U.S. internal medicine doctors: mass deportation would be bad news for the country’s health

As politicians rush to one-up each other on who would be toughest on the 12 million people who reside in the U.S. without legal residency documentation ("illegal immigrants"), the idea of mass deportation has become the flavor of the day, championed by Donald Trump and supported to varying degrees by other candidates.

While critics have appropriately pushed back citing the high cost, ineffectiveness, and impracticality of mass deportation, there is another consequence that has been largely overlooked, which is the grave impact that kicking millions of people out of the country would have on the health of those directly affected, on their families, on their communities, and on the overall health of our country.  There are an estimated 160,000 undocumented persons in Pennsylvania and another 550,000 in New Jersey (2010 estimates) whose health could be directly placed at risk under a mass deportation policy.

It is this concern about the health consequences of deportation that led the American College of Physicians, my employer, to urge physicians to speak out, individually and collectively, against mass deportation, reaffirming a position that it first adopted in 2011.  ACP, based in Philadelphia, is the nations' largest physician specialty society and second largest physician membership organization, representing 143,000 internal medicine physician and medical student members.

"Largely missing from the debate over immigration policies has been consideration of the potentially grave impact that large-scale deportation would have on the health of those directly affected, their families, their communities, and on overall U.S. public health," said Wayne J. Riley, MD, MPH, MBA, MACP, ACP's president.  "Large-scale deportation of undocumented residents would have severe and unacceptable adverse health consequences for many millions of vulnerable people.  Numerous studies show that deportation itself, as well as the fear of being deported, causes emotional distress, depression, trauma associated with imposed family separations, and distrust of anyone assumed to be associated with  federal, state and local government, including physicians and other health care professionals providing care in publicly-funded hospitals and clinics."

"Such distrust can result in patients delaying and/or not obtaining needed care, including for highly infectious diseases like SARS and tuberculosis," Dr. Riley continued, "especially if physicians in publicly-funded healthcare facilities would be required to report to authorities on the immigration status of those seeking care from them, as has already been proposed by some states. We would consider such reporting requirements to be an unacceptable, impermissible intrusion on the patient-physician relationship."

The College also reaffirmed its view that U.S.-born children of undocumented parents should have the same access to health coverage and government-subsidized health care as any other U.S. citizen, as guaranteed by the Constitution's 14^th amendment.

Finally, ACP again issued a call for a national immigration policy on health care that balances legitimate needs and concerns to control the country's borders, that makes appropriate distinctions in eligibility for publicly-funded benefits between those who entered lawfully and those who did not, and that ensures that all U.S. residents have access to health care.

As I noted in a related post that I wrote last week for the ACP Advocate blog, the medical profession's standards of ethics and professionalism obligate physicians to advocate for the health of all persons without regard to their legal residency status.  ACP's Ethics Manual, Sixth Edition, affirms that "All physicians must fulfill the profession's collective responsibility to advocate for the health, human rights, and well-being of the public. . . 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."

I hope that physicians and other health care professionals and their associations will heed ACP's call to speak out, 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.  And I hope that voters will heed the advice of their doctors when they inform us that mass deportation would be bad for the country's health, and that they will tell the politicians the same.

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