Bioethics Forum Essay
Being a Good Doctor When Patients Fear Deportation: Lessons for Future Physicians
An article in the New England Journal of Medicine last March warned of the “chilling effect” of recent federal immigration policy changes on health care access for undocumented immigrants. The Trump administration’s expanded immigration enforcement has seen an increased number of arrests at medical facilities and other “sensitive locations” compared to the Obama administration, whose policy avoided these locations. This is not the first time in recent history that immigration policy has had a chilling effect on health care use by a population. In 2010, Arizona passed SB 1070, which required immigrants to carry registration documents and penalized those aiding undocumented immigrants. Studies published in 2012 and 2014 showed how this law increased fear, diminished trust of officials, and limited residents’ mobility in a predominantly Latino neighborhood in Flagstaff, ultimately leading to decreased participation in preventive health programs. Furthermore, an epidemiological study that looked at the effects of a 2008 immigration raid in Postville, Iowa found that the heightened stress and fear of deportation led to a 24% reduction in birth weight among infants born to Latinas.
The health effects of the Trump administration’s immigration policies will need to be studied over time. In the meantime, however, physicians have been sharing their experiences caring for undocumented patients, providing poignant descriptions of the fear in immigrant communities and its tangible effects on health care use. As the New England Journal of Medicine article predicted, physicians describe how enforcement-oriented immigration policy changes are affecting the behavior of patients–making them avoid health care facilities or travel that might involve a traffic stop or other encounter with authorities–and even diminishing their trust in health care professionals. A recent New York Times article gave an account of a North Carolina psychiatrist who delivers prescription drugs to his undocumented patients at their homes because they are terrified of even leaving to come to the clinic.
Elsewhere, physicians have reported that undocumented patients with chronic conditions such as diabetes have started skipping dialysis and insulin appointments because they saw security on their way to the hospital. In California, pregnant women are torn between seeking prenatal care, potentially becoming detected by immigration authorities, and forgoing this care, posing significant health risks to themselves and their fetuses. Children in mixed-status families around the country are increasingly suffering from anxiety and depression, which may possibly have lifelong mental health implications, because they are fearful of losing their undocumented parents.
Clinicians have a unique opportunity to become advocates for their undocumented patients by helping the public and policymakers understand the health consequences of the Trump administration’s immigration enforcement policies. When physicians share stories with news outlets about their patients’ fears about coming to the clinic or their own decisions to alter how they record patients’ information, they humanize undocumented patients’ experiences and provide a strong counternarrative to anti-immigrant rhetoric. Yet, because undocumented patients are increasingly hesitant to seek health care in the current political climate, simply offering them health services may not be enough. The National Immigration Law Center has provided comprehensive guidelines on the legal rights of undocumented immigrants and of health care professionals and institutions. New York City’s public health system has also issued open letters that emphasize their commitment to quality care for immigrants, regardless of their immigration status, and to respect the confidentiality of patient information.
By sharing their stories with popular news outlets such as the New York Times and STAT News, many physicians already act as advocates for their undocumented patients. They are placing an important spotlight on the harm that federal immigration policies have on the health of undocumented immigrants. However, without a working knowledge of immigration policy, doctors may not know how best to care for undocumented patients. As a prospective medical student who wants to care for undocumented patients in a sanctuary city such as New York and Chicago, I will need to pair my medical education with training in how to navigate a health care environment that is increasingly influenced by lawmakers who do not share my view that undocumented patients have a right to quality health care. I hope that I can add to the substantial work that physician advocates have already done by not only sharing stories of my own with the public but also collaborating with legal and human rights groups to bring policy changes that would improve health equity for undocumented immigrants.
Daniel Ahn is an intern for The Hastings Center’s Undocumented Patients project. His work is supported by a grant from the Pozen Family Center for Human Rights at the University of Chicago, where he is a rising senior.