Bioethics Forum Essay
Thinking Beyond “The Border”: American Bioethics and the Repair of U.S. Immigration Policy
How should the American bioethics community respond to the latest “crisis at the border,” focused on record numbers of unaccompanied minors – children and teenagers traveling from the Northern Triangle of Central America without parents or guardians — presenting at border crossings along the U.S.-Mexico border?
The first step is to differentiate the recurrent challenge of fulfilling duties and providing care to unaccompanied minors from the horror of deliberate separation of parents and children under the previous federal administration’s explicitly antiimmigration policies. Both involve families and the care of children; they are not morally or politically equivalent situations.
The next step is to understand the “push” factors behind a migrant’s decision to start a journey of more than 1,500 miles to reach the border. Migration is multifactorial. Patterns of migration are discernable and often reflect regional affinities and rural-to-urban movement in search of jobs. The decision about when to leave and where to go reflects local conditions, which in the Northern Triangle nations of El Salvador, Guatemala, and Honduras include violence, environmental degradation, and income and food insecurity. Hurricane damage in 2020 and the previous U.S. administration’s failure to respond to these natural disasters are push factors now driving northward migration.
Many Central American migrants are fleeing extreme gang violence, including sexual assault and enslavement of girls. Valeria Luiselli’s book-length essay Tell Me How It Ends (2017) is a compelling brief introduction to the ethical, legal, and social dimensions of advocating for unaccompanied minors seeking asylum in the U.S. It is based on the author’s experiences as an interpreter during asylum interviews, and is structured around the 40 interview questions minors are asked. Luiselli’s essay and The Waiting Game, an interactive game produced by ProPublica and the public radio station WNYC, are useful in teaching and learning about the complex process of seeking asylum.
Most Central American migrants, like most migrants worldwide, are young. Whatever their reasons for leaving home, all migrants need to find work and know that the U.S. is a longstanding labor market for low-wage migrants. Unaccompanied minors often aim to rejoin family members already in the U.S.
Unaccompanied minors have rights under international human rights law that are threatened when a “receiving” nation’s immigration systems are not functioning well. The Biden administration is attempting to repair the damage done by the previous administration while responding to the immediate situation at the border, and trying to pass immigration reforms, such as pathways to citizenship for farmworkers and for “Dreamers” – undocumented immigrants brought to the U.S. as children, who have secured work permits and temporary relief from deportation through Obama-era executive action.
Migration is both a human phenomenon and a wicked problem. In the U.S. context, there is no easy fix to the moral and political challenges represented by the border. Vice President Harris will serve as point person on upstream problems that push Central American children to migrate: the dire political, economic, social, and environmental conditions in their home countries. It is hard to wait for political solutions when we see children suffer. When we call out “crisis” conditions that dismay us, such as housing unaccompanied minors in large shelters, we must be prepared to speak to the urgent downstream problem of where migrant children will sleep tonight.
Serious work on health justice includes the health and well-being of migrants, who exist in a state of extreme precarity as they seek refuge, stability, and a chance to flourish. For bioethics scholars, learning from scholars in fields such as migration studies and population health, from practitioners in immigrant health and immigration law, and from journalists on immigration and human rights beats, is crucial to developing a working knowledge of the issues. For example, this recent NPR interview with Mark Greenberg of the Migration Policy Institute summarizes upstream and downstream political challenges in reducing threats to the lives and well-being of residents of Northern Triangle nations in their home countries, during migration, and during processes of asylum, immigration, and resettlement in the U.S. This November 2020 report from Kids In Need of Defense (KIND), a leading nonprofit provider of pro bono legal services to unaccompanied minors and other children in immigration systems, describes policy changes needed to ensure the rights, safety, and appropriate care of unaccompanied minors.
Migrants face multiple vulnerabilities in their destination societies. They are often perceived as a “problem” population because of their precarious socioeconomic status. Migrants’ presence taps into histories of racism, colonialism, and other underlying inequalities that may cause them to be viewed as permanent outsiders or members of a servant caste. American bioethics can help repair this profound social damage by contributing to critical and practical work on “decolonization”: recognizing and changing cultural narratives that reinforce transnational hierarchies of domination and submission. As migration scholars Kudakwashe Vanyoro, Leila Hadj-Abdou, and Helen Dempster wrote in 2019 about this critical discourse, the framework of decolonization helps scholars and practitioners to “imagin[e] what a freer, less hierarchical world could look like,” and also to be clear that “the continuity of colonialism, manifested in current power asymmetries between and within different world regions in the Global North and South,” means people from disadvantaged regions and populations remain vulnerable to being seen as permanent colonial subjects, unfree people.
In a vision of bioethics that is oriented toward health justice, moving from crisis to repair will involve thinking beyond the border, to sustained practices of learning from migrant communities and from our colleagues in Global South, to understand health justice from their perspectives.
Acknowledgments: The author thanks Gaby Arguedas, University of Costa Rica, Emily Berkman; Seattle Children’s Hospital; and Josephine Johnston, The Hastings Center, for discussions and suggestions.
Nancy Berlinger is a research scholar at The Hastings Center. She co-founded the Undocumented Patients Project and is a co-author of a forthcoming paper prepared for the WHO’s Ethics and Governance Unit and the Public Health Emergency Preparedness and Response Ethics Network (PHEPREN) on learning from Covid-19 responses to migrant health.