Medical Ethics at the Border.
Medical organizations must loudly and clearly support and protect physicians who work with migrants in and around detention facilities, where inhuman government policy conflicts with medical ethics and human rights principles, according to a new New England Journal of Medicine paper by School of Public Health researchers.
“Providing decent medical care at the border is not a partisan issue; it is a straightforward matter of ethics and human rights that the medical profession should insist on,” write physician Sondra Crosby and health lawyer George J. Annas, both faculty in SPH’s Center for Health Law, Ethics & Human Rights.
“Volunteer physicians have responded heroically to this crisis, but they need more support from both the profession and their institutions,” they write. Support needs to include but go beyond condemning abuses such as family separation, child detention, and the humanitarian crisis of the “Remain in Mexico” policy, they write, pointing out that widespread knowledge of the unacceptable conditions at the border, including the continuing cruelty of separating children from their parents, has not led to change.
The authors draw from interviews with 15 physicians and psychologists who have cared for migrants at the border, in detention, post-detention, or at local hospitals, as well as interviews with immigration lawyers and with workers with nongovernmental organizations (NGOs), court records, and medical records.
Physicians and psychologists described being coerced into writing “clearance” letters for sick patients to be deported or returned to detention, not being permitted to provide medically-necessary treatment, having patients’ medications confiscated in detention, and feeling powerless to do anything about the harms of detention and separation.
Crosby and Annas call on the Association of American Medical Colleges to “require medical schools to provide human rights education so that government-employed physicians in potentially compromised positions can effectively advocate for patients,” and call for trainings and other resources for physicians struggling with unethical demands from U.S. Customs and Border Protection (CBP) and Immigration and Customs Enforcement (ICE).
The authors also argue that it is unethical for physicians to sign a nondisclosure agreement that restricts their ability to discuss the quality of care available to their patients: “CBP agents and immigration judges have spoken out after quitting their jobs; no physician working in detention centers has gone public, even after resigning or retiring,” Crosby and Annas write.
The most difficult ethical question for physicians, Crosby and Annas write, is whether to quit. They write that physicians working with the Department of Homeland Security to provide care for migrants need to ask themselves whether a reasonable medical observer would conclude that, by their presence, they are doing more to enable human rights abuses than to prevent them.
Read the paper here.