Operation Streamline

by Ruth Gomberg-Munoz

L Gipe

In October of 2015, I traveled with a group of Loyola health science students and faculty to southern Arizona for a 4-day immersion trip on the U.S.-Mexico border. On Monday, we took a short bus ride to the Federal Courthouse in downtown Tucson to witness a procedure called Operation Streamline. Operation Streamline prosecutes migrants caught at the U.S. border with Mexico on criminal charges of illegal entry—a charge that was considered a civil violation until 2005, but is now prosecuted as a federal crime that mandates at least 30 days in prison prior to deportation.

LGipe

I was astounded by the degree of repetition. Sixty-seven men and two women, sitting in seven rows composed of some ten seats each, all facing the judge seated at the far wall of the court. Sixty-nine times that the judge repeated a variant of this question: “Is it true that you are not a citizen of the United States and that you entered Southern Arizona from Mexico without coming through a port of entry?” Followed by this question: “How do you plead?” Sixty-nine times that a person—a father, a mother, a daughter, a son—responded, “culpable.” Guilty. Sixty-nine criminal convictions carrying federal prison sentences that ranged in length from 30 to 180 days. Sixty-nine times that a man wearing a suit and blue latex gloves cleaned sixty-nine translation headsets with Clorox wipes as he took them from the defendants filing past. Sixty-nine people who shuffled, shackled at the ankles, wrists, and waist, through a door on the far right wall of the courtroom, headed to serve out their sentences in federal prison and await their subsequent deportations.

I was astounded by the break in repetition. The fourteenth time that the judge asked her questions, a tall man dressed in camouflage hesitated briefly before replying. “It doesn’t matter if I waive my rights,” he said clearly into his microphone. “No one will listen to me anyway. I will just return to my country and eat beans.” His words echoed around the courtroom as defendants and spectators alike looked up in surprise. The judge, clearly stunned, repeated the question slowly in parts, as though the man had not understood her correctly. He answered her questions clearly and then added, “But it doesn’t matter what I say. No one will listen to me anyway.” A current of amusement and curiosity now rippled around the courtroom. The fifty or so remaining defendants began speaking with each other for the first time since the procedure began. They turned to one another, briefly touching shoulders and whispering behind barely-concealed grins. The shackles that bound their wrists and ankles tinkled like wind chimes as they shifted in their seats. The spectators murmured to each other, many smiling in surprised encouragement.

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A U.S. Marshall approached the rows and sternly ordered the migrants to stop talking. The murmurs quieted, but the modest rebellion had not yet run its course. Over the course of the following two hours, several more people spoke up to request more time with their attorney, to interrupt the steamrollered proceedings, to delay their incarceration. The facilitator who led our group later commented that this was the first time she had seen the proceedings disrupted; the continual interruptions extended the hearing for nearly an hour.

It would be a mistake to interpret the tall man’s reference to eating beans to his culinary taste. It is more likely that he was referencing the poverty in his home country of Mexico, where many poor people subsist on staples such as beans. He was also likely nodding to his positioning in the U.S. racial order, where for more than one hundred years Mexican migrants like him have been variously denigrated as “beaners,” “wetbacks,” and “illegals.” Programs like Operation Streamline reinforce the racial subjugation of Latino immigrants, and as a result, nearly half of all Federal prison inmates in the United States are Latino, most of them imprisoned on immigration violations.

“Tough crowd today,” remarked the U.S. Marshall to the man with the blue gloves as they passed near my row toward the end of the proceeding. Moments later, the tall man in camouflage glanced around the courtroom, and I caught his eye and smiled. He smiled back and nodded quickly: a moment of humanity in a sea of injustice. “What would have happened,” a member of our group wondered later, “if we had stood up and cheered” when the tall man spoke? What, indeed? The day is over now and the opportunity passed, save for the lingering possibility that one day we will all have the tall man’s courage to speak up.

