
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.