Ethics Dispatch September 2025

“Functioning as our better selves leads to better outcomes for patients and everyone.”

Tarris (Terry) Rosell, PhD, DMin, HEC-C

In August 2025, KCUR – Kansas City’s NPR member station – reported that recent federal policy changes under the current administration will strip many immigrants of access to essential health and social services (Taborda, 2025). The U.S. Department of Health and Human Services (HHS) announced that 13 programs – including community health centers, mental health services, and Head Start – will now be restricted to “qualified” immigrants.

While officials framed this as a cost-saving measure to “protect vital resources for the American people,” advocates in Kansas argued that this move represents something far more insidious: scapegoating. By blaming immigrants for the shortcomings of the health care system and then cutting off their access to aid, policymakers create a cycle of exclusion and suffering that makes those false accusations appear true. This engineered disadvantage is more than a political maneuver; it is a profound violation of the bioethical principle of justice.

Redirecting Anger

Scapegoating is an old political tactic. When systems fail, leaders often redirect public anger toward vulnerable populations. Monica Bennett, legal director of the ACLU of Kansas, told KCUR that immigrants are being used as “someone for people to point to and say, ‘it’s your fault that our health care system doesn’t work properly’” (Taborda, 2025).

This narrative reframes systemic issues – like the underfunding of public health infrastructure, rising hospital costs, and workforce shortages – as the fault of people with the least power to change them. The benefit to those in power is obvious: fear and resentment are stoked, political support is consolidated, and accountability for structural reform is evaded.

Engineering Disadvantage

Yet scapegoating alone is not the most dangerous part of this story. What makes the recent policy change particularly alarming is the deliberate withdrawal of aid. By cutting off access to community health centers and behavioral health services, HHS is not merely placing immigrants in a more precarious situation – it is actively engineering their disadvantage.

Data from the Kaiser Family Foundation show that 30% of immigrant adults rely on community health centers for care (Taborda, 2025). Removing this lifeline virtually guarantees that health outcomes will worsen, increasing the burden of preventable illness and untreated mental health conditions. In other words, the claim that immigrants are a “drain” on the system, while initially false, becomes closer to reality once policymakers create conditions that force crisis upon them.

This dynamic is a textbook case of a self-fulfilling prophecy. A false accusation – immigrants overuse health care – is repeated until believed, then enforced through policy that removes access to affordable, preventive care. When predictable negative outcomes follow, they are cited as proof that the original claim was true all along. The cruelty lies not only in the suffering inflicted, but in the way that suffering is used to validate and entrench discriminatory policy. It is policy-driven victim blaming.

Manipulating Access

From a bioethical perspective, the injustice is stark. The principle of justice demands fairness in the distribution of resources and protection for vulnerable populations. This policy does the opposite: it systematically excludes immigrants from services necessary for health and flourishing. Health is not a privilege for the few; it is a fundamental good that ethics and public policy alike should safeguard. By manipulating access to health care in order to reinforce a scapegoating narrative, policymakers erode the very foundation of justice.

This moment should remind us that bioethics is not limited to the clinic or the bedside. It extends to policy decisions that shape who gets access to care in the first place. The Trump administration’s expansion of restricted benefits under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 is framed as fiscal prudence, with HHS estimating that savings could redirect $374 million annually to Head Start services for U.S. citizens (Taborda, 2025). Yet this reasoning sets up a false choice, pitting vulnerable groups against one another. It suggests that justice can be achieved only by sacrificing some populations for the benefit of others – a logic that corrodes the very idea of a shared social good.

Bioethics and Justice

In truth, this policy is less about saving money than about manufacturing enemies. As the Kansas Immigration Coalition noted, the change “further institutionalizes the exclusion of undocumented immigrants from essential health and human services that are vital to community wellbeing, public safety and long-term recovery” (Taborda, 2025). Exclusion, fear, and division are not accidental byproducts; they are the desired outcomes.

The decision to scapegoat immigrants and strip away health care access is a cautionary tale about how easily ethics can be subverted by politics. It shows us how fear can be weaponized to dismantle justice, and how health policy can be turned into a tool of harm rather than healing. If bioethics is to remain relevant, it must speak forcefully not only in the hospital ward but also in the policy arena. Justice is not optional. It is the baseline of any ethical health care system. To deny it – especially to those already marginalized – is to undermine the integrity of medicine and the moral credibility of public institutions.

Source

Some Kansas immigrants will lose access to health care because of Trump policy changes | KCUR – Kansas City news and NPR

Mr. Ramirez is a 44-year-old male with multiple medical conditions, including cirrhosis of the liver and acute kidney failure. He has been receiving outpatient hemodialysis twice a week for the past eight months, which has managed his conditions effectively.

