At my old hospital, we used to joke that there was a direct shuttle from the airport to our emergency room. A seasoned nurse introduced me to the term “anchor baby.” According to constitutional amendment XIV, article I, section 1, “All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States….” Somehow, even low-resource individuals in remote villages, sometimes speaking dialects unrecognized by professional translators, have discovered the generous implications of the legal definition of American citizenship. These patients showed up at our doorsteps regularly, and trusted that we would take care of them without questions.
And we always did. For people like Hinna, I am grateful to have trained in a state that doesn’t require an ID for people to receive acute medical care. I treated every patient simply as a human being with a health need, not as someone on the right or wrong side of bureaucratic boundaries. For a long time, I adamantly protected my right not to know if my patients were legally or illegally here in the country. I didn’t want to complicate my doctor-patient relationships with the possibility that I was a conduit for criminal activity.
However, practicing medicine, especially obstetrics, means that you can get drawn into people’s lives and families. Sometimes, you find out that the patient plans to stay beyond their visa, and the baby is their insurance policy against deportation, like Merlene.
Merlene came in wearing a smart blazer over a floral dress. Except for her sharp intakes of breath with painful contractions, one might have missed that she was pregnant. She had just flown in from her home country to go shopping with her cousins; as a precaution, she carried her prenatal records. I raised an eyebrow. She decided to take an international shopping trip two days before her due date? Merlene avoided my gaze. She soon delivered a vibrant baby boy. By then, she had made friends with some nurses who were also from her country and they were speaking in their native patois, sharing updates about “back home.” Merlene’s boyfriend had left her recently for another woman. She saw the break-up as a chance for a new start.
I liked Merlene. She was fun and high-spirited. But, knowing her intentions, I had a nagging feeling that I was an accomplice. If a mother tested positive for drugs, I would be legally bound to report this information to a social worker, who would alert the appropriate authorities. The same goes for child abuse, sexual abuse, and testing HIV positive. There are no reporting requirements for undocumented immigrants.
On the human level, most would agree that immigration status should not be a barrier to urgent medical care. However, willfully traveling to the United States to give birth and gain a foothold on citizenship isn’t the usual, involuntary situation that sick people face. It actually feels a little like strangers have broken into your house and think they can help themselves to your possessions. They have contributed nothing to your society, but consider it acceptable to use your limited health care resources.
My parents won a green card lottery in Taiwan and brought me to America at age 8 in pursuit of better educational opportunities. When I take care of patients who are recent immigrants, I see the same aspiration in their faces. Most often, I remember patients like Ana Maria, a migrant worker, who came to my hospital to deliver all her babies, and I happened to deliver two of them. Each time, she lamented that she was missing valuable harvest income; she was already saving up for her kids to go to college.
Immigrants, like Ana Maria, give up the comfort of familiarity to create their own tomorrow. They craved freedom enough to transplant themselves to a different land. In that light, framing immigration and citizenship as purely legal issues is too narrow. What is ultimately at stake is our collective definition of what it means to be an American.
America is a nation of immigrants, people who take risks, challenge tradition, and generate new ideas. Diversity has value here. Self-determination is prioritized. Social mobility, not entitlement, motivates progress. The rest of constitutional amendment XIV, article I, section 1 reads: “…nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”
Merlene, Hinna, and Ana Maria are not legal Americans, but they remind me of the essence of America, the longing to change one’s inherited status for something potentially greater. That ideal can’t be fully codified into law, but it is worth honoring when someone dares to live it. While immigration laws are necessary and should be obeyed, I hope the energy and promise of the American character remains preserved in the legislative process.