A recent New York Times article highlights the fine line between medical care for individuals that need it and the difficulties that come because of immigration status. The story talks about an illegal immigrant from Mexico living in New York City whose kidneys are failing. His siblings are donors, but the cost of the surgery requires the need for surgery. The man was a waiter in his early 30s, a husband and father of two, so well liked at the Manhattan restaurant where he had worked for a decade that everyone from the customers to the dishwasher was donating money to help his family.
When his younger brother volunteered to donate a kidney to restore him to normal life, they encountered a health care paradox: the government would pay for a lifetime of dialysis, costing $75,000 a year, but not for the $100,000 transplant that would make it unnecessary.
For nearly two years, the brothers and their supporters have been hunting for a way to make the transplant happen. Their journey has taken them through a maze of conflicting laws, private insurance conundrums and ethical quandaries, back to the national impasse between health care and immigration policies.
Doctors sought a transplant center that would take him. Hospitals in the city receive millions of taxpayer dollars to help offset care for illegal immigrants and other uninsured patients. But at one hospital, administrators apparently overruled surgeons willing to waive their fees. At another, he was told to come back when he had legal status or $200,000.
A last resort is a return to Mexico, where the operation costs about $40,000. But to pay off the necessary loans, the and his brother, a deli worker, would have to sneak back in through the desert. If they failed, they would be cut off from their children in Brooklyn, who are United States citizens.
Bellevue performs no transplants but, as a trauma center, often supplies organs harvested, with family consent, from illegal immigrants fatally injured at work.
“Here’s the paradox: he could donate, but he can’t receive,” Dr. Manheimer said, calling the imbalance troubling. Organ registries do not record illegal status, but a study estimated that over a 20-year period noncitizens donated 2.5 percent of organs and received fewer than 1 percent.
To those focusing on immigration enforcement, however, the inequity runs the other way. “They should not get any benefit from breaking the law, especially something as expensive as organ transplants or dialysis,” said Representative Dana T. Rohrabacher, Republican of California, who contends that care for illegal immigrants is bankrupting American health care and has sought to require that emergency rooms report stabilized patients for deportation unless they prove citizenship or legal residence.
“If they’re dead, I don’t have an objection to their organs being used,” Mr. Rohrabacher added. “If they’re alive, they shouldn’t be here no matter what.”
To Ruth Faden, the director of the Johns Hopkins Berman Institute of Bioethics, the brothers’ case, like the transplant statistics, illustrates how quickly firm principles on both sides unravel in practice. “We tie ourselves up in knots,” she said, “because we’ve accepted as a country and in international human rights law that if someone shows up in extremis in your emergency room, the nurses and doctors and technicians are morally obligated, and legally obligated, to provide that life-saving care.”
How to begin refusing care, she added, becomes a dilemma for “real people in real time.”
This dilemma shows just how personal and difficult it is where the line in providing health care for those in need gets mired by the legal situations a person is in. Balancing the humanitarian side of medicine with the rule of law has become a focal point in a discussion where those that want reform on the immigration enforcement side appear unfeeling towards the plight of illegal immigrants who’s suffering have an impact on U.S. citizen children. The other side is that those who appear soft on immigration enforcement minimize the other concerns regarding the costs that come with trying to increase the enforcement and how it is a drain of taxpayer resources.
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