Who is a medical expert? How do we know that such experts are impartial?
Medical professionals are often asked to provide independent expert opinions as part of asylum and immigration cases. At the Helen Bamber Foundation, a significant part of our work includes providing expert medical reports (Medico-Legal Reports, or MLRs) which document the physical or psychological trauma linked to persecution or ill-treatment and play an important role in asylum decisions.
Each of our MLR writers have been trained in forensic documentation in accordance with the Istanbul Protocol (the international gold standard for documenting torture) and receive ongoing training and support to maintain the quality and integrity of our reports. Recently, though, we have been seeing a worrying trend where trust in medical expertise is under threat within the immigration system.
In a recent case concerning immigration detention, the judge refused to accept two MLRs written by a General Practitioner (GP), ruling that only a consultant psychiatrist had the “specialist knowledge or experience to be able to provide expert evidence” in the case. The judge also questioned the doctor’s impartiality because he worked for a charity that opposes immigration detention, suggesting that future experts should not come from NGOs that might be seen as "pro-detainee."
In a new editorial, Professor Cornelius Katona (Honorary Director of Medical and Research at the Helen Bamber Foundation) and colleagues challenge this ruling, raising two vital questions:
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Can a GP have sufficient expertise to give an opinion in the context of post-traumatic stress disorder and specifically on the impact of detention?
The authors argue that expertise comes from clinical experience and specific knowledge of a patients’ needs, not a specific qualification. Since GPs manage the vast majority of mental health cases and are legally recognised as able to provide ‘Rule 35 reports’ assessing whether an individual’s health may be harmed by ongoing immigration detention, their experience and expertise is often highly relevant.
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Can a doctor working for a charity be independent, objective, and impartial?
Medical experts owe an overriding duty to the court to be independent, objective and impartial. They must sign a ‘Statement of Truth’ and are held to account by the General Medical Council (GMC). There is clear guidance around ensuring impartiality for both the court and the professional to follow. By dismissing a medical professional based on their affiliations, this court decision sets a dangerous precedent.
Ultimately, high-quality medical evidence is an integral part of a fair and functioning asylum and immigration system. There are already well-established frameworks governing the quality and independence of expert evidence which should, in principle, ensure that it is objective, reliable, and of sufficient quality.
At a time when the government is consulting on the use of expert evidence in asylum appeals, it is all the more vital that trust in the integrity of medical expertise is not eroded by dismissing people based on their job titles or affiliations. To do so would risk making the system arbitrary and devaluing the rules of the court.