Bioethics Forum Essay
Courage in Action: Why Bioethicists Must Advocate for Immigrant Patients
As an immigrant, a trained bioethicist, and a lawyer, I am intimately familiar with the impact of fear and injustice on immigrant communities. Maya Angelou’s profound words on courage resonate deeply with me: “Courage is the most important of all the virtues because without courage you can’t practice any other virtue consistently.” These words illuminate the simple truth that courage is not only a virtue, but a necessity when confronting injustice.
Today, anti-immigrant rhetoric and policies have created a climate of fear and anguish and a chilling effect on seeking necessary medical care. It is here that bioethicists, equipped with their expertise in ethical decision-making, must rise to the challenge and advocate for doing the right thing. They must not merely analyze ethical dilemmas but stand as guardians of moral integrity within their institutions. For in the absence of courage, bioethicists risk being complicit in the implementation of cruel and unjust policies.
The recent essay in Hastings Bioethics Forum, “Supporting Patients and Students Who Are Immigrants: What to Do and Why Most Bioethicists Won’t Do It,” commendably shines a light on the “devastating wave of fear [that] now permeates immigrant communities.” It also correctly outlines what health care providers and institutions should do to protect immigrant patients and students from harmful policies. The essay is understandably skeptical that bioethicists will engage in advocacy for immigrant communities.
One of the concerns cited involves the transgression of professional boundaries. In this context, it is essential to recognize that bioethicists’ expertise extends beyond analyzing and advising on ethical dilemmas in clinical or research settings. It encompasses the obligation to speak out against policies that are harmful to patients and vulnerable populations. In so doing, bioethicists would not be overstepping their boundaries. Rather, they would be fulfilling their professional duty to uphold ethical standards and act with compassion and moral integrity.
Another concern raised is that advocating for immigrant patients is an uncomfortable role requiring significant resources. However, investing in creating and maintaining safe spaces and implementing policies to protect immigrant patients is not as daunting as it seems. Bioethicists can draw upon legal guidance from states like Massachusetts, which has provided clear directives on protecting immigrant communities, emphasizing the importance of adopting policies that respect individuals’ rights. Other states have developed initiatives to safeguard immigrant rights, offering valuable resources and training for health care providers and educators. Institutions can successfully implement these measures by leveraging existing resources and collaborating with community organizations. For example, hospitals can partner with local legal aid groups to provide know-your-rights training and legal support, enhancing policy effectiveness without incurring significant additional costs.
A third concern suggests that the current social and political climate makes it risky for bioethicists to advocate for immigrant communities, potentially jeopardizing their institutional political capital. Maya Angelou’s emphasis on courage as a foundational virtue highlights the importance of standing up against inhumane policies. Complacency is not an option at a time when mass deportations pose significant threats to the well-being and rights of immigrant communities. These policies exacerbate existing health disparities and social injustices, underscoring the need for bioethicists to exercise courage and advocate within their institutions to implement policies that are humane and just. Historical examples, such as the Mexican Repatriation of the 1930s and the internment of Japanese Americans during World War II, are reminders of the perils of unchecked xenophobia and the importance of standing against injustice.
Moreover, courageous actions that uphold human rights can lead to increased trust in institutions, as they demonstrate a commitment to ethical principles and moral integrity. This is particularly needed when trust in institutions is at a low point. In the face of adversity, it is precisely the courage to act that distinguishes true leaders from those who are complacent. Bioethicists, by advocating for immigrant communities, can inspire others to follow suit, creating a ripple effect of courage and compassion that can transform institutions and help restore trust in them.
Hannah Arendt’s concept of the banality of evil provides a poignant perspective. Arendt argued that evil often arises not from malicious intentions but from the mundane, everyday actions of ordinary people who follow orders and fail to question unjust systems. In the context of anti-immigrant policies, this concept highlights the importance of bioethicists speaking out against injustice. By advocating for policies that protect immigrant communities, bioethicists are not just addressing a moral imperative; they are also preventing the normalization of unjust policies that would most likely harm vulnerable populations.
Ultimately, the courage to advocate for immigrant patients is not merely a moral imperative; it is a fundamental expression of bioethicists’ professional integrity. Now is the right time to act, and the benefits of doing so far outweigh the risks. It is time for bioethicists to stand up, speak truth to power, and ensure that justice and compassion guide action.
