Ethical aspects of medical age assessment

If a medical age assessment is not conclusive, it’s better to say yes than no. That’s the advice from two Linköping University researchers who conducted an ethical analysis of several cases of medical age assessment, on behalf of the National Board of Health and Welfare.

“It’s worse if someone who needs protection isn’t granted asylum, than if someone who doesn’t need it that much is granted asylum,” says Erik Malmqvist, reader in medical ethics at Linköping University.

Together with Lars Sandman, professor of healthcare ethics at Linköping University, and Lisa Furberg, senior lecturer of medical ethics at Uppsala University, he has analysed the ethical risks involved with medical age assessment. The work was done on behalf of the National Board of Health and Welfare. The report is part of the board’s efforts to develop new guidelines for age assessment of unaccompanied refugee children.

The authors present eighteen of their most important conclusions.

In the first point they maintain that as long as a country’s migration policy gives under-18s advantages in the asylum process, the age of the applicant must be assessed in some way. But if medical age assessment is to be part of this process, there must be a high level of diagnostic security. Otherwise there won’t be sufficient legal certainty.

The Swedish National Board of Health and Welfare proposes that medical age assessment is conducted using magnetic resonance imaging of knees and ankles. According to the authors this isn’t an affront on the individual’s integrity, but care should be taken in each particular case.

Risks of medical age assessment

The report also raises a number of difficulties with medical age assessment.

“There is a potential risk involved with systematic medical age assessment. Directing suspicion at asylum seekers can spread to society as a whole. Fingers are pointed at a group that is already the target of negative attitudes,” says Erik Malmqvist.

Another problem is that if the age assessment has to be done by the healthcare system, this can affect other healthcare. For this reason the authors agree with a previous proposal from the Swedish National Board of Health and Welfare: that a parallel system is established for medical age assessment.

The authors also propose that medical age assessment is not done under the auspices of the Swedish Migration Agency. If someone doesn’t want an assessment, there must not be a risk that this reduces the person’s chances for being granted asylum.

Report (in Swedish):

Åldersbedömning inom ramen för asylprocessen - en etisk analys. (Age assessment in the asylum process – an ethical analysis)
Lisa Furberg, Erik Malmqvist, Lars Sandman (2016).