It seems to me that such actions would actively endanger more people of the categories for whom the authors advocate than it would protect.
A pro-illegal immigrant advocacy article in the New England Journal of Medicine urges doctors to protect undocumented patients by impeding law enforcement in the context of the physician/patient relationship.
First, the authors complain that enforcing immigration law has engendered an environment of fear:
The current climate echoes that surrounding the Covid-19 pandemic, when fears of surveillance, deportation, and the effects of new public-charge policies drove immigrant communities to avoid necessary care, which led to increased morbidity and mortality. As erosion of trust in institutions again drives patients away from clinics, confronting their needless suffering also exacts a toll on physicians, who may experience moral distress, feeling complicit in a system that’s failing marginalized groups. [Citations omitted.]
Whose fault is that? People who break the law and come here without authorization — which by definition entails risk of deportation — or the authorities enforcing laws duly enacted by Congress and signed by the president?
The authors urge doctors to treat patients under the principles of trauma induced care (TIC):
The foundation of TIC is safety. Given the precarity of undocumented patients’ daily lives, prioritizing physical and emotional security is paramount. Physicians should avoid both asking about and documenting a patient’s legal status, since doing so inherently undermines safety.
Maintaining patient privacy is fine. So is providing quality medical care for patients. And no one expects doctors to inform on patients who are here illegally, which would be a violation of patient privacy.
But the authors go farther, urging doctors to provide patients with information that would actively impede the ability of immigration authorities to enforce the law beyond the “sanctuary” of the examination room:
Since traveling to clinic can feel inherently risky, physicians should advocate for secure, alternative modes of care, such as telehealth visits, home visits, and mobile clinics. If patients report that fear of deportation is a barrier to leaving home, clinicians and staff should engage in action-oriented problem solving and use workarounds to assure their safety. Examples include coordinating with trusted contacts to get medications to patients or using mail orders to ensure continuity of care without exposing patients to unnecessary risk. Promoting emotional safety requires recognizing chronic trauma and ensuring that the exam room remains a reliable sanctuary.
The authors also advocate that doctors protect illegal immigrants by helping them stay hidden and/or represented by activists in non-medical contexts:
Physicians may not be aware of every local resource, but clinics can partner with dedicated social workers to facilitate connections. Linking patients to grassroots advocacy organizations and community health workers for peer support and community resources may nurture stability and ultimately translate individual empowerment into collective resilience. In addition, reminding patients that they can bring trusted support persons to their appointments reinforces these networks.
It seems to me that such actions would actively endanger more people of the categories for whom the authors advocate than it would protect. Illegal immigration involves horrible risks, such as being murdered, kidnapped, robbed, defrauded, sex trafficked, injured, malnourished, or sickened. The “safer” and more supported would-be illegal immigrants think they will be coming to the U.S., the more likely they will be to undertake such a hazardous passage.
That point aside, in reading this and other recently published articles in the NEJM urging doctors to actively impede immigration law enforcement, it seems to me that the medical establishment advocates providing undocumented patients with more personalized care than that generally received by citizens and those here legally. I not only find that odd, but since the presence of many millions of illegal immigrants is bad for the country generally, one might even go so far as to say that it is unpatriotic.