Recently, however, it has become increasingly difficult for Mr. Ramirez to access outpatient dialysis due to his immigration status as an undocumented resident living in the United States. As a result, his access to outpatient hemodialysis has been denied. He now often goes up to two weeks between treatments before presenting to the emergency department (ED) of his local hospital.

In the ED, Mr. Ramirez receives dialysis, is stabilized, and then discharged. The hospital does have a policy to provide dialysis to patients in need regardless of immigration or insurance status. However, the medical team has communicated to Mr. Ramirez that the emergency department is not the optimal method of receiving dialysis, as outpatient treatment would be more consistent and more cost-effective for both him and the hospital.

Mr. Ramirez has expressed that outpatient dialysis would indeed be his preference, but due to his undocumented status, accessing it is not an option.

In physics, it has long been a held belief that the universe is locally real. This may sound like fancy science jargon (without even going into the groundbreaking work of John Bell and Bell’s Theorem, which was proved and led to the Nobel Prize in Physics in 2022), but the idea is actually simple. It forms a foundation not only for physics, but also for much of human thought.

The principle of locality holds that “The principle of locality, i.e., local causality, states that cause of an event must have a direct influence to cause a change on another event.” (Maudlin, 2011)). The roots of this principle go back to Aristotle’s theories of physics and causality, particularly his notion of the efficient cause.

The Search for Causation

At its core, locality says that for something to cause something else, the two must directly or indirectly interact. If I claim to have caused the lights to turn on, I would have to walk over to the switch and flip it. The lights do not come on spontaneously, without cause. If I am sitting in a chair and the lights turn on, I wouldn’t assume it happened randomly. I would believe that something – other than me – caused the change. It is ingrained in our human understanding that things happen for a reason, that there must be a direct cause. For Y to happen, X must occur first. Therefore, X causes Y. This is how most of us are taught to see the world and how we seek answers. But the truth is that reality is often far more complicated.

America is going through a challenging time. The cost of living is increasing year after year. More people are living paycheck to paycheck, and many feel that the country is not headed in the right direction. A major source of frustration is the rising cost of healthcare, including insurance premiums, medications, life-saving procedures, and even routine care. As expenses grow, so do people’s anger and desperation. And in moments like these, people search for answers. They want to understand the cause.

This search for causation, in my view, is part of the rationale behind recent federal decisions impacting healthcare, particularly immigrants’ access to it. According to the Oregon Capital Chronicle, “While acknowledging that states can bill the federal government for Medicaid emergency and pregnancy care for immigrants without legal status, federal officials have sent letters notifying state health agencies in California, Colorado, Illinois, Minnesota, Oregon, and Washington that they are reviewing federal and state payments for medical services such as prescription drugs and specialty care. The federal agency told the states it is reviewing claims as part of its commitment to maintain Medicaid’s fiscal integrity” (Hart, 2025).

Restricting Access ≠ Lower Costs

The underlying idea is simple: immigrants are using healthcare resources, which is said to drive up costs for everyone. Therefore, if you restrict immigrants’ access to care, costs will fall. In other words: X causes Y. If you want to eliminate Y, you eliminate X.

If only it were that simple. Reality is far more complex. It is understandable that people who are financially struggling may feel it is unfair for others to receive healthcare “at their expense.” They may believe that restricting Medicaid – and narrowing who can access its resources – will lower costs for everyone. But this is a simplistic causation argument, and reality rarely works in simple causation.

It also runs counter to human behavior. People without health insurance still access healthcare. They still come to emergency departments. They still seek life-prolonging treatments like dialysis. Denying them access to insurance does not prevent them from needing care – it simply shifts the costs elsewhere, often increasing the financial burden on hospitals and the broader system.

Vaccination offers a clear example. It is cheaper to pay for everyone to receive a polio vaccine than to pay for the hospitalizations and long-term care of people who contract polio. Preventive care reduces long-term costs. Restricting it creates bigger bills later.

There are certainly serious problems with healthcare in America in 2025. But cruelty and a lack of compassion are not solutions. These traits will not only make life harder for immigrants; they will make healthcare more expensive and less sustainable for everyone.

Sources

Quantum Non‐Locality and Relativity | Wiley Online Books

Trump administration investigates Medicaid spending on immigrants in blue states including Oregon • Oregon Capital Chronicle

Written By Ryan Pferdehirt, D.Bioethics, HEC-C, Vice President of Ethics Services, Rosemary Flanigan Chair & Cassie Shaffer Johnson, MA, Program Coordinator