences sérieuses tant pour les immigrants prospectifs au Canada que pour les médecins eux-mêmes et le système de l’immigration canadien de façon générale.

Mots clés

dépistage obligatoire pour le VIH examen médical aux fins de l’immigration médecine de l’immigration médecins désignés méthodes critiques sociologie VIH/sida 

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Copyright information

© The Canadian Public Health Association 2012

Authors and Affiliations

  1. 1.Biomedical Ethics UnitMcGill UniversityMontrealCanada

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