Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-26T03:54:27.889Z Has data issue: false hasContentIssue false

A Right to Privacy and Confidentiality: Ethical Medical Care for Patients in United States Immigration Detention

Published online by Cambridge University Press:  01 January 2021

Abstract

Recently, John Doe, an undocumented immigrant who was detained by United States Immigration and Customs Enforcement (ICE), was admitted to a hospital off-site from a detention facility. Custodial officers accompanied Mr. Doe into the exam room and refused to leave as physicians examined him. In this analysis, we examine the ethical dilemmas this case brings to light concerning the treatment of patients in immigration detention and their rights to privacy. We analyze what US law and immigration detention standards allow regarding immigration enforcement or custodial officers’ presence in medical exams and documentation of detainee health information. We describe the ethical implications of the presence of officers in medical exam rooms, including its effects on the quality of the patient-provider relationship, patient privacy and confidentiality, and provider's ability to provide ethical care. We conclude that the presence of immigration enforcement or custodial officers during medical examination of detainees is a breach of the right to privacy of detainees who are not an obvious threat to the public. We urge ICE and the US Department of Homeland Security to clarify standards for and tighten enforcement around when officers are legally allowed to be stationed in medical exam rooms and document detainees’ information.

Type
Independent Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Stoughton, S. and Hampton, K., “Not in My Exam Room: How U.S. Immigration Enforcement Is Obstructing Medical Care,” Physicians for Human Rights Report (June 10, 2019), available at <https://phr.org/resources/not-in-my-exam-room/> (last visited February 12, 2020); Fink, S., “Migrants in Custody at Hospitals Are Treated Like Felons, Doctors Says,” New York Times, June 10, 2019, available at <https://www.nytimes.com/2019/06/10/us/border-migrants-medical-health-doctors.html> (last visited February 12, 2020).+(last+visited+February+12,+2020);+Fink,+S.,+“Migrants+in+Custody+at+Hospitals+Are+Treated+Like+Felons,+Doctors+Says,”+New+York+Times,+June+10,+2019,+available+at++(last+visited+February+12,+2020).>Google Scholar
Haddal, C. C., “Border Security: Key Agencies and Their Missions,” U.S. Congressional Research Service, Report for Congress, RS21899 (January 26, 2010), available at <https://fas.org/sgp/crs/homesec/RS21899.pdf> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
Puhl, E., Overview of the Deportation Process: A Guide for Community Members & Advocates (December 21, 2018), Immigrant Legal Resource Center, available at <https://www.ilrc.org/sites/default/files/resources/overview_deport_process-20181221.pdf> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
“ABA Civil Immigration Detention Standards,” American Bar Association, (2012), available at <https://www.americanbar.org/content/dam/aba/administrative/immigration/abaimmdetstds.authcheckdam.pdf> (last visited February 12, 2020) [hereinafter cited as ABA Standards], at 1; “Detention Management,” U.S. Immigration and Customs Enforcement, (February 5, 2020), available at <https://www.ice.gov/detention-management> (last visited February 12, 2020) [hereinafter cited as ICE Detention Management].+(last+visited+February+12,+2020)+[hereinafter+cited+as+ABA+Standards],+at+1;+“Detention+Management,”+U.S.+Immigration+and+Customs+Enforcement,+(February+5,+2020),+available+at++(last+visited+February+12,+2020)+[hereinafter+cited+as+ICE+Detention+Management].>Google Scholar
Luan, L., Profiting from Enforcement: The Role of Private Prisons in U.S. Immigration Detention (May 2, 2018), Migration Policy Institute, available at <https://www.migrationpolicy.org/article/profiting-enforcement-role-private-prisons-us-immigration-detention> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
