Should we let a man die because he is an illegal immigrant?
Hannah Dreier reports in the Contra Costa Times:
Without a new kidney, Jesus Navarro will die.
The Oakland man has a willing donor and private insurance to pay for the transplant. But he faces what may be an insurmountable hurdle in the race to save his life: He is an illegal immigrant.
Administrators at UC San Francisco Medical Center are refusing to transplant a kidney from Navarro’s wife, saying there is no guarantee he will receive adequate follow-up care, given his uncertain status…
…If transplant doctors working with illegal immigrants are in a bind, so are the Navarros.
“We don’t know what to do,” said Navarro’s wife, watching her husband chase after their 3-year-old daughter. “It’s like we’re on a ledge — we can’t go here or there.”
I can understand situations where there just aren’t enough resources to save everybody, where doctors and administrators and government officials make their best efforts, but it just isn’t good enough. But here, Jesus Navarro has insurance and a willing donor (his wife!). He’s made it to the top of the list, and he’s being refused treatment because of his immigration status. Is this excusable in any way, or do we really live in that place?
He has insurance that’s willing to pay…American doctors.
Because the insurance industry is racist.Report
???
In what way and where is CC – or anyone – calling the insurance industry racist? Or is this just a kind of a “bu-bu-bu-bu- rascists!” thing?Report
DD’s specialty is complete non sequiturs that are vaguely related to the topic at hand but are really just about insulting people who think racism is a real thing that exists.Report
Well, apparently any time someone implies that an illegal immigrant is going to suffer a negative situation, it’s due to racism; ipso facto the insurance company is racist.Report
You don’t think you might wait for CC to actually call someone a racist before mocking him for his faulty thinking in calling someone a racist?
Out of curiosity, had you read the post when you posted that – or did you just see the headline and decide what it was going to say? (God knows we’ve all done that.)Report
DD’s not calling CC a racist, or the doctors, or anyone else. He’s actually pointing out (backhandedly) that this is a situation which on the surface appears to be racially motivated, but which can be justified on non-racial grounds.
He’s trying to draw attention to how some people might reflexively view the situation as an example of racism by focusing exclusively on the consequences of the decision-making procedure.Report
What about when that decision-making procedure systematically discriminates against a particular race?
Actually, I didn’t even think about race when I wrote the OP. I was more going for how absurd it is that a legal category can trump someone’s right to continue his existence, especially when he is willing to enter voluntarily into a contract to such. That is to say, racism isn’t what I’m attacking here; it’s bureaucracy against common sense, humanity, and freedom that’s the villain. Although a discussion about how this incident may or may not showcase a racist immigration system is interesting; if our immigration system is racist or racially-motivated to the core, that’s a whole different issue. Report
It’s not racist at all.
We make sure that Chinese people, Irish people, Russian people, Japanese people, Persian people, Hmong people, Nigerien people, and French people can’t just meander across the border either.Report
Here’s the thing though. It is effectively racist in that European countries generally have competent bureaucracies in place and high standards of living so that if someone from a European country does want to come and live here, it is relatively easy for them to fill out the paperwork and pay the fees that allow them to do so legally. It’s not so easy for people who are trying to escape failed or corrupt states.
I’m not saying our immigration system was designed to be racist, but if someone wanted to design a racist immigration system that kept out, say, people from Africa and Latin America, they could design ours. And that effect – to the immigrant – is all that matters.Report
It’s actually excusable.
He needs a lifetime of immuno-suppressant drugs. Without them, he’ll reject the kidney and die shortly thereafter.
Since his private insurance is no doubt tied to his ability to pay for it, he’ll lose that insurance if he’s deported and there may not be a reasonable guarantee that he’ll be able to get those drugs if he goes home.
This is a surmountable problem, granted, but it’s not entirely off-base for the hospital to refuse to do the transplant until his status is resolved, or his home country agrees to foot the bill for his drugs, or some other provider steps to the plate.Report
How many years with these drugs would change the calculus from “we shouldn’t do this” to “it’s fuzzy” and how many from “it’s fuzzy” to “we should”?Report
Who’s the “we”, here?
I’ve seen this happen up close. A well-meaning citizen who had hired an illegal immigrant for daycare found out that her daughter back in Nicaragua needed a transplant.
Rather than say, “Oh, that sucks”, said citizen got on the phone, and managed to arrange for a legal visit, pro bono surgery, and (through a lot of haranguing) got the Nicaraguan government to pledge to cover the drugs in question.
Seriously one of the most awesomely selfless things I’ve ever seen anybody do, honestly.
Now, if I was on the board of directors for the hospital and someone shoved this news story under my face, I would call said administrators into my office this morning and say, “Jesus Christ, are you out of your minds? Pick up the phone and call your contacts and get somebody to cover the drugs and do it before noon… or I’m taking it out of your collective salaries. Or give me your goddamn resignations. I’m scheduling a press conference to announce we’re going forward with this surgery because we’re a hospital and we don’t let our patients die. ”
But that’s just me.Report
How presumptious is this position? Why is it assumed he wouldn’t have access to adequate medical care in his home country?
