Abstract
This chapter is an investigation of the morality of medical deportation, the practice of returning undocumented migrants, despite their ill health and/or injuries, to their countries of origin. In Sect. 16.1, I look more closely at the nature of medical deportation. In Sect. 16.2, I argue that understanding the morality of medical deportation requires nonideal theory. In Sect. 16.3, I outline contractualism as a nonideal theory. In Sect. 16.4, I apply contractualism to medical deportation and make the case that, first, there are in principle some cases in which medical deportation is morally permissible but, second, the standards that must be met in cases of morally permissible medical deportation are very high. In Sect. 16.5, I consider stakeholders other than the patient and the medical care facility and examine the ways in which effects on them might render medical deportation morally impermissible. I conclude that real-world cases of morally permissible medical deportation are rare at best, and there is little prospect of this situation changing.
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- 1.
In this paper I focus entirely on medical deportation within the U.S. both because it seems to be the epicenter for this practice and because I know much more about it than I know about medical deportation in other countries.
- 2.
- 3.
For discussion see Chambers (2006).
- 4.
- 5.
I am indebted to the editors for pushing me on this point.
- 6.
On the distinction between contractualism and contractarianism, see Darwall (2003).
- 7.
I note in passing that it is possible to doubt the social contract bona fides of Rawls’s approach as well. For example, Nussbaum (2006, 54–69) raises some interesting questions about whether Rawls is better thought of in the context of Kant’s non-contractarian thinking than of the social contract tradition.
- 8.
The language of stakeholders is natural to the contractualist approach, though it tends not to be used. For notable exceptions, see Silver (2012 and 2015). Scanlon himself tends to speak of the “beneficiaries” (1998, 213), but this practice is slightly misleading because the result of rejected principles is not always a benefit. For example, it might be the case that every principle that permits telling a lie can be reasonably rejected, even if no one is better off as a result of the lie not being told.
- 9.
This point deserves more consideration than I can give it here, but see Darwall (2006).
- 10.
It almost goes without saying that we are not usually meant to apply these principles and consider whether or not they could be reasonably rejected in real time. Contractualism provides a criterion of rightness, not a decision procedure, much like utilitarianism; see Brink (1986) and Crisp (1992) and perhaps some forms of Kantianism, such as Timmons (1997).
- 11.
For thinking along similar, if not identical, lines, see Southwood (Forthcoming).
- 12.
Florencia Luna’s contribution in this volume “Ideal and nonideal theories: The challenges of decision-making in an imperfect world” discusses this in detail.
- 13.
I am grateful to the editors for asking me to expand on this point.
- 14.
Scanlon himself does not walk through proposals and rejections of principles, so I have attempted to reconstruct the general line of thought here.
- 15.
I turn from the short run to the long run in just a moment.
- 16.
Note that I am ignoring cases in which the patient’s reason for coming to the U.S. is non-economic. If a patient came to the U.S. to avoid, say, political persecution, then this fact alone is enough to provide him or her with grounds for reasonably rejecting any principle that would permit their return. To the best of my knowledge, this issue has not arisen in a case of medical deportation, but it is only a matter of time before it does.
- 17.
Once again, I am indebted to the editors for pressing me on this point.
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Acknowledgments
I am grateful to Ben Bayer, Drew Chastain, Kimberly Kahn, and Joel MacClellan for comments, criticisms, and suggestions. Generous audiences at the American Society for Bioethics and Humanities, the Western Michigan University Medical Humanities Conference, and the Association for Practical and Professional Ethics did much to improve this paper as well. Finally my thanks to the editors of this volume, Liz Victor and Laura K. Guidry-Grimes, for their helpful suggestions and for their patience and supportiveness.
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Kahn, L. (2021). Medical Deportation, Non-Citizen Patients. In: Victor, E., Guidry-Grimes, L.K. (eds) Applying Nonideal Theory to Bioethics. Philosophy and Medicine, vol 139. Springer, Cham. https://doi.org/10.1007/978-3-030-72503-7_16
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