Parents who entrust the care of their children to doctors and dentists do so based on the belief that these professionals will act in the best interest of their children. A profound breach of that trust occurs when those professionals not only violate the “do no harm” maxim they pledged when taking the Hippocratic oath, but do so through the misuse of the licenses and privileges they’ve been granted in exchange for our trust. That’s happening right now on our southern border.
When immigration authorities believe that an individual who has crossed the border claims to be a child but might be over the age of 18, they call in forensic dentists to take panoramic X-rays. The dentists do this not to identify dental maladies or make sure they can provide appropriate dental treatment — which would be appropriate uses of X-rays — but because they claim they can identify an individual’s age with an extraordinary degree of precision from his or her X-rays.
All children ostensibly receive some dental care while in custody of the Office of Refugee Resettlement. Yet only two groups are X-rayed: those with obvious dental issues and those whose age is in question.
In one reported case, a dentist concluded that an immigrant was “between 17.1 and 23.7 years old — with 92.55 percent confidence that he was over 18.” That is not only absurd but flies in the face of the Royal College of Pediatrics and Child Health, among others, which have indicated that taking X-rays for nonmedical purposes is unethical because it exposes children to radiation while providing no health benefit.
The need for precision is essential to this task. The “calculation” that someone is 17 and 364 days old as opposed to being 18 and one day old has enormous consequences. Detained immigrants under age 18 are sent to shelters operated by the Office of Refugee Resettlement or sometimes released into the custody of relatives. Those who are 18 or older are sent to Immigrations and Customs Enforcement adult detention centers, which are essentially prisons.
Whether an individual is a minor when he or she crosses the border also carries consequences down the line related to his or her ultimate ability to obtain asylum and lawfully remain in the United States. Improper age determination may also cause a child to unnecessarily lose status as what the Office of Refugee Resettlement calls an unaccompanied alien child and the legal protections that come with that status, such as a non-adversarial asylum interview and release to an eligible sponsor.
Given the consequences, it isn’t surprising that immigration authorities have an interest in making claims about the ages of young immigrants. That they have turned to forensic dentistry to do so is deeply troubling and ethically impermissible.
Dentists can point to little evidence supporting the notion that dental X-rays can determine a person’s age to the degree of specificity they claim. At best, such dental age estimations are just that: Estimations of a range of years in which an individual’s age is likely to fall. A recent systematic review of age determination on the basis of dental maturation found that ages were consistently overestimated.
Despite the willingness of forensic dentists to say otherwise, evidence-based science simply does not support the use of X-rays to precisely identify that an individual is over age 18.
The absence of scientific support for these actions is troubling. What is shocking is the willingness of dentists to do harm at the behest of the state purely to serve the political/legal goal of defeating children’s rights.
The X-rays foisted on immigrant children expose them to radiation, and thus to medical risk. Doing that is ethical only when there is a compensating benefit that is “in the best interest of the child.”
To be sure, a single X-ray likely does minimal damage to the body, just as one cigarette does not cause cancer. Yet there is no question that X-rays are not innocuous events. This is why we permit only certain professionals to submit children to X-rays, and only when they are in the best interest of the child and with the informed consent of his or her parent or guardian.
Instigating a medical procedure for the purpose of depriving a child of the right to be treated as a child — or for the purpose of facilitating and permitting imprisonment — is absolutely prohibited by the ethics of medicine, not to mention by the notions of fairness and decency.
There have been all too many instances in history where clinicians, acting as agents of a state, subjected human beings to risk without consent or medical benefit. When these have come to light, they have been condemned. The dentists choosing to perform these “age-determining” X-rays along the southern border are breaching their professional duties, and should cease this punitive activity.
Brendan Parent is the director of applied bioethics at the NYU School of Professional Studies and a fellow of the Center for Genetics and Society. Nancy Neveloff Dubler is consultant for ethics at NYC Health + Hospitals, adjunct professor in the Division of Medical Ethics at NYU Langone Medical Center, and professor emerita at the Albert Einstein College of Medicine/Montefiore Medical Center.