First Music

Song of the Day: Fanfare for the Common Man - Aaron Copland

Quote of the Day: "What the superior man seeks is in himself; what the small man seeks is in others." --K'ung Fu-Tzu (aka Confucius)

Thought of the Day: To keep a semblance of political balance I like to mix up my news sources a bit. When I'm driving I'm almost always listening to NPR, which offers a fairly in depth, albeit extremely left-slanted, account of many news and general interest stories of the world. My conservative news sources are drudgereport.com, townhall.com, and boortz.com. To round out the two ends of the spectrum I enjoy reading google.com's News section. I skip television news entirely as Sweewawa and I very very rarely watch television. Anyway, when driving back from the hospital last week I heard on NPR this delightful general interest piece on Music for Newborns. In it was discussed what choices various public figures had made as far as what music to play for their newborns or young kids. The Song of the Day is Aaron Copeland's Fanfare for the Common Man, which one of my favorite jazz vocalists, Rene Marie, would often play for her young boys. I look forward to the day when Sweewawa and I will choose the music our kids will be exposed to early in life.

So despite being a 4th year med student I have been quite busy of late. I recently spent quite a lot of time filling out all the forms and completing other tasks required to begin my internship year. I also have been busy exercising daily and contributing to an online bulletin board Ethics course. Today I would like to share one short essay I wrote for this course, on the case of Jesica Santilan. Here is a brief synopsis of the case (offered by a classmate):

Jesica Santillan was a 17 year old girl originally from Mexico who died from a botched heart/lung transplant. Jesica and her family originally came to the United States as illegal immigrants in order for Jesica, suffering from restricitive cardiomyopathy with secondary pulmonary hypertension, to get life-saving medical treatment. After entering the U.S., the family moved to Louisburg, NC near Duke University Hospital in order for Jesica to get the best treatment. Her medical care was paid for by private donors in her community.

On February 7, 2003 Jesica received a heart-lung transplant. As the surgery was ending and the doctors were closing up, they received a phone call that made them realize they had made a fatal mistake. Jesica and the donor did not share the same blood type and no one had thought to check. The organs were originally made available from Boston to another one of the transplant doctor's patients at Duke. Once the transplant surgeon realized the organs would be no good for the other candidate, he asked about giving them to Jesica. A few hours later, the transplant surgeon was given the go ahead for Jesica's transplant. He assumed the blood type matched and no one checked until the surgery was almost over.

On February 20, 2003 another set of lungs/heart were found for Jesica and were transplanted, but the damage had been done. She was pronounced brain dead a couple of days later. Her family did not donate any of her organs.

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While there are a number of fascinating ethical questions regarding the case, one aspect I chose to write about is the debate about to what extent illegal immigrants should be given access to the public health system in the US. Here are my thoughts:

I think one of the most interesting aspects of this case is the question of whether and to what extent illegal immigrants should be allowed access to the US health care system. This issue has been a big one in California, where a steady flow of illegal immigrants has led to dramatic increases in costs for hospitals (and all social services) and the government. In 1994 the CA voters passed Proposition 187, which required publicly funded health care facilities to deny care to illegal immigrants and to report them to government officials. The proponents of the proposition declared "While our own citizens and legal residents go wanting, those who choose to enter our country illegally get royal treatment at the expense of the California taxpayer." The proposition was in 1997 found in federal court to be unconstitutional, in part because it was out of the scope of the state of California to pass legislation that encroached on the federal domain of immigration law.

Speaking as a citizen and not as a physician, I am a nationalist when it comes to this debate. I often get irate when I hear or read news stories where the rights of illegal immigrants are discussed. These people broke the law by evading detection on entrance into our country or overstaying visas. I have always wondered what the debate is when the entire premise of their being present in the US is an illegality. According to our law these people have no right to reside in the country, let alone to request public services. If you want to reside in the US then use the legal process of immigration. Side note: it also bugs me that the politically correct media have shifted away from using the term "illegal immigrants" to the less offensive (and less accurate) term "undocumented workers".

So the nationalist part of me wishes we didn't even have to have this debate. But the reality is that the problem of illegal immigration is not going to go away. This is a debate that we must address as citizens and as physicians. And when you look past the pure nationalist gun-toting border enforcer view of it this is a debate that has considerable gray area.

First there's the notion mentioned by others in previous posts that barring illegals from receiving medical care may result in a forced breach of professional ethics for us physicians. As physicians our job is to help to improve the health of those who walk in the doors of the hospital or medical office. We abide by the Hippocratic oath first and foremost. I like how David S. separated his opinion on the subject in terms of whether or not he was wearing his physician's or citizen's hat. I do think it's actually comforting to think that when we are in the hospital or medical office setting we just wear the physician's hat, we just follow the Hippocratic oath, and we just help people to improve their health. Proposition 187 would have required physicians in California to occasionally toss off that hat and call the INS.

Interestingly there are arguments to be made FOR providing the public-funded medical care to illegals from a public health or even from an economic standpoint. For example, if we refuse to treat illegals but many remain in the country anyway, one projected outcome is that the rates of Tuberculosis will rise dramatically. Thus, by trying to save the funds appropriated towards the handful of illegals you actually can end up with a national crisis affecting many people if the incidence of tuberculosis increased dramatically. Another interesting argument is that even from a purely economic standpoint -- it is arguable that illegals are actually providing near-equal benefit to society even if they are not legal residents paying income taxes. They pay sales taxes, they do jobs citizens don't want for very low wages, and in general they can be a driving force to keep companies and the economic engine running along smoothly.

So I do see there are arguments for and against providing publicly-funded health resources for illegal immigrants. If I had to pick one side for this case I would side with the nationalist viewpoint and state that I don't believe this patient who was here illegally should have been given a higher place than citizens or legal residents on the organ transplant list. This, however, is just my personal opinion and I respect the complexity of the issue and differing opinions.

Cheers, Dr. Kowawa