Adelaida (Adele) Jasperse, JD, MBE, is an attorney at the Massachusetts Executive Office of Health and Human Services. LinkedIn: Adelaida (Adele) Jasperse
This essay, and is mirror – a Hastings Forum piece cited in the text – are informative but unsatisfactory as they are. The other essay attends primarily to the institutional dynamics at hand while the mirror essay attends primarily to the emotional dynamics at hand (a plea for some sort of ‘courage’). Professionally and reasonably doing the tasks of ‘your day job’ (as the other essay refers to) are essential ethical duties, and bringing forward insights and commitments about ‘human dignity’ (as this essay discusses) are not separable. Of course we all know that, right? These two essayists would help us out by writing a joint statement. These are good starts but unsatisfactory. They may divide rather than to unite and in the worst case keeping ethical motifs divided will do us little good. For example, when we elevate virtues like ‘courage’ shouldn’t we discuss how courage requires a hard look at the ‘rational architecture’ of institutions: e.g. budgets. A courageous bioethicist SHOULD want to know a lot about how the institutional budget is made: e.g. who revenues are coming from; where commitments are being made. Ask: are taxpayers who make up a large part of hospital or clinic revenues (through Medicaid and Medicare, etc) being served justly? does the budget respect the labor and sacrifice of taxpayers as matters of their ‘human dignity’ or are they abstracted out as mere numbers and figures? This is how – in my experience – they taxpayers are usually mis-treated. This is morally wrong. And many taxpayers currently supporting the DOGE efforts are saying ‘stop treating us so disrespectfully; why haven’t YOU already stopped waste, bad practices, ineffective systems, etc’. A professionally/organizationally dutiful bioethicist SHOULD be well aware of the social determinants of health in the local community and the social resources available in the local community, beyond referring to the hospital/clinic ‘Social Work’ office or even a list of possible referral sites in the community. Now knowing how society – out there – actually works for working class folks, including immigrant folks, is morally wrong. Many voters who supported the current Administration, and many who did not vote, are sick and tired of health systems not knowing them really, not knowing their real worlds. Bioethics should be understanding all of this. Why doesn’t it?
I was pleased to see another call for advocacy for patients who are immigrants. But this critique of my essay seems to miss my main point. I tried to show that blanket calls for bioethicists to take up a specific task often fail to appreciate the on-the-ground institutional realities of the day-today work of clinical bioethicists or bioethicists who work primarily in the area of responsible conduct of research. It is important to acknowledge such realities in order to invite bioethicists to gamble in transgressing their assigned boundaries and to help them consider how to do so wisely.
The author seems to mistake the idea that bioethicists, like everyone else, have an imperfect moral duty to oppose injustices that affect patients with the reality of how the job descriptions of bioethicists actually read. I think it’s regressive to again confuse these two or pretend they are the same. Because we wish them to be identical does not make it so institutionally. I tried to acknowledge this gap and to find things in our toolkit that can help us bridge the divide. But this takes not just courage but practical wisdom and skill. (I have pursued this line of thought in a few other places)
The author misunderstood my point about the continual vigilance these issues require and characterized it as a resources issue. But I was pointing out that the bioethicist will need to be vigilant and risk annoying a lot of people. My example is of keeping security poised to respond appropriately to visits from ICE. Having done it awhile back for a several-year span, I know that the interest of security personnel and the administrators that oversee the security officers waxes and wanes (or maybe just wanes) and trying to maintain preparedness for an event that they know is unlikely to happen is very difficult and takes long-term effort and stamina by the bioethicist.
I was moved by the author’s final point which is an inspired call for courage. But we must still counsel that bioethicists should use their political capital wisely and effectively. Fear currently permeates the leadership ranks of most health-care and educational institutions. We are not effective if our university president, CMO, hospital president, etc., thinks, “Oh no, not that guy again” every time he sees us. It would be foolishness to see that acknowledgment as timidity.
Nevertheless, I am grateful for this essay by Adelaida Jasperse. After, as I my essay noted, . . . “we are in one of those times when the worst thing we can continue to do is nothing.”