I frequently drive on the New Jersey Turnpike. On a clear day, I can see the Statue of Liberty in New York Harbor, right there at the tip of Manhattan. At night, its light is visible for miles. These stirring words, from a poem written by Emma Lazarus, are inscribed on its base:
“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!"
Now the statue is no longer a beacon of hope and promise; it's a reminder of days gone by. Recent events and reports have left me feeling that we as a nation, as a society of people who are purportedly guided by moral and ethical values, are hurtling forward without brakes. We find ourselves in a surreal world in which we have become the abusers, the bad guys, the callous bullies who turn our backs on those less fortunate.
In May, a report published in the Annals of Internal Medicine examined burnout and stress among clinicians who provide “emergency-only hemodialysis” to undocumented immigrants with end-stage renal failure. Undocumented immigrants are not eligible for Medicare or Medicaid, and only a few states cover outpatient hemodialysis as an emergency condition. Therefore, instead of receiving dialysis several times weekly, which is the standard of care, most undocumented immigrants can only receive dialysis when they present to the ED in life-threatening renal failure. That our system causes life-threating conditions and postpones treatment based on a person's citizenship status is inhumane.
And who would have ever thought the United States would precipitate a humanitarian crisis within its borders? When the White House initiated the policy to separate families apprehended crossing the Mexico–Texas border, it was met by an unprecedented backlash of outrage. Fueled by media reports of young children being forcibly removed from their parents (according to Kaiser Health News, 20% are younger than age 13); photos of hundreds of children sleeping on mats in pens inside warehouses converted to shelters; and the lack of a system to keep track of the children so they can be reunited with their parents—many of whom have already been deported—groups as disparate as religious and health care professionals, the living first ladies, 21 state attorneys general, and many in the president's own party condemned the action and urged him to stop the policy. Several governors refused to allow their national guard troops to assist at the border, and several airlines said they would not knowingly transport the children.
Although there was partisan finger-pointing as to who had the power to change the situation, the president relented and signed an executive order on June 20 to end the policy and allow families to be detained together. As we went to press, a federal judge ordered the reunification of families and a halt to most family separations at the border. However, it's still not known how the more than 2,000 children who were separated from their parents will be reunited with them. These children have now joined the estimated 10,000 others who have crossed the border as unaccompanied minors and are living in detention centers around the country—and they will likely remain there for months as their cases are sorted out.
It remains unclear how these children's health needs are being met or whether anything is or will be done to try to mitigate the stress and anguish and emotional trauma that is being inflicted on them. That the leaders of our government thought this was a reasonable thing to do reflects a callousness and detachment to the suffering of others that's unprecedented and truly unconscionable.
AJN has a long history of documenting nursing's development as an ethical profession. Our pages are filled with stories detailing how nurses have always risen to the occasion and done the right thing, from starting charity hospitals to Lillian Wald's Henry Street Settlement to present-day community-based health clinics. Our values, our history, our very raison d'etre center on providing care and being advocates for the vulnerable and disenfranchised. Now, more than ever, we need to embrace that legacy.