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Immigration: Pragmatism & Prophecy Mark Kuczewski, PhD Loyola University Chicago 1.Three common scenarios involving undocumented patients: a. DREAMer M.D.s.

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Presentation on theme: "Immigration: Pragmatism & Prophecy Mark Kuczewski, PhD Loyola University Chicago 1.Three common scenarios involving undocumented patients: a. DREAMer M.D.s."— Presentation transcript:

1 Immigration: Pragmatism & Prophecy Mark Kuczewski, PhD Loyola University Chicago 1.Three common scenarios involving undocumented patients: a. DREAMer M.D.s – Loyola Stritch breaks ground (Fall 2012) b. Forced Medical Repatriation c. 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

2 Loyola University Chicago Neiswanger Institute for Bioethics & Health Policy 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

3 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

4 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”

5 Outstanding academic qualifications Personal qualities: Overcame extraordinary life circumstances Added Value of Diversity Social Justice – for Patients for Clara But Clara was out of luck (2011) till Deferred Action for Child Arrivals program (DACA), June 15, 2012. Why Clara Interested Stritch...

6 Day 1 DREAMERS of DACA Status Welcome

7 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”

8 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).

9 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”

10 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;restrictive amendments © 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)

11 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 Expanded Medicaid Immigrants > 5 Yrs Yes Immigrants < 5 Yrs Yes NO DREAMers (DACA) NO Undocumented Immigrants NO

12 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

13 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

14 “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

15 What Catholic Hospitals Are Doing LOYOLA UNIVERSITY CHICAGOHEALTH 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

16 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 Indifference E-mail: @mkuczew

17 References DREAMERS of DACA Status Welcome Kuczewski MG, Brubaker L. (2014) Medical Education for “Dreamers”: Barriers and Opportunities for Undocumented Immigrants. Academic Medicine 89(12): 1593-1598.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 BlogAcademic 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.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: @mkuczew

18 Church Documents St. John Paul II (1999) Ecclesia In AmericaSt. John Paul II (1999) Ecclesia In America USCCB (2000) Welcoming the Stranger Among Us: Unity in DiversityUSCCB (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 HopeCatholic Bishops of Mexico & the United States (2003) Strangers No Longer: Together on the Journey of Hope Pope Francis Homily at LampedusaHomily at Lampedusa Cardinal Sean O’Malley, OFM, Homily at the BorderHomily at the Border


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