Sometimes, the medical profession and governments are on the same page. Examples are public health initiatives like immunisation programs or bowel cancer and cervical screening programs, when medical expertise informs policy.

This week we sadly saw the opposite, an ugly clash between medical ethics and political expedience.

On one side, there were 13 medical colleges, the Australian Medical Association and thousands of doctors who were arguing passionately to keep the medevac process in place.

On the other side, a government hell-bent on repealing a piece of legislation that gave doctors the ability to carry out our professional oath to do no harm, and to put the patients needs at the forefront of decisions about medical care.

When I heard about the repeal of the medevac legislation, I felt a mixture of emotions, but mainly a profound sense of sadness. This repeal signals a return to the governments unambiguously cruel and inhumane policy in the treatment of a small cohort of people seeking asylum. These are among the most vulnerable people on the planet.

The decision to repeal medevac is an absolute violation of Australias obligations under international law to provide these refugees with safe asylum and medical care. It also strikes at the heart of our medical training and ethical principles.

Before medevac, medical treatment of refugees in offshore detention was often delayed until conditions were life threatening and even then, human rights lawyers were often forced to fight for their transfer in the courts. Before medevac, 12 people died in offshore detention.

Usually cloaked in secrecy, the dire situation on Nauru and Manus Island began to emerge in late 2018. Brave whistleblowers, risking a jail sentence for speaking out, told us of the intolerable conditions in Australian offshore refugee facilities.

So now we go back to politicians and bureaucrats deciding who lives and who dies

When the medevac legislation was passed, the government made no apparent attempt to set up a process to honour the new law. It was left to a group of doctors who came to be known as the Merg (Medical Evacuation Response Group) to set up an urgent triaging and assessment system. It was essential that this process was to be a robust and as credible as possible. Many of these doctors were involved in the Senate inquiry into the repeal bill. Of the 84 submissions, 82 argued against the repeal. There is a reason the medical profession was united in support of medevac. It fulfilled one of the most basic of medical ethics to provide medical care based on need and without discrimination.

After all, one of our responsibilities as doctors is to advocate for the health and wellbeing not only of our own individual patients, but for groups and communities without discrimination.

I have had messages from doctors around the country who are aware of the state of health of the refugees who have been transferred to Australia, and of many of those who remain in offshore detention who fear what will happen as we return to business as usual.

Secrecy surrounded conditions on Nauru and Manus Island. Secrecy was demanded of health professionals working in the detention camps.

The fact that the Senate was forced to vote on a secret back-room deal a deal which the Coalition denied even existed with no information as to what that deal was and with one person making that deal in isolation from experts and then casting the key vote is a cynical desertion of our democratic principles.

There was no secret that Scott Morrison and Peter Dutton did not want the medevac legislation.

When it was passed, the government waited 14 days to make it officially law.

They then made absolutely no move to set up a process for assessment of cases requiring transfer.

This week the government took only five hours to make the visit to the governor general to end medevac. They also ended any independent medical oversight of medical transfers from offshore detention with the demise of the Ihap (Independent Health Assessment Panel).

So now we go back to politicians and bureaucrats deciding who lives and who dies, who is transferred for crucial medical treatment and when.

Through this process I have seen the best and the worst of political decision-making affecting the provision of healthcare.

Any MP or senator who voted to repeal this legislation will have to live with the consequences of that vote on their conscience forever.

In contrast, we have seen the wonderful refugee advocates, lawyers, and doctors who have selflessly given their time for these medevac transfers to happen, and for those who took to the streets in support of the people who are still held in Papua New Guinea or on Nauru. I thank them for their hard work, their compassion and for fighting against the governments indefensible decision to repeal this legislation.

To those who remain in Papua New Guinea and Nauru, please know this. There are many, many Australians of good heart who understand your plight and will continue to fight on your behalf not only for your medical care, but for a future for you in freedom and safety.

This is not over.

Kerryn Phelps is a medical professional and former independent MP for Wentworth

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To those stuck in offshore detention: we will keep fighting for you. The medevac repeal is not the end - The Guardian