Immigration: Pragmatism & Prophecy Mark Kuczewski, PhD Loyola University Chicago 1.Three common...
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Transcript of Immigration: Pragmatism & Prophecy Mark Kuczewski, PhD Loyola University Chicago 1.Three common...
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Immigration: Pragmatism & ProphecyMark Kuczewski, PhD
Loyola University Chicago1. Three common scenarios involving undocumented patients:
a. DREAMer M.D.s – Loyola Stritch breaks ground (Fall 2012)b. Forced Medical Repatriationc. Access to Health Insurance
2. Each best resolved by treating patient/person as full member of community rather than truncating participation. (Preservation of values of community institutions; recasting concept of benefit)
3. Through participation, community’s equity interest in person grows and vice versa.
4. Prophetic Role of Catholic Health Care
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Loyola University Chicago Neiswanger Institute for Bioethics & Health Policy
www.bioethics.luc.edu
Mark G. Kuczewski, PhD Bioethicist
• Former President American Society for Bioethics & Humanities (ASBH)
• Chair, Department of Medical Education
• Interests include End-of-Life Care, Spirituality & culture in medicine, Communitarian & Case-based ethics
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An e-mail arrived . . .(May 2011)
A professor at a Jesuit university enquired of the medical school prospects for his student Clara:•3.94 GPA•Pre-Med double major in Biology & Spanish•Strong volunteer & service record•Does not have an authorized immigration status, i.e., is a DREAMer
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DREAMer M.D.s: Typical DREAMer Students
• Born outside the United States• Brought to the U.S. at a young age (< 16 yrs.)• Lived in U.S. more than 5 years• Commonly bi-lingual and bi-cultural• Sometimes university educated (High School
Diploma/GED is significant)• “Americans in every way but one: On paper”
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Why Clara Interested Stritch . . .
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DREAMers
• Financing of Medical Education – Illinois Finance Authority (IFA) – “no taxpayer dollars”
• Larger problem of educational financing for DREAMers
• Dreamers & DACA – “Liminal legality” Implications for Future of U.S.
• “Makers” v. “Takers”
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The Prophetic Voice of Catholic Philosophical Anthropology
Human beings are
• Intrinsically valuable beings - dignity
• Laboring animals – in a global economy; capital flows across borders but labor is artificially restricted
• Social animals with cultures – God’s self-revelation
• Political animals – entitled to participate in self-governance
Respecting our nature means
Welcoming the participation of all persons in the life of the community and society (i.e., hospitality, solidarity, social justice).
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Uninformed & Sinful Attitudes about Immigrants
• They take our jobs & depress wages by working for so little.
• They are free loaders: They come here for benefits/handouts, e.g., welfare, health care, education
• They refuse to assimilate, e.g., they won’t learn English.
• They have no right to be here and should stay in their own countries & the undocumented are law breakers
• Conclusion: In essence, they are ungrateful thieves by taking what does not belong to them. They are the “undeserving poor” i.e., “Takers”
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Policy Flows from Sinful Attitudes
• Prohibit or restrict any and all “benefits” to immigrants in general, but especially to undocumented immigrants, e.g., (a) Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996; (b) Affordable Care Act – Ineligibility issues; Further restrictive amendments offered; © Proposals to limit EMTALA-related benefits
• Any immigration reform is accompanied by increased penalties on immigrants and employers; Immigration Reform & Control Act 1986 (Simpson – Mazzoli)
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Affordable Care Act
LOYOLA UNIVERSITY CHICAGO Stritch School of Medicine
Reduces uninsured from approximately 50 million to 15-20 million by (a) Subsidized individual purchase and (b) Medicaid expansion
Individual Purchase on Exchanges
Indiv Purchase on Exchanges w/ subsidies
ExpandedMedicaid
Immigrants > 5 Yrs Yes Yes Yes
Immigrants < 5 Yrs Yes Yes NO
DREAMers (DACA) NO NO NO
Undocumented Immigrants
NO NO NO
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Insurance as Community Benefit
• EMTALA – community does not want people “dying in the streets.”
• Insurance enables delivery of care to be efficient, effective, rational; benefits community by minimizing cost, containing contagion, fostering opportunity
• ACA (exchanges, subsidies, Medicaid exp.) enable community members to participate in payment to extent possible and assume responsibility for health
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The Prophetic Example of Catholic Health Care in an Unjust World
• No Forced Medical Repatriation Jeopardizes our hospitals’ identity as caring, efficient, promoters of
public health Best Practice in Medical Repatriation = Informed Consent + Best
interest
• Treatment Consonant with Standard for Uninsured Patients Ex: Dialysis/kidney transplant v. Liver transplant Creativity & Shared Responsibility – with community, with local
providers
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“Welcoming the Stranger Among Us: Unity in Diversity” (USCCB 2000)
1. Rejection of anti-immigrant posture
2. Welcoming stance– Understanding cultures as hospitality
3. Acknowledgment that current immigrants are predominantly Catholic
4. Advocacy – (a) Legalization of maximum number of
undocumented
(b) Change of 1996 laws – IIRIRA & PRWORA
5. Ministry Outreach – Catholic health ministry
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What Catholic Hospitals Are Doing
LOYOLA UNIVERSITY CHICAGO HEALTH SCIENCES DIVISION
Cultural Hospitality • Interpreter programs
• Patient navigators
• Written materials – incl. consent forms, discharge instructions; attention to “low literacy” needs;
• Signage
• Masses
• Staff education programs (diversity committees)
• Build staff diversity
• Cultural celebrations – Feast of Our Lady of Guadelupe
• Bilingual baby showers
• Offer English as a Second Language classes (ESL)
Medical Hospitality
• Health screening programs for seasonal workers
• Develop community-wide provider consortium
• Find medical home for undocumented
• Mobile units deployed to appropriate areas
• Health promoter programs (promotoras de salud)
• Full-time advocate for immigrant community
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Argument for Permanent Inclusion
1. Duty to steward, not waste, resources; common good; People are naturally makers; exclusion turns them into takers
2. Globalization of Economy: Presence of large numbers of contributors in community suggest needs to be filled; needs are more objective than policy by fiat.
3. Globalization of IndifferenceE-mail: [email protected]
@mkuczew
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References• DREAMERS of DACA Status Welcome www.stritch.luc.edu/daca
• Kuczewski MG, Brubaker L. (2014) Medical Education for “Dreamers”: Barriers and Opportunities for Undocumented Immigrants. Academic Medicine 89(12): 1593-1598.
• Kuczewski MG, Brubaker L. Accepting Undocumented Immigrants: How We became the "Medical School of Dreams" and Dreamers. Academic Medicine Blog
• Kuczewski MG, Cassidy T. (2013) Health Care for Our Immigrant Neighbors: The Need for Justice and Hospitality. Health Care Ethics USA 21(3): 8- 16.
• Kuczewski MG. Can Medical Repatriation Be Ethical? Establishing Best Practices. American Journal of Bioethics 2012;12(9): 1-5.
• Kuczewski MG. Who is My Neighbor? A Communitarian Analysis of Access to Health Care for Immigrants. Theoretical Medicine and Bioethics 2011;32(4): 327-336
E-mail: [email protected]
@mkuczew
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Church Documents
• St. John Paul II (1999) Ecclesia In America
• USCCB (2000) Welcoming the Stranger Among Us: Unity in Diversity
• Catholic Bishops of Mexico & the United States (2003) Strangers No Longer: Together on the Journey of Hope
• Pope Francis Homily at Lampedusa
• Cardinal Sean O’Malley, OFM, Homily at the Border
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