Ruth Gomberg-Munoz, PhD is an Assistant Professor in the Department of Anthropology, Loyola University Chicago and Associate Editor for North American Dialogue.

Images created by Lawrence Gipe.

Resources:
Fact Sheet: Operation Streamline. No More Deaths. March 2012

Santos F. Detainees Sentenced in Seconds in "Streamline" Justice on Patrol. NY Times, Feb 02, 2012.

Social Media: Confessions of a Digital Immigrant

By Patrick D. Herron, D.Bioethics

Among my fellow faculty, who view my fondness for tweeting, posting and sharing content with a mix of apprehension and appreciation, I have been described as “savvy” when it comes to social media. I take that, as an extraordinary compliment, since my usage was very limited several years ago. My deliberate choice to professionally engage through social media started with its use in the teaching of medical students, searching for and sharing content of interest for faculty development sessions, networking with other colleagues, patient advocacy, and utilizing it as a tool to further my own knowledge base in multiple content areas (i.e. medical education, bioethics, public health, etc.). While my academic peers viewed this being a natural inclination, it was not. In fact, it took a lot of work!

Still though, some consider me to be a Digital Native (more on that later), but like many of my faculty peers, initially I didn’t know a “tweet” from a “feed” and the symbol “#” was the pound sign on my phone and not a “hashtag.” I’ve been asked often, “Where did you learn all this stuff?” and “How did you find the time to get into this?” As to where I learned it? Where else, but online! The most important thing to know about social media is that it is meant to be experiential and not something that can be learned without engagement. As to time, there’s no denying that using social media does require you to put in some effort. Your ROI (Return On Investment) is dependent on what goals you have for starting out and your own commitment to the learning process that will follow.

Digital Natives, as coined by Marc Penskyi, refer to those persons who grew up with the Internet and whose familiarity with technology and its application makes them native speakers of the digital language. They stand apart from those who have had to learn to adopt and integrate these new technologies into our lives as Digital Immigrants. I’m frequently reminded that my own status is that of immigrant as there are some aspects of social media usage that remain unfamiliar to me and I hear myself saying, “I just don’t get it.” Pensky would view this as a manifestation of my own digital immigrant accent. Like any accent, some people have ones that are more pronounced than others. The good news is that social media is very much like a proverbial melting pot of users! Yes there are many native speakers, but the majority of users are immigrants with the fastest growing age demographic being persons age 65 and olderii. The desire to connect with others transcends one’s age; it just has taken some of us longer to learn the new language.

Social media is all about communication and the relationships that exist among usersiii. In time social media and online technology will surpass traditional or legacy mediums of learning and communication (i.e. print material). I feel it is not only in my own best interests to continue developing my skills but an obligation to my students, colleagues, patients, and community members I work with to effectively partner with them in their evolving learning processes. That is why I’m proud to be a digital immigrant. Recognizing that my own emerging status offers an opportunity to be a resource for other immigrants as well as share insights formed before and during the dawn of the digital era with native speaking social media users.


Patrick D. Herron, D.Bioethics, is a 2014 graduate of the Loyola University Chicago Doctorate in Bioethics program. He is an Assistant Professor in the Department of Family & Social Medicine at the Albert Einstein College of Medicine in Bronx, New York.

i Prensky, M. Digital Natives, Digital Immigrants: Part 1. On the Horizon, 2001. 9(5), 1-6.

ii Duggan, M., Ellison, N.B., Lampe, C., Lenhart, A,. and Madden, M. “Social Media Update 2014,” Pew Research Center, January 2015.

iii Herron, PD. Opportunities and Ethical Challenges for the Practice of Medicine in the Digital Era. Curr Rev Musculoskelet Med. 2015 Jun;8(2):113-7.

