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Bioethics Forum Essay

DACA at 10: More, Please

DACA, the Deferred Action for Childhood Arrivals program, has been with us for 10 years. On June 15, 2012, President Obama announced the creation of what has since been called the most successful immigration program in our nation’s history. Granting a work permit and a renewable two-year stay of deportation to undocumented youth who have grown up in the United States turned out to have enormous benefits for them and for our nation. They report that DACA changed their prospects, with better jobs,  better wages,  more education, and better health. The children of mothers who are DACA recipients are healthier than the children of mothers who were not recipients.

It is the workforce and our communities that have benefitted most from DACA. For instance, at the medical school where I work, we have graduated 33 DACA recipients and sent them into the physician workforce. They are a rich source of diversity in a field that struggles with it. More than half of our physicians with DACA self-identify as Latino and speak Spanish fluently. The number of DACA doctors is relatively small owing to the length of training and the difficulty in funding a medical education while ineligible for federal student loans. However, more than 60,000 DACA recipients work in health care. The contributions of these essential workers were often noted early in the pandemic as they put their lives on the line. And, in general, recognition of the contributions that immigrants also make in low-wage but essential jobs threatened for a moment to displace the xenophobia that has been prevalent in recent years in the United States. But that moment has passed and insofar as immigration is at all on the national radar, it is discussed in terms of attempting to discourage asylum seekers from presenting themselves at our southwestern border.

The 10th anniversary of DACA reminds us that when given the opportunity, young immigrants renew our nation’s trademark optimism and determination, the themes of the narrative of the American Dream. This infusion of the immigrant spirit seems most needed now, at a time when our nation is trapped in a post-pandemic malaise that’s fed by an acute labor shortage, an aging population, and a general pessimism about the future. Unfortunately, at 10 years old, DACA is simply inadequate in being fair to these young people and providing for our nation’s needs.

In his remarks announcing the creation of DACA, President Obama acknowledged that as an executive order, this program was not meant to be permanent but, rather, to be a bridge to a legislative solution. We’ve since watched it come under threat during the Trump administration and survive owing only to a Supreme Court decision  based on administrative procedural grounds and President Trump being voted out of office. But even at this juncture, DACA continues to be challenged in the courts. And, of course, as long as young DACA recipients do not enjoy the benefits of citizenship, their contributions to society will be limited by such barriers as ineligibility for federal student loans. But even more important is the limited number of people eligible for DACA.

Most undocumented students attending U.S. colleges do not even have the protection from deportation and the opportunities that come from having the work permit DACA grants. The DACA memorandum contains some arbitrary eligibility requirements, such as that the applicant must have been present in the U.S. on June 15, 2012, and lived continuously in this country for the five years prior. These requirements have not been updated. As a result, the pool of DACA recipients who can eventually join the physician and health care workforce is diminishing and the path forward for undocumented youths who are ineligible for DACA and attending colleges and universities is not clear.

A commitment to justice and fostering the health of the nation requires that the health care superstructure, e.g., professional societies, health systems, academic medicine, public health officials, and bioethicists, need to increase their efforts in two ways. First, in practical terms, we need to create opportunities for those in the undocumented population to be educated and, trained and to practice as physicians and other types of health care professionals. As more students who are undocumented enter higher education without DACA, training and practice pathways that do not require work permits need to be developed.

Some states, such as California and Illinois, require that professional licenses not be contingent on immigration status. Nevertheless, the medical profession remains inaccessible because residency training requires the ability to be paid as an employee of an institution. Creative solutions, such as residency programs that are true education programs and do not employ the trainee or programs that enable the resident to be an independent contractor, could enable qualified undocumented youth to serve in the health care workforce despite not having DACA. Providing these opportunities is warranted both by simple fairness to these young people who have grown up in the U.S. and meet the standards of admission to the profession and also by the needs of the health care workforce.

Finally, health care and bioethics must contribute to fostering a more true and just narrative regarding immigration. This no small task and exactly how to do so is not obvious. But a commitment to fostering health and justice is hard to honor while remaining silent in the face of widespread racist conspiracy narratives that promote fears of invading hordes of inferior ethnicities that are being brought to the U.S. to “replace” white Euro-Americans as voters. We must tirelessly trumpet the contributions of immigrants, both with lawful and undocumented immigration statuses, to health care, as well as the need to utilize more of this talent pool to keep our health care infrastructure staffed and in a way that is maximally suited to serve our nation’s patients. And we must revive and further develop the narrative prevalent early in the pandemic that recognized the dignity and service of essential workers and emphasized the interconnectedness of all of us in the effort to address the pandemic. We must never stop emphasizing that the exclusion of any population in our community from the health care system undermines the benefits to all of us. Health care and bioethics should seek to show that an understanding of immigration that emphasizes its relation to health and health care highlights our unity as a people and should not be an issue that stokes fear and division.

Mark G. Kuczewski, PhD, HEC-C, is the Michael I. English, S.J. Professor of Medical Ethics and director of the Neiswanger Institute for Bioethics at the Stritch School of Medicine at Loyola University Chicago. He is a Hastings Center fellow. @BioethXMark

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  1. As we celebrate the tenth anniversary of DACA we also need to recognize one it’s most ardent advocates. Given Mark Kuczewski’s modesty it would be easy to overlook the normative significance of what he and his colleagues have accomplished at Loyola graduating 33 DACA recipients into medical practice. It is a singular accomplishment in American medical education and is testament to walking the walk and putting articulated values into practice. As we grapple with structural racism in society, and it’s malignant effect on health care, organized medicine needs to emulate the courageous actions of Kuczewski and colleagues and make medical school admission and residency eligibility accessible to DACA recipients. Each of us who work in medical education can be allies in this cause locally within our institutions and by advancing policies at the state and national level that advance equity in medical education.

  2. I will share this article with former colleagues at University Hospital in Newark and Rutgers-NJMS. We in healthcare (and especially Pediatrics) have several particular vantage points on the Dreamers’ experience and outcomes. We have an obligation to turn those perspectives into political action. A first step would be to draft and mail a brief letter to our US senators and representatives.

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