And if this is the standard being applied, we probably shouldn’t offer medical treatment to drug addicts or alcoholics or fat people who are just going to waste all that good medicine the next time they shoot up or have a drink or go to McDonalds.Report
Actually, we’d really only need to ignore the elderly.Report
I’m actually on board with this… then again, I plan to check out when I’m 75.Report
Why is it assumed he wouldn’t have access to adequate medical care in his home country?
I don’t know, it probably depends on his native country and their health care policy. I heard enough about Nicaragua during my little anecdote above to know that international health policy is kind of a mess.
And if this is the standard being applied, we probably shouldn’t offer medical treatment to drug addicts or alcoholics or fat people…
Point of fact, drug addiction and alcoholism will get you knocked right off most transplant lists.Report
Transplant lists… but what about other medical care?
And it is not like the organ will go elsewhere. The organ either goes to him or stays with his wife. There is no cost incurred to the system by performing the operation. None.Report
And it is not like the organ will go elsewhere. The organ either goes to him or stays with his wife.
That’s an excellent point, and it makes me think that this is really just a pure bureaucratic problem. They have a pretty good rule in place, “don’t give the transplant to someone who we can’t be sure will get followup treatment,” because normally transplant situations actually are situations where (to quote the OP) “there just aren’t enough resources to save everybody.” That is, normally, giving that liver to Mr/Ms X means a Mr/Ms Y somewhere goes without. The rule is defined to maximize the utility of these limited resources.
The problem with such bureaucratic rules, though, is they’re not generally written to allow for exceptions, the unusual cases. If there’s no box on the form to check “wife’s liver, won’t go to Mr/Ms Y” then the bureaucrats hands (and doctors are, usually to their chagrin, bureaucrats) can’t move forward.
As I had a U of Oregon bureaucrat tell me once, “we can’t do this because there’s no rule saying we can.”Report
The problem with such bureaucratic rules, though, is they’re not generally written to allow for exceptions, the unusual cases.
Sure. This is why the top administrators should exercise actual judgement. Hence my earlier comment:
I would call said administrators into my office this morning and say, “Jesus Christ, are you out of your minds? Pick up the phone and call your contacts and get somebody to cover the drugs and do it before noon… or I’m taking it out of your collective salaries. Or give me your goddamn resignations. I’m scheduling a press conference to announce we’re going forward with this surgery because we’re a hospital and we don’t let our patients die.”
You need some semblance of baseline rules to prevent egregious mistakes. You need administrators to exercise oversight but they also need to know when they need to get on the phone and arrange for the rules to be followed while still allowing the outcome to happen.Report
Pat,
Obviously I’m sympathetic, but this is the UC Medical Center–the administrators are to a large extent merely high-level bureaucrats, not autonomous policymakers. It’s not too terribly likely their hands are tied, too.
I do, however, agree with you that they can ” get on the phone and arrange for the rules to be followed while still allowing the outcome to happen.” Many times in the maze of bureaucracy it’s not what you do that matters, but what you call it, that matters. But bureaucrats never get in trouble for saying “no,” and they can get in trouble for saying yes. If everyone’s in CYA mode, it’s all over.Report
This is a textbook case of a crisis that didn’t need to happen.
These are the sorts of things that should make you furious, if you have any sort of authority. And if it happened because you didn’t give people below you enough authority, you really should be pissed at yourself, too.Report
Well, but there it is. It’s entirely possible that nobody has the authority to order this transplant done.
What the legal practice of the past few decades has taught large high-liability companies is that if there’s One Man who Makes The Call, then that Man is gonna get sued every day of the week and twice on Sunday. Because, y’know, he didn’t Make The Call in my favor because he’s racist, or sexist, or a homophobe, or it was medical malpractice or a violation of labor law, I’m an atheist, whatever, he hates me for some reason and that’s why he didn’t decide my way. Lawyer up. Let’s do this.
When you have a Board Of Directors who Operate By Best Practices And ISO-Certified Procedure, then, well, we make our decisions according to fair and open transparent practices subject to periodic independent review. And who can sue someone for going by the book? And if the book says you don’t get a transplant, well, we’re all real sorry about that, but we’ve got these procedures and guidelines, see, and they say that ensuring continuance of patient care is one of our top priorities, and we shouldn’t make decisions that won’t allow for such. And no individual board member can do anything without a decision discussed at the periodical operations review meeting.Report
I don’t know if it’s universal, but in my state if the person gets treatment, they can get on the list.
But, in this case, some doctor and facility will do the operation. They just need exposure of the issue.Report
In this situation, the necessity of future healthcare coverage isn’t ethically relevant. The hospital can and therefore should do what it can to save Jesus Navarro’s life. That others may fail in their future obligations is no excuse for one to fail at one’s present responsibilities.Report
Setting asside racial politics a moment, it’s a numbers game.
You have a finite number of organs and a greater number of candidates. You have to have a system to be sure that the organs go to those who are going to get the most benefit for them. You try to do this compasionately. You try to do this fairly.
