Clinicians who assess the medical age of refugees seeking asylum as children face ethical and legal challenges, according to an article published in the International Journal of Legal Medicine.

Erik Malmqvist, PhD, associate professor of medical ethics at Linkoping University, Sweden, and colleagues note that in contrast with adults, individuals younger 18 who seek asylum are entitled to schooling, full access to health and dental care, and if not accompanied by their legal guardian, can acquire special secure housing and an advocate to ensure that their interests are protected. However, determining whether or not an individual is a minor can be difficult when reliable documentation is lacking.

Nonetheless, the researchers maintain that as long as children are accorded special rights and a certain degree of priority in the asylum process, it is necessary to establish some way of determining whether or not asylum seekers are under 18 years of age. Furthermore, to ensure equal treatment and rule of law, the methods used to assess age must be highly accurate. Uncertainties must be communicated transparently to the proper authorities and those authorities must be educated on the implications of such uncertainties. If there is considerable uncertainty the asylum seeker should be given the benefit of the doubt.

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Another challenge is the dictum that health care is voluntary on the part of the patient, and to protect this right the decision as to whether to request an age assessment and to present its results to the authorities should rest with the asylum seeker. Respect for asylum seekers’ autonomy demands that age assessments can only be performed with voluntary informed consent. The information gathered during any exam should be available only to people authorized by the individual seeking asylum.

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“Perhaps the most fundamental and challenging ethical question in regard to the asylum process is not whether and how to perform age assessments, but rather what a society’s basic criteria for granting asylum should be,” the researchers concluded.


Malmqvist E, Furberg E, Sandman L. Ethical aspects of medical age assessment in the asylum process: a Swedish perspective [published online November 11, 2017]. Int J Legal Med.