Human Dignity, Undocumented Immigrants,and Palliative Care


Mr. Cifuentes migrated to the U.S. on a work visa at the age of 49, hoping to earn money on a watermelon farm in California to send back home to Guatemala. His daughter had been badly injured in an accident and the cost of her medical care was skyrocketing. Cifuentes also worked as a painter, a landscaper, and a tree pruner, continuing to send money home to his daughter, who began to walk again.[1]

While in the U.S., Cifuentes developed a strong faith and a community of other Christians. Then, tragedy struck the family again, and Cifuentes was diagnosed with late-stage cancer. He needed hospice care. But there was a problem: his visa had expired, making him an undocumented immigrant, and ineligible.

Under federal law, he qualified for emergency room visits, but not ongoing hospice care.  

The Affordable Care Act would not have helped him. Under the Act, undocumented immigrants may not purchase private insurance through an exchange. Reimbursements to hospitals that care for the uninsured are being cut. Hospitals already pay for private planes for returning sick patients to their home country. One patient received over $1 million in medical care before returning to Poland.[2]

There is no simple solution, and this problem is not unique to the United States. Canada’s Court of Appeal rejected the claims of an “illegal migrant” with chronic and severe health problems. The court concluded that there is no constitutional right to healthcare. The court was worried that Canada would become a “safe-haven” for everyone who needed health services.[3]

While the policy debates continue, the ethical and moral challenges remain. As it stands, healthcare clinicians often bear frontline responsibility. They may be forced to choose to care for some undocumented patients over others, to “work the system,” or else send their patients back to their home country. Cifuentes’ doctor argued that foreign consulates should help provide palliative care and end-of-life care, or provide transportation back home, if that is what is desired.[4] Mr. Cifuentes chose to return home and die near his daughter.

So how do we think about this as Christians?  I’m not talking about the politics of immigration reform, or abuse of the system. I’m talking about our response to the deep suffering of another human being who is near the end of their life.

One of the basic principles of bioethics you’ve heard me emphasize repeatedly is human dignity. Respect for dignity means that we must care for the human being in front of us, the one who is facing inhumane suffering. We may not be able to do everything, but we can do something. You and your local church don’t know when or if an opportunity will come. But you can think and pray about what your response would be if someone like Mr. Cifuentes comes to your church.

[1] Ricardo Nuila, “Home: Palliation for Dying Undocumented Immigrants,” New England Journal of Medicine,  May 31, 2012.

[2] “Deported While Unconscious,” NPR News. Interview with David Pitt. May 1, 2013.

[3] Nell Toussaint v. Attorney General of Canada, 2011 FCA 213 (,%20J..pdf). The appeal was rejected by the Supreme Court of Canada, leaving the lower court’s decision in place. (

[4] Suzanne Koven, “Care for Undocumented Immigrants: Who Is Responsible?” The Boston Globe, June 18, 2012 (accessed April 30, 2013). 


Everyday Bioethics Audio Commentary Album Art