Rethinking Formation for Diversity & Inclusion

by Patrick, McCruden, D.Bioethics, MTS
Senior Vice President, Mission Integration
CHI St. Vincent

Serving as a Mission executive in catholic health care I’ve long been fascinated with a tension that exists between our desire to have diversity in our workforce and our commitment to the formation of our leaders and co-workers into a particular charism or vision of catholic health care. Many health systems have formal programs to increase diversity in hiring and respond to the diverse cultures of our patients and co-workers. Hiring a diverse workforce entails diversity not only of gender, color, culture, etc. but a diversity of ideas, values and beliefs that flow from these characteristics. However, many formation programs stress adherence to a set list of values, beliefs etc. often rooted in the tradition of the founding order(s). I think a recognition of the historical roots of this tension and a concerted effort to revamp formation programs will enhance the ability of our diverse community in catholic health care to work together for the care of our patients.

In 1982, my first job in Catholic health care was in a hospice run by the Hawthorne Dominican sisters. I didn’t realize it at the time but I was given a glimpse of Catholic healthcare that was all but extinct.  The hospice’s administrator, director of nursing and almost all the nurses were Dominican sisters. From the early times of the church down through the middle of the twentieth century, religious orders cared for the sick and operated hospitals principally with the labor and leadership of the members of the order. These communities of women shared a common tradition and commitment to a vision of healthcare interpreted through the particular charism of their founders and handed down through the formation of new members of the order.

By the time I had my first full time job in Catholic healthcare five years later the hospital where I worked only had one member of the founding order who served as the VP of Mission Effectiveness. This was the new norm. It was accepted wisdom that employees and especially leaders would be “formed” into the vision of the hospital’s founders. In a sense the formation of leaders and staff replaced the formation of novices and sisters. Through these programs the founding orders sought to ensure that the identity of the institution would be maintained and that decisions would be made consistent with the charism of the order.

Today very few catholic hospitals are sponsored by one religious order. Most are part of large health systems and loyalty to a particular order’s charism is now being replaced by loyalty to the values and mission of the new entity. Often these values are articulated in a manner that are translatable to a workforce that is growing increasingly diverse. This seems to me to be a positive development and a movement away from formation analogous to religious formation towards a more dialogical approach seems necessary.

The Canadian communitarian Charles Taylor has argued that human diversity is part of how we are made in the image of the triune God .  Truly acknowledging this diversity and recognizing it as a part of God’s plan is therefore fully “Catholic” and transforms the Gospel mandate to “go and make disciples of all nations” (Mathew 28:18) from a  “unity-through-identity” understanding to a “unity-across-difference” understanding .  Thus, we do not have to make physicians, co-workers and leaders into replicas of the amazing women who started these hospitals or close approximations to the same through formation programs in order to be faithful to our Catholic identity. We do have to ensure that our actions as Catholic healthcare are always faithful to a Gospel rooted in agape love.

In our developing relationships with our diverse workforce we must engage in dialogue around the languages and practices that can unite us across our ideological differences. Without doubt there will be practices that the Catholic health system will demand of anyone who wishes to become a part of the ministry including the respect for innocent life, compassion and a willingness to serve the poor. Apart from these essentials there will be a need for dialogue. I feel certain that there will be common themes of reverence, gratitude, forgiveness that cross all cultures and traditions. In faith we believe that in serving the sick and the poor we encounter Christ and this encounter cannot help but be transformative and we need to invite our diverse workforce to encounter this transformation with faith in the Holy Spirit.

Just care for patients in different neonatal intensive care units: a tenable goal?

By Dalia Feltman, MD, MA

One look at a healthcare billboard will reveal that hospitals want to appear unique—one touts superior surgical care; another state-of-the-art cancer treatments.  Quality of medical staff and the array of services offered are not what I mean here by “equal opportunities.” What I’ll examine in detail using two neonatology studies is the variation of initiating and withdrawing life-sustaining treatments for critically-ill newborns between medical centers. I’ll argue that from a principlist standpoint, because extremely premature or critically-ill newborns are completely incapable of autonomous decision-making, and beneficence and non-maleficence are extremely difficult to judge, the remaining principle, justice, is an especially important goal for these patients.

