Wednesday evening, the Michigan Medicine Department of Psychiatry hosted its 24th Annual Waggoner Lecture on Ethics & Values in Medicine, featuring medical doctor Pamela K. McPherson. McPherson’s lecture focused on her experience witnessing harmful conditions in immigration detention centers along the U.S. – Mexico border, and her ethical dilemma over what to do with this confidential information.
McPherson is a medical doctor triple-boarded in general, child and adolescent, and forensic psychiatry, and also works as an expert for the Department of Homeland Security’s Office of Civil Rights and Civil Liberties.
As a mental health expert for the CRCL, McPherson was working under a non-disclosure agreement — a condition common for this position. She was trusted in the family residential facilities she visited. She toured the physical grounds, interviewed women and children and examined mental health records.
“My professional ethical obligation to maintain confidentiality and the trust placed in me as a mental health subject matter expert are obligations that I had kept for my 30 years of forensic work,” McPherson said. “That is, until 2018 — in July 2018, after fully considering this trust and my ethical obligations as a physician I became a whistleblower.”
McPherson’s work focuses on studying children and adolescents, known as unaccompanied minors in immigration proceedings. In the United States, different agencies have different control over different facilities, providing a range of complicated bureaucratic difficulties for evaluating conditions and policies. Legally unaccompanied minors can be held up to 72 hours in Customs and Patrol Border facilities, before they are transferred to the Department of Health and Human Services.
“The average length of stay for an unaccompanied minor in a DHH facility in 2018 was 60 days,” McPherson said.
The number of unaccompanied migrant children has been continuously increasing since 2015, as well as the number of immigrants in detention centers as a whole, according to McPherson.
“In 2018, ICE held an average of 42,000 per day, including an average of 2,113 in family detention, at a cost of over 8 million dollars per day,” McPherson said.
With many of these centers becoming significantly overcrowded, McPherson and her colleagues observed the harmful effects on everyone, especially children as they were separated from their families.
“I could barely contain my outrage,” McPherson said. “I’m a child and adolescent psychiatrist. I’m a medical doctor who specializes in helping children with overwhelming emotions. I help children and families be stronger, but I was watching them be torn apart.”
She explained that with children, the trauma of being detained causes them to regress, and hinders their ability to recognize safe relationships upon release. Even when their mother or father is simply dropping them off at school for the day, they may feel like they are being abandoned all over again, and become inconsolable. These impacts increase the longer they are detained, and are especially exacerbated when the length of their detention is unknown.
“I knew children were being harmed, and that I should act, but I didn’t know what to do,” McPherson said.
Robert Sain, a community child psychiatrist in southeast Michigan, attended the lecture and told The Daily he related to McPherson’s experiences through his experience working in Detroit with Mexican immigrants.
“It takes a lot out of me because all of these families have been traumatized — the kids have been traumatized, their parents have been traumatized, it goes on for generations,” Sain said. “I get very frustrated with the lack of resources, or concern, for helping these families.”
McPherson’s colleague Scott Allen, also an expert for CRCL, reached out after working in the Department of Homeland Security together in 2014 and they discussed their course of action. Both were worried about the legal repercussions of speaking out — on themselves, and on their families, coworkers, employers and patients. McPherson recalled several people discouraging them, claiming that the letter would not affect any real change and that it was better to stay quiet, considering the risks.
McPherson also discussed the dilemma over working for an organization that causes the harms she witnessed. Margo Schlanger, professor at the University of Michigan Law School and the former presidentially-appointed officer for CRCL, elaborated on the ethics of this in an interview with The Daily.
“The question is, is reform the right approach, or does reform entrench the problematic institution?” Schlanger posed. “I’m a believer in trying to address ongoing harm while you also try to get rid of the thing that causes the harm.”
The pair sought legal counsel from the Government Accountability Project, and decided to write a letter to Congress, rather than an Op-ed as originally planned.
“The fundamental flaw of family detention is not just the risk posed by the conditions of confinement — it’s the incarceration of innocent children itself,” the letter reads. “Detention of innocent children should never occur in a civilized society, especially if there are less restrictive options, because the risk of harm to children simply cannot be justified.”
The New York Times caught hold of their letter, garnering the attention and support of 14 professional medical organizations. The president of the American Psychological Association reached out to them personally, thanking them for their moral courage. Allen and McPherson also received letters from children their letter had affected, thanking them.
“I was reminded that our children are always watching and listening, [and] when we use our voice, we give them hope and teach them that change is possible, if we take action,”McPherson said.
Deborah Pinals, director of the Program in Psychiatry, Law, and Ethics at the University, helped introduce McPherson and later reflected on the importance of the lecture in an interview with The Daily.
“In today’s climate when there’s so much in the press about immigration, detention, and detention of families and children,” Pinals said. “I think what was really important was to hear about the ethical dilemma of the physician working trying to improve conditions of confinement and then finding out that the very conditions were harmful in and of themselves.”