In a recent Hasting Center Bioethics Forum Essay, “Supporting Patients and Students Who Are Immigrants: What to do and Why Most Bioethicists Won’t Do It,” Mark Kuczewski asserts that bioethicists, and medical systems in general, should not cooperate with any governmental attempts to identify or detain aliens who seek medical care within our hospitals and clinics. He goes so far as to state that we should defy U.S. Immigration and Customs Enforcement (ICE) efforts to identify any immigrants regardless of their circumstances, history or reasons for being present in this country without documentation. The title of his article asserts three errors, and the author castigates those who disagree with him.

 

His first error is the use of the word “immigrant.” Immigrant is an umbrella term, which means anyone who comes to live permanently in a foreign country. This incredibly broad term would include all who seek to emigrate to the U.S. through legal means, as well as any who have arrived here illegally. The mainstream press has done much to blur the distinction, eschewing terms such as illegal aliens, illegals and persons unlawfully present in the U.S. Instead, the terms immigrants, migrants or undocumented persons are used. Even this last term pointedly fails to recognize that being present on U.S. soil without appropriate documentation, while not a felony (unless the persons are repeat offenders), is grounds for deportation. While some have arrived here fleeing political or religious persecution, many have come primarily for better financial opportunities—albeit at the expense of those who are already living here. By lumping them all together, he gives the impression that their distinctives do not alter the argument. They do, of course.

 

A common logical error is oversimplification of complex questions. For numerous complicated problems, there are simple, straightforward solutions—usually wrong. Another error is taking words that have clear, accepted definitions and applying them to arguments for which they do not fit. Kuczewski commits both of these mistakes in the title of his essay before fleshing them out. Starting from false premises, he mixes truth with error.

 

The second error in his title is to imply that he knows and can state categorically what bioethicists are to do about this situation. This is hubris. He again is simplifying a complicated situation and providing a naïve unworkable solution. In one paragraph he admits, “I often lose patience with calls for bioethicists to take on issues that are remoted from our ‘day jobs.’” He then goes on to do exactly that. He tackles immigration law with no acknowledgment of the nuances that bedevil these issues.

 

His third logical error is a variation on the straw man argument. He asserts two reasons that keep bioethicists from doing what he deems to be the right things—namely because they define their roles in society too narrowly and because they are fearful. Interestingly, he doesn’t define what the true role of bioethicists is. He also asserts, without proof, that those who are unwilling to act as he suggests are primarily fearful. He doesn’t state precisely what they fear or consider if such fears are legitimate. Fear, even if this is a motivation, is not necessarily a bad thing. Legitimate fear may be a good thing.

 

There may be several valid reasons his dissenting colleagues disagree with him, and he fails to explore these possibilities. They may include, but are not limited to:

 

1. His suggested actions are illegal, and most bioethicists respect the law.
2. He assigns the risks and costs that aiding and abetting this mixed group of immigrants represents to current legal residents who have no culpability in creating the crisis.
3. He does not state an assumption buried in his plans, that the federal government and the taxpaying, legal residents of this country have an obligation, in fact duty, to bear the costs for this group. He offers no cogent argument to support this assumption.
4. He fails to note that we do not protect or advocate for other lawbreakers, such as drunk drivers, murderers, pedophiles, abusive parents or assailants who injure themselves or others due to their poor choices and actions. Instead, we cooperate with promoting law enforcement access to such persons in our healthcare facilities. Failing to report abusive parents to authorities, for instance, is unethical and illegal.

 

Writing in the National Review, Wesley J. Smith responds concisely but persuasively, and this essay is worth reading. Kuczewski laments that he fears “that very, very few bioethicists will engage in any activity to advocate for (noble sounding term—my comment) or implement such measures (impeding ICE from apprehending illegals—clarification from context) in their university or health system.” Smith states, “I hope he is right. Bioethicists should support law enforcement, not seek to thwart it in favor of a particular category of wrongdoer.”

 

What are we to do? Complicated problems require complex solutions, and I cannot address all the elements of this difficult question here. Further discussion is needed. I concede that Kuczewski’s intentions may be good, and there are many godly, kind souls who would agree with him. However, I have some thoughts.

 

While principlism, a la Beauchamp and Childress, has its own problems, it can serve as a useful scaffold to examine this issue:

 

1. Justice—is it just to demand that uninvolved, neutral parties bear the costs and risks for the bad decisions of others?
2. Beneficence—is another of the four standards. While impeding ICE may be beneficial for the immigrants, it could prove costly and dangerous for those who take such actions and for many who will be impacted by the choices of those who do. Think about Laken Riley.
3. Autonomy—focuses on individuals’ rights. Kuczewski attempts to impose his concepts of morality on many, condemning those who disagree with his as fearful and unwilling to fulfill their duties to others.
4. Non-maleficence—forcing bioethicists as a group, and hospital systems as a whole, to pursue his demands may results in negative outcomes for numerous innocent persons.
5. Compassion is a worthy sentiment, but when establishing laws and policies for a hospital or nation, justice to all parties—including currents residents as well as undocumented immigrants—is paramount. We cannot demand actions of some to benefit others, particularly when such actions may directly injure those of whom such actions are demanded.

 

We live in unusually tempestuous times: open border policies, espoused by some and in essence implemented in the U.S. for the last four years, and notably not practiced anywhere else in the world, have created numerous problems. Good solutions are hard to come by, but illegally defying ICE is not one of them.