Because newborns lack autonomy, we rely on parents and physicians to make medical decisions in their best interests.  This means weighing benefits and burdens of treatments to maximize beneficence and non-maleficence. However, for newborns whose survival or neurodevelopmental outcomes are ambiguous, life-sustaining treatments such as breathing support, chest compressions, and cardiac medications may seem burdensome. The difficulty in finding beneficent, non-maleficent options is of interest in many neonatology bioethics inquiries. However, evidence that some neonatal intensive care units (NICU’s) are more aggressive in providing life-sustaining treatments than others leads to a different arena of questions, concerning whether justice is a tenable goal for these patients.

Treatments after birth
Based on high chances for death and neurologic impairment, being born at 22 to 24 weeks’ gestation is considered “periviable.”  Professional guidelines from groups such as the American Academy of Pediatrics (AAP) advise: 1.) For babies born into circumstances incompatible with survival, comfort care rather than delivery room resuscitation should be provided; 2.) For a baby with high chances of poor outcome, best estimates of survival and morbidity should be conveyed to parents to inform their decision on resuscitation; and 3.) When good outcomes are likely, resuscitation is indicated with continued reassessment of treatment benefits in collaboration with parents.1

Revasy, et al. examine outcomes for extreme preterm infants born at 24 hospitals.2  While not representative of all NICUs, this is a robust sample of nearly 5000 preterm infants born between 22 and 26 weeks with an impressively high percentage of patients followed until 18-22 months. These authors report survival and neurodevelopmental outcomes for the entire sample of 22-week preterm infants as worse than for the subgroup of patients receiving life-sustaining treatments. Similar trends were noted for each gestational week until 25 and 26 weeks, because babies born 25 weeks and older all received active treatment. None of this is surprising, since we know these babies’ immature lungs require support to survive past a few hours or days. Furthermore, the more mature the baby, the more the benefits of treatment outweigh risks, so life-sustaining treatments are provided. What has been impressive, however, to the authors and the neonatology community, is the fact that, controlling for other patient factors, the hospital itself was what most predicted provision of life-sustaining treatments vs. comfort care, and therefore mortality and morbidity (for without survival there can be no morbidity). The earlier the gestational age of the baby, the more profound the inter-hospital variability, until 25 weeks.

Treatments before death

Another article compared circumstances around deaths of NICU patients in four centers—two Midwestern, one Canadian, and one in the Netherlands.3  In all but one center, most “unstable” neonates died with life-sustaining treatments withdrawn. That same outlier center had higher rates of babies dying after chest compressions than the other three. No baby died in the delivery room at that center, while the other three reported similar rates of deaths in the delivery room.

Directions for future study

Equal opportunities will only be possible when we understand why hospitals have such different rates of providing life-sustaining treatments. What options are offered to parents?  Do parents’ cultural differences account for hospital variability? How do obstetricians influence these decisions?

One might argue that if there’s no clear-cut answer on what’s in a certain type of preterm infant’s best interests, why strive for uniformity? To ensure NICU patients receive a just experience, options of comfort care and offering life-sustaining treatments need to be consistently explored with parents in truly shared decision making. A new clinical report from the AAP encourages institutions to create approaches to threatened deliveries at 22 to 24 weeks.4  One possibility for institutional variability is that centers have created strategies to promote just opportunities for their patients. If so, these studies are a call to foster another level of agreement—across hospitals. Otherwise, it may only be where the ambulance brings a prematurely-laboring woman that might determine her baby’s outcome.

