In a perspective article published in the New England Journal of Medicine, experts from Boston Children’s Hospital in Massachusetts described modern threats to medical deferred action in the United States. Anti-immigration policies restrict access to medical care, separate families, and jeopardize the lives of children who are ill.

Granted by US Citizenship and Immigration Services (USCIS), medical deferred action is a designation that allows immigrant children with serious, chronic illnesses to live in the United States while receiving life-saving healthcare. Recipients often come from low-resource countries with high child mortality and limited access to necessary therapies. Some parents of these children also receive permission to live in the United States. In August 2019, however, many such patients and families received letters indicating that USCIS would “no longer be processing non-military deferred action requests” and that current recipients would have 33 days to leave the country. Following backlash from the public and health professionals, the statement was revoked, and USCIS announced that it would continue to process medical deferred action applications. Even with the reversal in direction from USCIS, anti-immigration rhetoric remains a significant threat to these children and their families.

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Anti-immigration politics in the United States are built on a legacy of “caging…children, mass deportation, and family separations that predate [the Trump] administration.” Policies that target undocumented immigrants deter many from seeking medical care, for fear of deportation, detention, or family separation. Many of the children receiving medical deferred action are aware that they are at the “mercy of [a] government” that can separate families and, through deportation which interrupts critical care, “issue…death sentence[s].” As one 13-year-old patient at Boston Children’s Hospital said, “It isn’t death itself that I fear. What I fear more is my father facing deportation.”

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Physicians have an obligation to the health of their patients, independent of age, condition, country of origin, race, or nationality.  The investigators urged physicians to act compassionately toward patients who are immigrants, assuage fears, and provide legal support when necessary. At the institutional level, physicians and other health professionals can leverage their voices to protect vulnerable people from policy changes that may jeopardize their care.

For individuals who rely on medical deferred action, political efforts from physicians “may make the difference between life and death.” The August 2019 reversal from the USCIS sets a precedent: efforts from healthcare professionals have the power to curb policies that threaten the lives of immigrant children.   

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures


Ganapathi L, Caldas A, Miranda J, Köhler JR, Visner G, Sawicki G. Medical deferred action – living on borrowed time. N Engl J Med. 2019;381(17):1601-1603.