But if someone is unlikely to get the required medical care to survive after the surgery, is that the best use of the ~limited~ resource?
It’s disappasionate, yes, but there it is. It’s about the odds, and while that might not give warm fuzzies, that’s the nature of it. It’s (as said above) why certain addictions will get a patient removed from the candidate list. They want to be sure that the organ does the most good over time.
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But this won’t be using up that limited resource. There’s no indication that the wife would just donate the kidney to whomever was at the top of the list. She’s giving it to her husband.
Now, if they don’t have enough doctors to perform all the scheduled transplants, that’d be using up a limited resource, but I doubt that’s the case.Report
I completely agree with your “limited resource” logic, but my initial reaction to the OP was that the policy was built on the assumption that the donated kidney was a “limited resource” (part of the generally available pool of kidneys) and therefore required the patient to be assessed on a standard set of criteria.
Could it be as simple (in every sense of the word) as that?Report
Exactly. Policies don’t allow for the complexities and nuance of real life. It’s up to competent administrators to modify policies accordingly.Report
She can’t just yank a kidney out and stick it in him.
There is a rather intensive pair of medical procedures that need to be executed. Each one comes with risks attached.
I would not, for example (myself, if I was a doctor) agree to perform a kidney transplant from a healthy person to someone who was in a terminal state and would die in a month, even if they were both willing, even if the transplant would give the patient an extra week or three of life. The likelihood that your donor will suffer adverse effects over their lifespan is nontrivial… I, again just myself, would not want to enable this transaction by being a part of it.
Admittedly, I’m not a doctor.
So it’s not quite right to say that the only resource involved here is the kidney and it comes free of cost.Report
But then, if it’s only a couple months, maybe they could just put the kidney back when he’s done with it. (bah-DOOMP)Report
Well put, Kyle.Report
It’s pretty easy to spin that idea as “bastard hospital directors just care about money, ignore the years of follow-up treatments that would be necessary to ensure patient health”.Report
Odd, I’m not getting a limited resource question so much as a “We’re doctors and we’re not supposed to harm our patients. If we transplant your kidney and you get deported you’ll die painfully” response from the hospital. That really sucks but is slightly more defensible than a resource position since, as has been noted, the kidney is only available to him.Report
This, basically.Report
Perhaps I’m not reading you correctly – is the argument that doctor’s are willing to let the man die in a controlled environment because the risk that he might die painfully is too great?
Outside of “do no harm” consideration for the wife or the “limited resource” idea, the above doesn’t sound like proper ethical grounds for refusing treatment to the husband.Report
No, this is unjustifiable. If he was just on a transplant list and it was a situation with a shortage of donor, I could understand a policy of giving transplants to American first. But given that his wife is willing to donate a kidney to him, there’s no justification whatsoever for refusing him a life-saving transplant.Report
A kidney transplant is not an atomic procedure. Without the immunosuppressants, the patient dies (not well), and you’ve subjected the donor to a risky procedure for little actual benefit.
This isn’t about refusing him treatment because he’s not a citizen (or at least, it isn’t necessarily: we don’t have enough details to know for certain).
It’s about refusing him treatment because he has no guarantee of required access to the entire, necessary, treatment.Report
Ok…so I finally went and read the linked article…
The reason he’s not getting treated is because he can’t pay. Turns out he lost his job in an immigration audit and his insurance situation is now the problem – not the chance of deportation.Report
Not true. He can pay for the operation. The reason he’s not getting the treatment is that he may be put on public insurance or deported because of his immigration status, which was also the reason he was fired from his job. (Seriously, history will condemn us for this.)
Since California’s public insurance does not cover immuno-suppressants, UCSF won’t allow the operation to go through. Legally-speaking, it’s a very complicated situation. Morally-speaking, it’s not so complicated.Report
If he wants to gamble his life on the chance that he may receive the necessary post op drugs, that is his option.Report
It’s nice to see that the conversation has revolved around the fact that he’s going to another country, and not the reasons he’s going there. If Mr Navarro had been here on a tourist visa and needed the transplant, the same arguments would apply.
Congrats, guys (said VERY sincerely)Report
The fact that the U.S. doesn’t consistently offer donor visas is a stupid aspect of our consistently stupid immigration policy, yes. Sometimes it works itself out.
This is not the first time this story has happened, mind you.Report
I guess I’d have to say the War on Terror is the stupidest aspect of U.S. policy. Immigration is a very close second.Report
Sorry CC, I’d rank to War on Drugs considerably higher than Immigration on the stupid-o-meter. It’s hard to think of much that’s dumber than the WoT tho so I’ll give you that one.Report
You’re probably right.Report
We should probably make this a quiz.Report
We could have like ten different policy arenas and have people rank them from dumbest to least dumb and then add up all the points?Report
Yeah, I’m curious as to how the League would vote. Not just 10, though. Hm.
Okay, I’m going to make this a project.Report
I was thinking about doing it if you weren’t sure or didn’t want to. You are our data guy, however. Let me know.Report
I don’t want to make Murray’s mistakes 🙂
Give me a couple of days.Report