A whistleblower complaint was filed against immigration officials at the Irwin County Detention Center in Ocilla, Georgia, according to a Sept. 14 Associated Press report.
Dawn Wooten, a former nurse at the facility, asserts in the complaint that women were receiving questionable hysterectomies for which questionable consent was given.
On Sept. 18, the Associated Press released exclusive interviews with other women from the facility claiming they did not consent to similar procedures.
In the same week, NPR reported that congressional lawmakers were able to stay the deportation of Pauline Binam to Cameroon in order to give her a chance to testify about her experience.
This comes on the heels of 173 members of Congress signing a letter demanding that the Department of Homeland Security’s inspector general open an investigation in the above allegations.
These allegations must be taken seriously. They bring up several issues at the core of our health care system and serve as a reminder of our horrible failures in the past.
Modern bioethics are based on four primary principles: beneficence, personal autonomy, nonmaleficence and justice. These cases appear to violate all of them.
Frist, the reports coming from the Irwin County center make specific allegations about a lack of informed consent.
Personal autonomy is a value prized by Americans, but in health care it is one of our most sacred values.
The legal precedent for informed consent in the U.S. goes back to Schloendorff v New York Hospital (1914) where the Supreme Court upheld the right to self-determination, arguing for a requirement to obtain a patient’s consent prior to treatment.
This requirement for patient consent was expanded to require the disclosure of risks and benefits prior to consent in the landmark decision Salgo v Leland Stanford Jr. University Board of Trustees (1957).
Both decisions were based on the belief that human beings have an innate right to self-determination.
Informed consent is about more than just self-determination. It is also about confidence in the health care system. People will not trust their medical provider if they are afraid of what will happen to them.
The above allegations bring into question the integrity and safety of our health care system. How can a woman trust her physician if she is worried about losing the ability to have future children?
Second, the allegations bring up questions of beneficence and nonmaleficence.
Ancient texts including the Hippocratic Corpus argue that a physician’s duty is to provide benefit to the patient and not to make matters worse.
Helping people who suffer is at the heart of all the healing professions. Once that is set aside, the system and the profession as a whole become questionable.
Helping and not harming the sick and injured is the definition of health care. Therefore, it is absolutely imperative the inspector general and congressional leaders discover the scope of these allegations.
For our health care system to work, no one should wonder if their doctor or nurse wants to harm them. No one should have to worry about the intentions of their health care provider.
Third, and probably the most disturbing, is the potential violation of justice involved in these cases.
These cases call to mind the memory of the eugenics programs at the beginning of the 20th century.
In 1914, the United States Public Health Service adopted the ideas of the eugenics movement and pushed for restrictions on immigration, arguing that certain classes of migrants were undesirable and harmful to society.
For decades, immigration officials characterized Latino immigrants and migrants as diseased and inferior, arguing that sterilization would protect the public from being overrun. In many states, federal agencies and tax dollars were used to promote the initiative.
Public outcry emerged when 10 Mexican women filed suit arguing they were coerced into signing consent forms they did not understand (Madrigal v Quilligan, 1978).
These aggressive practices parallel similar programs of the Indian Health Services. The Family Planning Services and Research Act of 1970 (Title X) subsidized sterilization for women treated by the Indian Health Services and for Medicaid recipients.
The 1970s saw record numbers of sterilizations among Native Americans, African Americans and Latina Americans, causing many to accuse public health officials of committing genocide.
The allegations of the Irwin County Detention Center bring back the horrors of just 50 years ago.
These horrors force us to question the intention of not only our physicians and bedside nurses but also public health officials and the system as a whole.
This type of systemic racism destroys the integrity of the public health system and continues to divide us.
Therefore, we as a society must stop and take these allegations seriously and demand immigration officials and congressional leaders do a thorough investigation.
The events at the Irwin County Detention Center should shock the nation to its core. This goes beyond a discussion of immigration, law enforcement or even a path to citizenship.
It takes our collective consciousness back to a time when public health leaders decided who was and who was not worthy of having children.
This cannot stand in a nation based on the idea that each human being has intrinsic and eternal value. Society deserves to know that our health care system is safe.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
