Bioethics Forum Essay

Detention, Dignity, and a Call for Bioethics Advocacy

A federal complaint filed last month on behalf of a nurse who worked in the Irwin County Detention Center in Georgia alleged that immigrants held in this U.S. Immigration and Customs Enforcement (ICE) facility were medically neglected and forced into solitary confinement for speaking out, and that some underwent unnecessary hysterectomies.

According to news reports, the nurse, Dawn Wooten, said that the hysterectomies were  performed by an offsite physician. “Everybody he sees has a hysterectomy – just about everybody,” Wooten said in an interview with The Guardian. “That’s his specialty, he’s the uterus collector. Everybody’s uterus cannot be that bad.” The complaint also cited health and safety violations, including a lack of anesthesia, and a failure to get consent from the patients.

These allegations, if true, run afoul of ethical practice, international norms, and human dignity, as outlined in documents such as the United Nations Universal Declaration of Human Rights. It is important for bioethicists and health care professionals not to respond merely to these particular instances. Broad and extensive change is needed to address  confirmed violations of persons who have been detained, incarcerated, or otherwise institutionalized.

Failure to respect the dignity of incarcerated women has been well-documented. Between 1980 and 2017 the number of women jailed or imprisoned in the U.S. grew 750%, according to the Equal Justice Initiative. EJI reports, “The United States incarcerates its citizens more than any other country. Mass incarceration disproportionately impacts the poor and people of color and does not make us safer.” Violations are extensive, as documented by organizations such as EJI,  Dream Corps: #cut50, and the Vera Institute of Justice. Shackling  incarcerated pregnant persons, for example, has been justified by the need for “the safety of correctional officers and the public.” This rationale highlights that the problem to be addressed – the violation of the human dignity of members of our communities – is structural. Structural racism and sexism perpetuate the dehumanization of members of our communities, a dehumanization that calls out for a response from bioethicists.

Covid-19 has exacerbated the challenges faced by detained and incarcerated persons. Not long into the pandemic, the public learned of Covid spreading like wildfire through institutions like the Marion Correctional Institute in Marion County, Ohio; of persons being placed in institutions that could not safeguard their health and for minor violations, like the tragic situation of  Ramon Rivera, who contracted Covid at Riker’s Island jail complex and died; and of unsafe practices like the handcuffing people together and placing them on buses bound for institutions that did not keep people appropriately distanced, ultimately leading to their deaths. These situations serve as further evidence that the allegations against the ICE facility in Georgia, if true, were not merely isolated instances of malpractice but the result of structural injustice.

Bioethicists should embrace the call to advocacy. Bioethicists might–as citizens–write to local, state, and national politicians, urging them to take seriously the plight of detained persons, who are members of their communities, and highlighting the unethical behavior occurring within  their jurisdictions. They might also–as members of communities–join protests, offer encouragement, and use their  privilege to call attention to health-related violations of dignity. They should–as bioethicists – think more deeply about their own practice, teaching, research, and policy contributions, and critically reflect on the impact and priority of their work.

 Taking this call seriously might mean, for some bioethicists, staying the course. For others, it might mean a range of actions. For example, open up spaces for conversations with students, friends, and colleagues about how to balance the importance of participating in protests with their own safety and their possible contributions to the spread of Covid. Amplify less-heard voices. Consider reviewing research priorities and not letting some urgent bioethics matters caused by Covid–for example, a revision to a ventilator allocation policy–obscure equally important and longer-lasting bioethics issues, such as the lack of language translation resources in health care, which can lead to failures in shared decision-making and delays in care. However, bioethicists respond, this is a call to advocacy that must be heeded.

Bryan Pilkington, PhD, is an associate professor in the School of Health and Medical Science at Seton Hall University and an associate professor in the Hackensack Meridian School of Medicine. Twitter: @bcpethics