Mass deportation, as proposed by Donald Trump, and echoed to varying degrees by other politicians, would have a catastrophic effect on the health of the approximately 12 million undocumented residents of the United States. Physicians accordingly have an ethical responsibility to speak out, individually and collectively, for the health of these people, and against mass deportation.

That the medical profession is obliged to advocate for the health of all persons, without regard to their legal residency status, is well-established. As the ACP’s Ethics Manual, Sixth Edition, affirms, “All physicians must fulfill the profession’s collective responsibility to advocate for the health, human rights, and well-being of the public.”

“Health and human rights are interrelated,” it continues. “When human rights are promoted, health is promoted. Violation of human rights has harmful consequences for the individual and the community. Physicians have an important role to play in promoting health and human rights and addressing social inequities. This includes caring for vulnerable populations, such as the uninsured and victims of violence or human rights abuses. Physicians have an opportunity and duty to advocate for the needs of individual patients as well as society.”

It is indisputable that people who are undocumented, and at risk of deportation, are especially vulnerable to adverse and inequitable health consequences:

• “Worries about their legal status and preoccupation with disclosure and deportation can heighten the risk for emotional distress and impaired quality of health.”
• “Restricted mobility; marginalization/isolation; stigma/blame and guilt/shame; vulnerability/exploitability; fear and fear-based behaviors; and stress and depression are specific to undocumented immigrants and have health and mental health implications.”
• The psychosocial impact of deportation include “the trauma of sudden and imposed family separation” … “drug use and less interaction with medical or treatment services (including HIV testing, medical care, and substance abuse treatment” … adverse “changes in family structure and stability.”
• “The aftermath of deportation impacts entire communities as it instills fear of family separation and distrust of anyone assumed to be associated with the government, including local police, school personnel, health professionals, and social service professionals.”

Such adverse health impacts would be exponentially higher if the United States were to attempt to remove by force every person who is in the country unlawfully.

Recognizing this danger, the American College of Physicians asserted in a 2011 position paper on immigrant access to health care that:

“Any policy intended to force the millions of persons who now reside unlawfully in the U.S. to return to their countries of origin through arrest, detention, and mass deportation could result in severe health care consequences for affected persons and their family members (including those who are lawful residents but who reside in a household with unlawful residents — such as U.S.-born children whose parents are not legal residents), creates a public health emergency, results in enormous costs to the health care system of treating such persons (including the costs associated with correctional health care during periods of detention), and is likely to lead to racial and ethnic profiling and discrimination.”

Instead of mass deportation, ACP advocated “for a national immigration policy on health care that balances the needs of the country to control its borders, provides access to health care equitably and appropriately, and protects the public’s health.”

In the same paper, the College also cautioned that a policy of mass deportation could compromise the patient-physician relationship if it required that physicians report on the legal status of their patients:

“Any law that might require physicians to share confidential information, such as citizenship status to the authorities, that was gained through the patient–physician relationship conflicts with the ethical and professional duties of physicians. National immigration policy should respect the boundaries of this relationship and the ethical obligations of physicians and not require physicians to reveal confidential information. Therefore, federal policies should not intrude upon a physician’s obligation to treat patients, regardless of legal status, and physicians should not be required to report on the immigration status of patients.”

Finally, ACP advocated that:

“U.S.-born children of parents who lack legal residency should have the same access to health coverage and government-subsidized health care as any other U.S. citizen” noting that “as outlined by the 14th Amendment to the U.S. Constitution, all persons born or naturalized in the U.S. and subject to the jurisdiction thereof are citizens of the U.S. and of the state wherein they reside. This means that a child born in the U.S. to immigrant parents automatically becomes a citizen … U.S.-born children should not be at a disadvantage from receiving the benefits of U.S. citizenship because of their parents’ immigrant status and fear of deportation.”

ACP clearly was prescient in anticipating the current debate over mass deportation and the citizenship of U.S. born children of undocumented persons, addressing the issue solely from the standpoint of advocating for the individual and collective health of the all persons, without regard to legal residency status.

But given that the direction of the debate has taken a decidedly wrong turn in the four years since ACP released its recommendations, it is high time for physicians, and their professional associations, to raise their voices now, individually and collectively, against mass deportation of undocumented persons, for the constitutionally-guaranteed right of their U.S. born children to have the same access to health coverage and government-subsidized health care as any other U.S. citizen, and against any policy that would require that physicians report on the immigration status of their patients or otherwise compromise their ethical obligation to provide care for all.

Today’s question: Will you take up the call to speak out against mass deportation and for policies to ensure access to healthcare for all U.S. residents, regardless of legal residency status?