Physicians might be facing a moral dilemma when it comes to immigration

The Hippocratic oath is the oath of ethics physicians typically abide by, but those working in U.S. immigration detention facilities may be facing a major dilemma. In fact, physicians working in these facilities may not be able to uphold the pledge updated and approved by the World Medical Association in 2017 to “not use my medical knowledge to violate human rights and civil liberties, even under threat.”

That’s according to Paul Spiegel, MD, MPH, of Johns Hopkins Bloomberg School of Public Health, and colleagues, who penned a viewpoint in JAMA in August.

According to the authors, the immigration issue in the U.S. at the border with Mexico has become a “humanitarian emergency,” with migrants being held in overcrowded and unsanitary conditions without sufficient medical care. Of particular concern is the detention of children, who should not be detained for immigration reasons at all, they said.

“Given the reports of inhumane, overcrowded, and unsanitary conditions, including insufficient water and toilets, lack of clean clothing and bedding, high exposure to psychological stress, and poor medical care in many of the DHS processing and detention facilities, how can and should needed medical care for detainees be structured, especially given the dual loyalty challenges that emerge if physicians are employed by the agency in charge of detaining migrants?” Spiegel et al. wrote.

To care properly, without violating ethical oaths, healthcare professionals should insist to adhering to clinical independence to provide care to patients in detention centers. That means clinicians are not subject to retribution for reporting medical charts or to provide transparency to authorities.

The care of these patients in immigration detention facilities also need an independent health oversight body to monitor the health services, insulated from government interference. Lastly, the agencies involved in the detention facilities should be required to regularly report how they are meeting their own and international standards for each facility.

See the full viewpoint here.