A nurse at an Immigration and Customs Enforcement (ICE) detention center in Georgia has alleged that detainees have been denied basic and COVID-specific medical care. In her own words, the staff behavior has been representative of a “jarring medical neglect.” Her assertions also included the ominous accusation of “an exorbitant rate of hysterectomies” in the same cohort of immigrant women.[1] In the absence of proof one way or the other, her claims should be characterized as allegations demanding intense, unbiased investigation. From a bioethical perspective, both assertions could represent serious lapses in ethical behavior. I would like to concentrate initially on the ramifications of the purported hysterectomies; the basic care breaches will be addressed after. Each of these has had a diabolical history in the twentieth century.
Throughout the last century, the spirit of the age exhibited a voracious appetite for human life. Medicine became the source for myriad racial enmities and immoral projects catalyzed by ascendant science and reckless medical research that was completely oblivious to the dignity of human life. The contingent bioethical lapses reflected the impact of social Darwinism on an age of physicians who primarily acted as scientists, not healers.
Against the backdrop of two world wars, the sinister efforts of medical research and experimentation were obscured by the killing taking place on the battlefield. The earliest atrocities were perpetrated by the German medical establishment during the first decade of the twentieth century, which used medical technique as a weapon against the indigenous Herero tribe of Namibia.[2] There would be an intimate and lethal continuity between the WWI-era German physicians in Namibia and the Nazi doctors who followed in WWII—Josef Mengele’s medical school professor was an active participant in the heinous medical experimentation a generation earlier in Namibia.[3] After WWII, humanity was forced to take notice of the medical atrocities. The Nuremberg trials and United Nations Resolution 96 were published as specific responses to these nefarious activities under the aegis of physicians. Five activities would come to characterize genocide under the umbrella of international law: (1) killing members of a specific group; (2) causing serious bodily or mental harm to members of that same group; (3) deliberately inflicting conditions aimed directly at those persons’ destruction; (4) forcibly transferring children of the target group to ethically/racially dissimilar individuals for rearing; and, last but not least, (5) imposing measures to prevent births of the group-in-question’s progeny.[4]
Notice that the final activity is more subtle and may be hidden in times of peace. As recently as the 1970s, when I went to medical school, the United States—through the Public Health Service and private physicians—secretly violated the provisions of United Nations Resolution 96 through the sterilization of Native American women. The violations were uncovered serendipitously when a Navajo-American physician discovered numerous women of her tribe who had received seemingly unnecessary hysterectomies while they were undergoing medical care for unrelated problems like appendicitis. [5] If the Georgian nurse’s allegation of an “exorbitant rate of hysterectomies” is accurate, it is consistent with a terrifying step back to a reprehensible practice of sterilizing non-consenting minority women for the assumed purpose of reducing or eliminating certain racial groups from society.
There are obvious reasons to condemn any institution that fails to provide basic care to detained persons. However, a “historical” frame may add further insight. Twentieth-century persons who resided in American or immigrated to the US have similarities to recent detainees in that both groups have experienced prejudice that was fueled and actively exercised by physicians.
In the twentieth century prior to WWII, Jewish immigrants to America were prejudicially characterized as the “embodiment of germs that travelled.”[6] American physicians chalked a “T” for trachoma on its Jewish victims, a foreshadowing of the Star of David as a pejorative and fatal label in Germany (trachoma is a disease that affects the eyes, causing the eyelids to turn inward and the eyelashes to scrape against the eyeball, eventually causing blindness).[7] The care of these Jewish immigrants has been described as “brutal,”[8] with their trachomatous eyelids repeatedly scraped with an unsterilized stone coated with corrosive chemicals (as no other cure was available at the time); many who were found to have the disease were immediately sent back to their home country. Unethical physician behavior in the context of immigrant persons unfortunately has a repeating pattern in American history.
As one author recently observed, “there is no social problem that will not enter the health care system.”[9] Immigration, in general and in the plight of detainees, has entered with an ethical bang. The recent allegations from Georgia are in no way trivial. The soul of America is being torn apart by prejudice and racial strife. Medicine has to stand out as healer and reconciler to the vulnerable who have again become conspicuous because they are created in the Image of God in a variety of colors and tongues. As Christians who uphold this high view of human dignity, we have a responsibility to care about and for these vulnerable ones among us.
References
[1] Jerry Lambe, “‘Like an Experimental Concentration Camp’: Whistleblower Complaint Alleges Mass Hysterectomies at ICE Detention Center,” Law & Crime, September 14, 2020, https://lawandcrime.com/highprofile/like-an-experimental-concentration-camp-whistleblower-complaint-alleges-mass-hysterectomies-at-ice-detention-center/amp/; Tim Elfrink, “Pelosi demands probe after ICE nurse raises alarm over medical care, hysterectomies at detention center,” The Washington Post, September 15, 2020, https://www.washingtonpost.com/nation/2020/09/15/ice-covid-irwin-complaint-nurse/.
[2] David Olusoga, “Dear Pope Francis, Namibia Was the 20th Century’s First Genocide,” The Guardian, April 18, 2015, https://www.theguardian.com/commentisfree/2015/apr/18/pope-francis-armenian-genocide-first-20th-century-namibia; Mohamad Abhikari, “‘Streams of Blood and Streams of Money’: New Perspectives on the Annihilation of the Herero and Nama Peoples of Namibia, 1904–1908,” Kronos 34 (2008): 303–20.
[3] Benjamin Madley, “From Africa to Auschwitz: How German Southwest Africa Incubated Ideas and Methods Adopted and Developed by the Nazis in Eastern Europe,” European History Quarterly 35, no. 3 (2005): 429–64, https://doi.org/10.1177/0265691405054218.
[4] Adapted from United Nations, “Convention on the Prevention and Punishment of the Crime of Genocide,” January 12, 1951, https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.1_Convention%20on%20the%20Prevention%20and%20Punishment%20of%20the%20Crime%20of%20Genocide.pdf.
[5] Gregory Rutecki, “Forced Sterilization of Native Americans: Later Twentieth Century Physician Cooperation with National Eugenic Policies,” Ethics and Medicine 27, no. 1 (2011): 33–42.
[6] Howard Markel, When Germs Travelled: Six Major Epidemics That Have Invaded America and the Fears They Have Unleashed (New York: Vintage Books, 2005), 81.
[7] WHO, “Trachoma,” World Health Organization, August 11, 2020, https://www.who.int/news-room/fact-sheets/detail/trachoma.
[8] Howard Markel, “Before Ebola, Ellis Island’s Terrifying Medical Inspections,” PBS News Hour, https://www.pbs.org/newshour/health/october-15-1965-remembering-ellis-island.
[9] Mark G. Kuczewski, “How Medicine May Save the Life of US Immigration Policy: From Clinical and Educational Encounters to Ethical Public Policy,” AMA Journal of Ethics 19, no. 3 (2017): 221–33, https://www.doi.org/10.1001/journalofethics.2017.19.3.peer1-1703.