Dalia Feltman, MD, MA, is a 2015 graduate of the Loyola MA program in Bioethics and Health Policy.  She is a neonatologist at Evanston Hospital in Evanston, IL and a Clinician Educator at the University of Chicago Pritzker School of Medicine, Chicago, IL

1. Batton DG.  Antenatal counseling regarding resuscitation at an extremely low gestational age.  Pediatrics 2009;124:422–427.
2. Rysavy MA, Lei L, Bell EF, Das A, Hintz SR, Stoll BJ, et al.  Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants.  N Engl J Med 2015;372(19):1801-11.
3. Verhagen AA, Janvier A, Leuthner SR, Andrews B, Lagatta J, Bos AF, Meadow W.  Categorizing Neonatal Deaths: A Cross-Cultural Study in the United States, Canada, and The Netherlands.  J Pediatr 2010 Jan;156(1):33-7.
4. Cummings J, AAP Committee on Fetus and Newborn.  Antenatal Counseling Regarding Resuscit

Labor Day Reflection: Being Hospitable toward Labor

Originally published 8/27/2013

Labor Day traditionally marks the end of summer in the United States. Most of us observe the holiday without much reflection on labor and its meaning in our lives and our society. Many trends have contributed to this lack of identification with the concept of labor including the conversion from a manufacturing to a knowledge-based or service-oriented economy and the erosion of collective bargaining and unions. However, labor is a fundamental feature of human life and is central to our dignity and flourishing.  For this reason, the United States Conference of Catholic Bishops issues an annual letter to mark Labor Day. I would like to share a some key features of the place of labor in a Catholic philosophical anthropology (a theory of being human) in order to show why the bishops have identified the need for immigration reform as central to their labor day message.

Our labor, i.e., our work, is how we provide sustenance for ourselves and our families.  But work is also a way that we express our creative natures – it is a means of self-expression. Clearly, when we speak of our work as our vocation, it even assumes a spiritual dimension as an expression of our relationship to God. In our creativity, we image the activity of God and in discerning the work proper to us, we respond to God’s call. In our culture, we often recognize these higher dimensions of work in the professions such as medicine and in highly-compensated paths that we term careers.

Unfortunately, our attitudes are often quite different toward work performed at the low end of the wage scale. We somehow have come to dichotomize the labor ladder into the “makers” at the more fortunate end and the “takers” on the lower rungs. Such a view is implicitly suspicious of those on the lower end and can blind us to our duty to foster opportunity for all.

The Bishops in their letter have kept in sight the fundamental principles of the Catholic social justice tradition. This tradition sees the state as established to foster the common good, i.e., the conditions for all community members to participate to their full capabilities. This tradition prioritizes giving a “hand up” over a “hand out.” It recognizes that people do not seek dependency but an opportunity to contribute to their community. When one views our society through the lens of these principles, the immigration question comes clearly into focus. The struggles of immigrant workers to find work, to provide for their families, and to have a say in the shaping of their lives are the defining features of their day-to-day existences. Once we are liberated from prejudices that assume people intrinsically are “takers,” we see our essential similarities and our differences recede.

The Bishops tell us, “Whenever possible we should support businesses and enterprises that protect human life and dignity, pay just wages, and protect workers’ rights. We should support immigration policies that bring immigrant workers out of the shadows to a legal status and offer them a just and fair path to citizenship, so that their human rights are protected and the wages for all workers rise.

We honor the immigrant worker by remembering that the building of America has been carried out by so many who fled persecution, violence, and poverty elsewhere, coming to America to offer their talents and gifts to support themselves and their families. We welcome the stranger, the refugee, the migrant, and the marginalized, because they are children of God and it is our duty to do so. But at the same time it is important to end the political, social, and economic conditions that drive people from their homelands and families. Solidarity calls us to honor workers in our own communities and around the world.”

On this Labor Day, I wish you a full appreciation of the value of your work. And I pray that we might all be bound in the hospitality that flows from mutual respect and solidarity.

Sincerely,
Mark
—
Mark G. Kuczewski, PhD
The Fr. Michael I. English, SJ, Professor of Medical Ethics
Chair, Department of Medical Education
Director, Neiswanger Institute for Bioethics & Health Policy
Loyola University Chicago Stritch School of Medicine


For the full USCCB Labor Day Statement, go to:
http://www.usccb.org/issues-and-action/human-life-and-dignity/labor-employment/labor-day-statement-2013.cfm