With the influx of unaccompanied minors into the United States, a way of advocating on behalf of a child’s best interests regarding medical care is necessary to ensure the health and safety of the child. A call-to-action article relating to this topic was published in the AMA Journal of Ethics.

More than 50,000 unaccompanied minors crossed into the United States at the Mexican border between October 2017 and September 2018 as a result of increased violence occurring in Honduras, El Salvador, and Guatemala. The process of vetting potential local sponsors is time consuming, with backlogs and an increased amount of time spent in detention centers. There is currently no legislation to advocate on a child’s behalf for appropriate and necessary medical care during the prolonged stay. Parents or court-appointed guardians typically advocate and consent to medical treatment for a child, but in this scenario, no clear advocate is identified.

Most of these children have been exposed to trauma, violence, and malnutrition, in addition to expected pediatric health issues. They require appropriate and necessary medical and mental health care, and, according to the author, their care should be held to the same standards applied to other children without an advocate.

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Currently, private immigration detention centers are responsible for initiating and implementing healthcare services. There is no standard policy for who is responsible for making medical decisions for detained children, and it is up to the individual detention centers to determine what is considered consent. The author highlights that consent must be free from coercion. Reports of undue influence for medication, such as using psychotropic injections as a form of behavior control or threats of delaying reunification with family members because of a medication refusal, compromise consent for this vulnerable population.

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According to the author, medical professionals need to express their support for child advocacy programs to ensure that medical care is free from coercion and undue influences and is actually in the best interest of the child. Although “detained children are not US citizens, they are entitled to dignity, health, and decisions made in their best interest rather than that of the governmental agency detaining them.”


Malina G. How should unaccompanied minors in immigration detention be protected from coercive medical practices? AMA J Ethics. 2019;21(7):E603-610.