See Luan, supra note 5; “Performance-Based National Detention Standards 2011, Revised December 2016,” U.S. Immigration and Customs Enforcement, (December 2016), available at <https://www.ice.gov/doclib/detention-standards/2011/pbnds2011r2016.pdf> (last visited February 12, 2020) [hereinafter cited as ICE PBNDS 2016].+(last+visited+February+12,+2020)+[hereinafter+cited+as+ICE+PBNDS+2016].>Google Scholar
See ABA Standards, supra note 4; See ICE Detention Management, supra note 4.Google Scholar
See ICE PBNDS 2016, supra note 6, at 257.Google Scholar
See ICE PBNDS 2016, supra note 6, at 261.Google Scholar
See ICE PBNDS 2016, supra note 6, at 268.Google Scholar
See ICE PBNDS 2016, supra note 6, at 268.Google Scholar
See ICE PBNDS 2016, supra note 6, at 268.Google Scholar
See ICE PBNDS 2016, supra note 6, at 268.Google Scholar
“National Standards on Transport, Escort, Detention, and Search,” U.S. Customs and Border Protection, (October 2015), available at <https://www.cbp.gov/sites/default/files/assets/documents/2017-Sep/CBPTEDSPolicyOct2015.pdf> (last visited February 12, 2020) [hereinafter cited as CBP Standards], at 17.+(last+visited+February+12,+2020)+[hereinafter+cited+as+CBP+Standards],+at+17.>Google Scholar
Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub. L. 104–191, 110 Stat. 1936 (1996), 45 C.F.R. § 160, § 164(a), and § 164(e) (2002).Google Scholar
See ICE PBNDS 2016, supra note 6, at 277.Google Scholar
Goldstein, M. M., “Health Information Privacy and Health Information Technology in the U.S. Correctional Setting,” American Journal of Public Health 104, no. 5 (2014): 803–9.CrossRefGoogle Scholar
“Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: A Guide for Law Enforcement,” Department of Health and Human Services Office of Civil Rights, available at <https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/emergency/final_hipaa_guide_law_enforcement.pdf> (last visited February 10, 2020) [hereinafter cited as OCR HIPAA Guide].+(last+visited+February+10,+2020)+[hereinafter+cited+as+OCR+HIPAA+Guide].>Google Scholar
See ICE PBNDS 2016, supra note 6, at 277–278.Google Scholar
See ICE PBNDS 2016, supra note 6, at 277.Google Scholar
See ICE PBNDS 2016, supra note 6, at 261–263.Google Scholar
See ICE PBNDS 2016, supra note 6, at 262; “Chapter 6-Communicable Diseases of Public Health Significance,” U.S. Citizenship and Immigration Services Policy Manual, (2019), available at <https://www.uscis.gov/policy-manual/volume-8-part-b-chapter-6> (last visited February 12, 2020) [hereinafter cited as USCIS Policy Manual]; 42 C.F.R. § 34.2(b) (2009).+(last+visited+February+12,+2020)+[hereinafter+cited+as+USCIS+Policy+Manual];+42+C.F.R.+§+34.2(b)+(2009).>Google Scholar
See ICE PBNDS 2016, supra note 6, at 262.Google Scholar
Winston, S. E. and Beckwith, C. G., “The Impact of Removing the Immigration Ban on HIV-Infected Persons,” AIDS, Patient Care, and STDs 25, no. 12 (2011): 709711.CrossRefGoogle Scholar
See USCIS Policy Manual, supra note 23.Google Scholar
See ICE PBNDS 2016, supra note 6, at 277.Google Scholar
See OCR HIPAA Guide, supra note 19.Google Scholar
Schumann, J. H., “When the Cost of Care Triggers A Medical Deportation,” NPR, April 9, 2016, available at <https://www.npr.org/sections/health-shots/2016/04/09/473358504/when-the-cost-of-care-triggers-a-medical-deportation> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
See ICE PBNDS 2016, supra note 6, at 261–263; Privacy Impact Assessment for the ICE Alien Medical Records Systems,” U.S. Department of Homeland Security, DHS/ICE/PIA-029 (November 27, 2012), available at <https://www.dhs.gov/sites/default/files/publications/privacy_pia_ice_alienmedicalrecordssystems_november2012_0.pdf> (last visited February 12, 2020) [hereinafter cited as DHS Privacy Impact Assessment], at 16.+(last+visited+February+12,+2020)+[hereinafter+cited+as+DHS+Privacy+Impact+Assessment],+at+16.>Google Scholar
See DHS Privacy Impact Assessment, supra note 30, at 16.Google Scholar
See DHS Privacy Impact Assessment, supra note 30, at 16.Google Scholar
See DHS Privacy Impact Assessment, supra note 30, at 16.Google Scholar
“Asylum Bars,” U.S. Citizenship and Immigration Services, (April 1, 2011), available at <https://www.uscis.gov/humanitarian/refugees-asylum/asylum/asylum-bars> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
