CMDA's The Point

Ethics of Immigration

December 12, 2019
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by Robert E. Cranston, MD, MA (Ethics)

Yesterday I attended a seminar at our hospital entitled “Immigration Ethics.” I was hoping to be enlightened on this complicated topic. Unfortunately, the only messages I got were that immigrants are people, too, and we should be humane in dealing with them. I heartily agree with these two points, but the issue is complex and entails a number of points on which many people cannot agree. One major question in discussing this is whether we are referring to legally documented or undocumented immigrants. Most of us are grateful for the legal, highly skilled immigrant engineers, scientists and physicians who make our lives better in many ways.

How many of you have been treated by or professionally collaborated with a legally documented immigrant physician, nurse or engineer? I think we would all agree that permitting a finite number of professional immigrants to emigrate is in all of our best interests, so I will leave that side of the discussion aside and restrict this essay to consideration of undocumented immigrants. Most of us agree to the idea of helping families stay together, and these two reasons—family unity and professional skills—are the two most common reasons for legal immigration.

Moving on to immigration of undocumented persons, the questions raised below, though clearly not an exhaustive list, essentially fall into two categories: those that are primarily political/philosophical questions, and those of a more personal nature. All have ethical implications. One could write a doctoral thesis on each of these, but I will offer a list of political considerations, which I will not address, and respond primarily to the latter category of questions. I realize that many people of good moral character and intentions may not agree with my responses, but hope they will be received civilly, as they are offered. Civility is sorely lacking in much American discourse today, impeding reasoned discussions of complicated topics.

The first seven questions are, in my opinion, primarily political/philosophical. You may look at a few of these as being unquestionable, but in my research for this essay, I found that all of them are debated in the literature. I offer no opinion on these questions, but I do list them to highlight the complexity of the issue.

  • Do sovereign nations own the right to decide who enters their countries?
  • If so, what are ethical criteria for acceptance and the appropriate number to allow in?
  • How do we exclude people intent on causing harm to our citizens or country?
  • Who owns the natural resources located within the borders of a given country?
  • As stewards of resources in the U.S., does the influx of immigrants threaten our environment?[1],[2]
  • Is the border wall an immoral concept, as some have claimed?
  • Does the influx of immigrants displace American workers from job opportunities?[3]

On a more personal level,

  1. What do we do with all the undocumented immigrants currently interned and those who are currently at large?

For those interned, the principle answer is fairly straightforward. We need to treat them with respect. They need to be housed in humane conditions. As much as possible, families should be grouped together. The specifics of how we engage this problem may differ, but they are all issues that require thoughtful consideration.

As far as those who have been released pending adjudication, we need to keep better tabs on them. This is more of a political/logistical issue.

The answer to both of these is complicated and costly. It will cost American taxpayers more for either or both of these actions, but some actions need to be taken.

  1. Do we have an obligation to accept and protect applicants seeking asylum?

In Deuteronomy 23:15-17, the Jews are instructed, “You shall not give back to his master the slave who has escaped from his master to you. He may dwell with you in your midst, in the place which he chooses within one of your gates, where it seems best to him; you shall not oppress him” (NKJV). While we do not live according to all of the Old Testament laws, this principle seems fairly clear. The tough part is knowing who is a true victim of war, persecution or other violence, and who isn’t.

Another difficult asylum question is that we often cannot determine the character and past behavior of the asylum seeker. If we are confident that the people in question were truly being oppressed in their home countries for religious or political reasons and do not pose a risk to our citizens, one would think we are compelled by love to help in some way.

Another question I recently read about was that of a woman who had suffered domestic violence at the hand of her husband in her home country. What responsibility does her home country, as opposed to the U.S., have to her and her children? Should our foreign mission organizations deal with this? (Many of them are.)

  1. Are we morally obligated to treat any undocumented alien present in the US who requires medical care at government expense?

Luke 10:25-37 relates the Parable of the Good Samaritan, in which a Samaritan reaches across ethnic lines and pays for the medical needs of an injured Jew. This is a parable, however, and it is dubious to draw political direction from a parable designed to prompt greater love on an individual basis for all persons. If the U.S. government becomes the main source of financial support for all undocumented immigrants with medical concerns, how much will this cost? Is the government the appropriate source for funding?

The government has an obligation to its own citizens first. Even then, not all needs are best addressed by a centralized government. In Marvin Olasky’s classic book The Tragedy of American Compassion, he makes a case for individual Christians, churches and charity groups to undertake the needs of the poor in our midst. Before the government became involved in providing funding for Medicare and Medicaid, a strong sense of accountability to the givers helped maintain the integrity and relationship between giver and receiver. This is no longer the case.

Is it time for more Christian charities to see to the needs of undocumented immigrants? Clearly, we are instructed to help the poor, needy, ill, orphaned and widowed, but with finite funding, how big is our field of endeavor?

  1. What is an individual Christian to do about all of this?

Like most complex ethical issues, individually, we are to begin with prayer, Scripture and the quiet contemplation required to listen closely to the Holy Spirit as He impresses attitudes and actions on our hearts and consciences. We should corporately, as Christ’s bride, do the same. As James 4:17 states, “Therefore, to him who knows to do good and does not do it, to him it is sin” (NKJV). If we turn away from this great need, will we be held accountable for our neglect? Think European asylum seekers in World War 2.[4]

On the other hand, there are many people suffering in many different ways throughout the world. As a given individual, we are not called to serve every need. Christ Himself did not cure everyone in Israel of all their physical ailments, though it would seem this was within His power. We should only take on the needs to which the Lord leads us.

Finally, we should allow for the fact that people of good faith may not agree on complex issues. Some will personally feel called to address this crying need. Others may choose to become involved in the political process to get to the roots of the problem. Still others may be called to different actions. We each need to be faithful to God’s directions in our lives, as well as respectful of others’ decisions and their actions. We should all treat each other with civility, love and mutual respect. We need not always agree, but we are to always act in ways that honor Christ.





Robert E. Cranston, MD, MA (Ethics)

About Robert E. Cranston, MD, MA (Ethics)

Robert E. Cranston, MD, MA (Ethics), MSHA, FAAN, CPE, is a board certified neurologist, with additional training and experience in palliative medicine, executive coaching and medical leadership. He is completing his 30th year serving at Carle Health, (formerly Carle Foundation Hospital) in Urbana, Illinois, as an attending neurologist, and (Past Chair—14 years) of the Carle Ethics Committee. He is a clinical professor of medicine (neurology) at Carle Illinois College of Medicine in Urbana-Champaign and is on the clinical faculty of University of Illinois, Urbana-Champaign. He is a member of the CMDA Ethics Committee. He and his wife Tammy are grateful for their five grown children, their daughters- and sons-in-law and their 11 grandchildren.


  1. Avatar Gregory Koury MD on December 21, 2019 at 7:45 pm

    Dr. Cranston,

    You have written an excellent commentary, thoughtful, and inspiring. I appreciate your words.
    Thank you and God bless you.

    • Avatar Jill Townsend on January 8, 2020 at 5:19 am

      Dr. Cranston,

      Thank you for this most thoughtful article. So glad to be a part of CMDA now and glean such information.
      Looking forward to further involvement as both a medical professional and Preacher’s Kid! Just throwing in a thought, my father always taught us to look at such questions through the perspective of the Kingdom first, then the nation ( a challenge for sure).

  2. Avatar Jerry Wittingen on January 1, 2020 at 4:47 pm

    Dr. Cranston

    This is indeed a thorny issue. I found your commentary to be thought provoking and well written. Thank you for being willing to delve into the immigration debate.