Medical professionals are getting increasingly entangled in the anti-immigrant rhetoric that has gripped the U.S. and other countries - and, predictably, it’s having horrible consequences for their patients.
According to a case report published this week in the New England Journal of Medicine, medical care professionals in the UK turned over a migrant sexual trafficking victim in their care to the police, and in Baltimore, a paediatrician was censured by their hospital for providing undocumented Mexican parents with information about their legal rights.
The first case details a woman who had reportedly fled her home country of Nigeria to the UK, after her husband and her father were murdered. Once she was there, however, the distant relatives who arranged her travel kidnapped her, stole her passport, and imprisoned her in a home. Over the next six months, the woman was repeatedly raped. It was only after the door was left unlocked by her captor that the woman was able to escape.
The women then spent several days sleeping on buses, before an elderly couple brought her to the emergency room of a London hospital. She was understandably shell-shocked and traumatised. Her attending doctor explained that she was entitled to free health care, regardless of her immigration status and arranged for her to get follow-up care at a local clinic.
But a nurse, who felt that undocumented people were “illegal” and didn’t deserve care, called the police on her, according to the case report. As soon as the woman left the emergency room, she was arrested and once again detained for a month, until a lawyer was able to arrange her release.
To protect the patient’s identity, the incident described in the report is a composite story based the details of more than one case, study author Sarah Polk, a paediatrician with Johns Hopkins University, told Gizmodo in an email.
In the second case — not a composite, but with identifying details left out — a Baltimore family had been struggling to get care for their 3-year-old child, who had speech delays. They had moved farther away from their paediatrician, after reportedly avoiding a raid by Immigrant and Customs Enforcement agents in their predominantly Hispanic neighbourhood.
The paediatrician, upon hearing their story, decided to give them information on their legal rights as undocumented residents. Another doctor then told the hospital’s legal department about the actions taken by the paediatrician, who was then sanctioned.
Both cases, the authors wrote, illustrate the growing conflict between medical care professionals and other social support workers (the “left hand” of the state, as commonly referred to by social scientists) and the “right hand” arm of the law. They also represent an abject failure by certain professionals to do right by their patients.
“When the clinic serves as a site for police action instead of care and welfare, access becomes contingent on citizenship, not personhood. Health professionals can find themselves acting as agents of the punitive state, turning patients into deportees,” they wrote.
There was some measure of justice here, at least. According to the report, the Baltimore doctor appealed their sanction to the hospital’s ethics department. They ultimately agreed the doctor did nothing wrong and ruled in “favour of distributing ‘know your rights’ materials in the clinic, given the well-documented negative effects of family separation due to deportation on children’s health and well-being.”
The UK woman, meanwhile, was counselled by her lawyer to sue the hospital (the nurse had likely violated her confidentiality by calling the police), but she simply requested an apology and training on the part of hospital employees so that “this would not happen to others.”
While training and information about the legal obligations heath care workers and organisations have to fulfil when treating undocumented people is important, though, the authors of the report say it’s just as crucial that doctors and nurses remember their moral obligations, too.
“Health care professionals trained to think critically about their relationship with shifting governance priorities can more easily recognise when a given policy may be turning them into instruments of exclusion and punishment,” they wrote. “This tension warrants resistance from individual clinicians and professional groups to maintain the integrity of the medical code of ethics.”