See Stoughton, supra note 1; Defilippis, E. M., “When Hospital Rooms Become Prisons,” New York Times Well Blog, May 5, 2016, available at <https://well.blogs.nytimes.com/2016/05/05/when-hospital-rooms-become-prisons/> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
See HRW Detained and Dismissed, supra note 8; “US Immigration Detention Neglects Health,” Human Rights Watch, March 17, 2009, available at <https://www.hrw.org/news/2009/03/17/us-immigration-detention-neglects-health> (last visited February 12, 2020) [hereinafter cited as HRW Detention Neglects Health]; “Dying for Decent Care: Bad Medicine in Immigration Custody,” Florida Immigrant Advocacy Center (February 2009), available at <https://d3n8a8pro7vhmx.cloudfront.net/aijustice/pages/273/attachments/original/1390427524/DyingForDecentCare.pdf?1390427524> (last visited February 12, 2020); “Detained and Denied: Healthcare Access in Immigration Detention,” New York Lawyers for the Public Interest Report (February 15, 2017), available at <https://nylpi.org/wp-content/uploads/2017/02/HJ-Health-in-Immigration-Detention-Report_2017.pdf> (last visited February 12, 2020).+(last+visited+February+12,+2020)+[hereinafter+cited+as+HRW+Detention+Neglects+Health];+“Dying+for+Decent+Care:+Bad+Medicine+in+Immigration+Custody,”+Florida+Immigrant+Advocacy+Center+(February+2009),+available+at++(last+visited+February+12,+2020);+“Detained+and+Denied:+Healthcare+Access+in+Immigration+Detention,”+New+York+Lawyers+for+the+Public+Interest+Report+(February+15,+2017),+available+at++(last+visited+February+12,+2020).>Google Scholar
See Stoughton, supra note 1; See Fink, supra note 1; Tunzi, M., “Caring for the Undocumented: A View From the Safety Net,” American Journal of Bioethics 19, no. 4 (2019): 6062; Kuczewski, M., “Clinical Ethicists Awakened: Addressing Two Generations of Clinical Ethics Issues Involving Undocumented Patients,” American Journal of Bioethics 19, no. 4 (2019): 51–57.CrossRefGoogle Scholar
See HRW Detained and Dismissed, supra note 8.Google Scholar
Shear, M. D. and Benner, K., “In New Effort to Deter Migrants, Barr Withholds Bail to Asylum Seekers,” New York Times, April 16, 2019, available at <https://www.nytimes.com/2019/04/16/us/politics/barr-asylum-bail.html?fbclid=IwAR2GqpAuK7Fzt_6NpcllYT8NUowa0QU2YE-ackBZ2DxcLq5v63dGwepEROc> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
“Systemic Indifference: Dangerous & Substandard Medical Care in U.S Immigration Detention,” Human Rights Watch Report (May 8, 2017), available at <https://www.hrw.org/report/2017/05/08/systemic-indifference/dangerous-substandard-medical-care-us-immigration-detention> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
See HRW Detained and Dismissed, supra note 8.Google Scholar
See HRW Detention Neglects Health, supra note 36.Google Scholar
“Code of Medical Ethics (Chapter 3): Opinions on Privacy, Confidentiality, and Medical Records,” American Medical Association (2016), available at <https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-3.pdf> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
Fabi, R., “‘Respect for Persons,’ Not ‘Respect for Citizens,’” American Journal of Bioethics 16, no. 10 (2016): 6970.CrossRefGoogle Scholar
“Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment,” United Nations, (1982), available at <https://www.ohchr.org/EN/Profession-alInterest/Pages/MedicalEthics.aspx> (last visited February 12, 2020).+(last+visited+February+12,+2020).>Google Scholar
See ICE PBNDS 2016, supra note 6, at 277.Google Scholar
See ICE PBNDS 2016, supra note 6, at 261; See CBP Standards, supra note 15.Google Scholar
See Luan, supra note 5.Google Scholar
See Luan, supra note 5.Google Scholar
See ABA Standards, supra note 4.Google Scholar
See Shear, supra note 39.Google Scholar
See ICE PBNDS 2016, supra note 6.Google Scholar
See Stoughton, supra note 1; See Kuczewski, supra note 37; Kuczewski, M., “We Can Do Something! Caring for the Ongoing Needs of an Undocumented Patient,” American Journal of Bioethics 19, no. 1 (2019): 8283; Rodriguez, N., “Undocumented Migration and Evolving Health Care Ethical Issues,” American Journal of Bioethics 19, no. 4 (2019): 58-60; Kuczewski, M., “The Really New Jim Crow: Why Bioethicists Must Ally With Undocumented Immigrants,” American Journal of Bioethics 16, no. 4 (2016): 21–23.CrossRefGoogle Scholar