Knucklehead AIDS policy

Arthur Caplan

August 14, 1991|By Arthur Caplan

EVERY SO often, a public policy decision is so dumb, so knuckleheaded, so out of touch with the facts that, even in the daily parade of oddities that passes for government policy, the decision stands out. Such is the nature of the federal government's decision to retain its immigration ban against those infected with the AIDS virus.

I know what you're thinking: Here comes another bleeding-heart broadside against any law or policy that inhibits the rights of those who have AIDS. Isn't the Bush administration right to worry about the costs associated with treating AIDS? you may ask. It is one thing to open our doors to those yearning to be free. It's quite another to pay the bill for treating immigrants with AIDS.

Indeed, the administration cites the high costs associated with the medical treatment of AIDS as its primary rationale for maintaining the ban. But let's allow a little reality to cloud this argument. Suppose you lived in Haiti, the Netherlands, Brazil, Tanzania or Thailand and you found out you had AIDS. Let's also suppose you are poor. Would your first response be to book a flight to the States?

Well, think about it. What is the reality of health care for the poor in America today? Is it such as to make those in other lands, even those who are desperately poor, pull up stakes and relocate here? Hardly.

The hospitals that bear the brunt of caring for the poor -- public facilities in large cities -- are in a state of near collapse. The quality of care for those on Medicaid or who lack insurance in New York, Los Angeles, Detroit, Houston, Miami and New Orleans is not likely to attract too many foreigners with AIDS.

Our urban hospitals, as any first-year resident who works in one will tell you, cannot adequately care for those currently seeking care. Waiting lists are long, emergency rooms are crowded, babies who are HIV-positive languish in neonatal nurseries, and overcrowding is often so bad that acutely ill patients lie in beds in the corridors.

Is it really likely that a foreigner, faced with a diagnosis of AIDS, will dedicate himself to come here to join the line of 50 million Americans who have inadequate insurance or the 37 million who have none?

But the conceit that we will have to beat back hordes of AIDS-infected immigrants from our shores does not end with the failure to touch base with the misery that is health care for the poor in our nation. The ban misses the psychological realities of terminal illness.

If you have AIDS, the chances are especially good that you will want to stay in your own home. If you are very sick or dying, the chances are good that you will want to stay close to those who know and love you rather than travel to a foreign land to live out your remaining days in a strange setting.

If immigration by AIDS victims were a real problem, the countries of Western Europe, Scandinavia and Canada, which all have better health-care services for the poor than we do, would be swamped by people with AIDS trying to sneak across their borders. They aren't. Given the state of our health-care system for the poor, we won't be, either.

So, if no foreigner with AIDS is going to choose permanent residence in this country, why all the fuss about the ban? Because the ban has other implications. The rest of the world sees the United States as hostile toward AIDS victims, so much so that an international AIDS conference scheduled for Boston next year is in danger of being moved to another country.

Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota, is a columnist for the Saint Paul (Minn.) Pioneer Press.

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