Migrants’ Lives, Immigration Policy, and Ethics Work

The Russ­ian poet Anna Akhma­to­va was a moth­er sep­a­rat­ed from her child by a state pol­i­cy of ter­ror. Dur­ing the 1930s, she and oth­er moth­ers would gath­er out­side a Leningrad prison, des­per­ate for infor­ma­tion. One day, after 17 months of “wait­ing in prison queues,” anoth­er woman whis­pered to her, “‘Could one ever describe this?’ And I answered, ‘I can.’” Akhmatova’s poem cycle Requiem reflects on the anguish of fam­i­ly sep­a­ra­tion from the per­spec­tive of a par­ent, who “stood for three hun­dred hours/And no-one slid open the bolt.”

The U.S. Jus­tice Department’s April deci­sion to jail and crim­i­nal­ly pros­e­cute adult migrants appre­hend­ed after cross­ing the U.S.-Mexico bor­der and sep­a­rate chil­dren from par­ents, explainedhere, and here in visu­al form, has pro­duced its own nar­ra­tives of ter­ror. The most hor­ri­fy­ing thus far is the record­ing of the voic­es of chil­dren in a Bor­der Patrol deten­tion facil­i­ty, plead­ing for their par­ents. In the record­ing obtained by ProP­ub­li­ca, a Sal­vado­ran girl is deter­mined to shape her own sto­ry, to “describe this.” She has mem­o­rized her aunt’s phone num­ber, and begs a con­sular offi­cial to make a phone call. Any adult who has been respon­si­ble for a young child would rec­og­nize how this lit­tle girl’s moth­er has pre­pared her for a sep­a­ra­tion, by teach­ing her cru­cial infor­ma­tion and explain­ing how to find an adult to trust.

ProP­ub­li­ca also spoke with the child’s aunt, who said, “‘Imag­ine get­ting a call from your 6‑year-old niece. She’s cry­ing and beg­ging me to go get her. She says, ‘I promise I’ll behave, but please get me out of here. I’m all alone.’” The listener’s hope that this child had found a way out of her ter­ri­fy­ing sit­u­a­tion was dashed by the real­i­ty of her aunt and cousin, whose years-long process of seek­ing asy­lum has been jeop­ar­dized by the recent Jus­tice Depart­ment rul­ing that peo­ple flee­ing gang or domes­tic vio­lence would no longer qual­i­fy for pro­tec­tion. They, too, are ter­ri­fied.

In the past six weeks, 2,342 chil­dren have been sep­a­rat­ed from their par­ents; as yet it is unclear how the June 20 exec­u­tive order end­ing fam­i­ly sep­a­ra­tion will be imple­ment­ed. Jour­nal­ists and immi­grant rights advo­cates have done hero­ic work on the ground, describ­ing injus­tice and work­ing for jus­tice. Attor­neys have had to swift­ly adapt ethics poli­cies and relat­ed pro­to­cols designed for inter­view­ing teenagers. As one attor­ney explained to a jour­nal­ist: “Our duty as attor­neys is to rep­re­sent the child’s express wish­es. Some­times, when they are real­ly young, it’s dif­fi­cult to ascer­tain those wish­es … because they can’t express as much…It is very emo­tion­al on me, and every­one else on staff. It is very hard to see very young chil­dren .…I feel like if we don’t do this, who else is going to? As upset­ting as it is, we have to do it.”

What should the field of bioethics do, beyond lend­ing our names, as cit­i­zens and pro­fes­sion­als, to the out­cry? Here are three rec­om­men­da­tions for our field, reflect­ing the con­tin­u­ing impor­tance of migra­tion as a phe­nom­e­non shap­ing our world.

1. In clin­i­cal teach­ing and learn­ing, frame and ana­lyze chal­lenges con­cern­ing care for migrants as prob­lems of jus­tice.

Pro­vid­ing good care to migrants whose legal sta­tus is uncer­tain or threat­ened is often expe­ri­enced as an eth­i­cal­ly fraught aspect of prac­tice. While acknowl­edg­ing prac­ti­tion­er moral dis­tress, bioethics edu­ca­tion should aim for a high­er stan­dard of basic knowl­edge con­cern­ing the sit­u­a­tion of migrants in a soci­ety. Research insights on how a system’s lead­ers and admin­is­tra­tors influ­ence pro­fes­sion­al behav­ior con­cern­ing a stig­ma­tized pop­u­la­tion should be part of this analy­sis.

2. In teach­ing and learn­ing, orga­ni­za­tion­al ethics, and pub­lic ser­vice, aim to under­stand and reflect the local impli­ca­tions of nation­al pol­i­cy.

World­wide, most migrants live in cities; most immi­grants to the U.S. live in just 20 met­ro­pol­i­tan areas. Pro­fes­sion­als in safe­ty-net health care in these cities are like­ly to encounter patients whose lives are shaped by a nation’s immi­gra­tion enforce­ment poli­cies. Pro­fes­sion­als who work near immi­grant deten­tion facil­i­ties will also encounter nation­al issues local­ly. Learn­ing from local col­leagues with exper­tise in immi­gra­tion law and immi­grant health advo­ca­cy con­tributes new knowl­edge to our field. Our vocab­u­lary can help these col­leagues reflect on their own eth­i­cal chal­lenges.

3. In eth­i­cal the­o­ry, account for the migrant and her chil­dren.

The­o­ries of jus­tice that spec­i­fy duties of wealth­i­er to poor­er regions con­cern­ing health-relat­ed resource allo­ca­tion and devel­op­ment may not ful­ly account for the rela­tion­ship between aid and migra­tion, or speak to the sta­tus of migrants. Bioethi­cists inter­est­ed in the glob­al dimen­sions of pub­lic health can con­tribute to the­o­ry, research, and pol­i­cy rec­om­men­da­tions con­cern­ing duties to migrants, and to their chil­dren.

Nan­cy Berlinger is a research schol­ar at The Hast­ings Cen­ter. She recent­ly com­plet­ed an aca­d­e­m­ic writ­ing res­i­den­cy at the Bel­la­gio Cen­ter of the Rock­e­feller Foun­da­tion for a book project on migrants as social cit­i­zens. She codi­rects The Hast­ings Center’s Undoc­u­ment­ed Patients project, a knowl­edge hub on health care access for unau­tho­rized migrants and mixed sta­tus fam­i­lies in the Unit­ed States. Rachel Zacharias, a project man­ag­er and research assis­tant at The Hast­ings Cen­ter, pro­vid­ed back­ground research.