American College of Physicians urges physicians to oppose mass deportation

The American College of Physicians (ACP) today called on physicians, individually and collectively, to speak out against proposals to deport the 12 million U.S. residents who lack documentation of legal residency status, citing the adverse impact that mass deportation would have on individual and the health of the public.

ACP has had policy since 2011 opposing mass deportation of undocumented residents while also recognizing the need for the United States to have control over who it admits within its borders and to enact and implement laws designed to reduce unlawful entry.

In recent weeks, there has been a renewed political and policy debate over deporting all U.S. residents who lack legal documentation, as well as other changes to immigration law and enforcement.

"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."

Today, ACP formally reaffirmed its view, expressed in its 2011 paper, that any policy intended to force the millions of persons who now reside unlawfully in the U.S. to return to their countries of origin could result in severe health care consequences for affected persons and their family members, create a public health emergency, result in enormous costs to the health care system of treating such persons (including the significantly increased costs associated with correctional healthcare services during periods of detention), and would likely to lead to racial and ethnic profiling and discrimination. 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 14th amendment.

In a related blog post, Robert Doherty, ACP's senior vice president of governmental affairs and public policy, suggested that the medical profession's own standards of ethics and professionalism may obligate physicians to advocate for the health of all persons without regard to their legal residency status. The College's Ethics Manual, Sixth Edition, he noted, 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. Physicians have an opportunity and duty to advocate for the needs of individual patients as well as society."

Finally, ACP reaffirmed its 2011 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.

"The national debate over immigration policy today is at a key juncture," Dr. Riley concluded. "Physicians and other health professionals must remind politicians and policymakers that deporting millions of vulnerable people would have adverse health care consequences, not only for the people directly affected and their families, but also, for their local communities and for the United States as whole. Instead, we need a balanced immigration policy that ensures access to healthcare for all U.S. residents while recognizing that we need appropriate controls over who is admitted."