Yesterday's article in the LA Times about young immigrant liver-transplant survivors who hit 21 and lose state coverage, often causing a lapse in their post-transplant care without chances for re-transplantation, raises issues so important, it should spark questions in a forthcoming presidential debate. Not only does it shine a light on whether or not young, illegal immigrants should receive taxpayer-supported medical treatment; it is powerful enough to illuminate a candidate's sheer humanity, regardless of his or her opinion on immigration reform.
In reporter Anna Gorman's story, a young woman circumvented near-certain death and won her way back to state-supported care at UCLA, which could offer her another transplant if necessary as opposed to care provided by the county. Her strategy? Admitting that she lives in this nation illegally. Bold.
Now, I am not in support of every immigrant having to take such a leap in our current immigration-reform environment; but that isn't the issue. When terminal or chronic and progressive illnesses strike, certain compromises need to be made.
And surprise: For as many citizens who don't want an illegal immigrant on a liver-transplant waiting list in a country where supplies are low and costs are high, there are humanitarians in medicine and the field of medical ethics who believe that a hospital should not drop a pediatric immigrant transplant case--or any other type of chronic case--just because the patient has reached legal drinking age.
It is a terribly imperfect system, to be sure. But I don't just feel for these patients as a chronic disease sufferer who received a transplant during the pediatric period of my life. I see and hear about what these patients deal with firsthand as the husband of a cross-cultural health-psychology researcher who, among other things, assesses quality of life and depression in monolingual immigrant patients with similar circumstances.
The facts: These patients are under tremendous stress outside of their medical predicaments--as if they need anything else to worry about. Other cultures also sometimes view chronic illness differently than Americans—it's not just "bad luck" or something that can be "fixed." Some patients from other countires, for instance, may consider one disease a curse or punishment. Some may never tell family members. Some may not seek treatment consistently enough without strong reminders. These factors need to be considered when rendering a decision about medical care for non-citizens.
In fact, it's even harder to be a sick young adult as an illegal resident, and I say that knowing how terribly difficult it is to weather multiple conditions of this severity as an American citizen. When these 21-year-old immigrants received livers as children under state-supported insurance plans, they didn't ask for American care. They didn't ask to be here at all, most likely. We cannot hold them responsible for a choice they didn't make, and to ignore them on this count would show some of the lowest regard for human life I can imagine. While these patients may not pay the same taxes as other American residents, notifying the government of their status is not as simple as it sounds. It is a brave and risky measure. One with potentially harsh repercussions for their families that should be rewarded with at least the same care that would be given to any other American child.
For the record, oncologists consider patients "pediatric" up to and sometimes beyond 20 years of age. But the public has caught on to this labeling due to powerful cancer survivorship networks like that of Lance Armstrong's (love him or hate him). Liver disease and other ailments that strike patients up to this age, and perhaps beyond, should also be considered pediatric. And pediatric patients--for starters, at least—should have a reliable medical support system in this country regardless of how or when they arrived on these shores. As Dr. Michael Shapiro, the vice chairman of the ethics committee for the liver network, said in Gorman's LA Times piece: there's probably a better chance that more illegal immigrants donate organs in America than those who receive them.
So let's pose the question to all candidates, regardless of political party. The results could tell us not who is ultra-conservative or ultra-liberal but who really values human life. They could give us a true sense of a candidate's character. And wouldn't that be a little more interesting than getting nitpicky about whose national health plan will do exactly what before it's even put into place.