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.

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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.

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  • Your ethics concerns are well taken.I have been doing age determination for over 20 using x-rays of the third molars which are inconclusive but i also take an x-ray of the radius and ulnar bones of the wrists which is much more accurate than molar films.I have made over 1000 age determinations .Call me for the truth-516 978 2950.My office is in JFK&LGA AIRPORTS.

  • It is interesting that whenever someone refers negatively to the “previous administration” (Obama), they are automatically condemned as racist. This ignorance is exactly why we have a race problem in this country.

    • Doctor,
      It sounds like you have been misinformed by your choice of news outlets. There are plenty of people who are aware that Obama was not perfect. That has nithing to do with the current Trump administrations racist policies of putting children in cages. One really should educate oneself about the Facts , before putting in their 2 cents. Perhaps getting your news and fact form somewhere besides Fox News or the National Enquirer would help a lot.

  • Yet somehow killing children just after birth, as some states have legalized, is ethical?

    Sorry progs, these children were exposed to much worse things while being dragged over 1000 miles by who knows who.

  • Several items are very concerning least of all the fact that ILLEGAL aliens are being exposed to 1 X-ray. First it is interesting to me that automatically the current administration is being blamed for this. Is it far fetched not in the least but I’m also so over the previous administration being blameless and never held accountable for anything negative. How is it fair that a child who came into this country ILLEGALLY receives better “Free” for them health care than my son that my husband and I work tirelessly for. Then to add salt to the wound (thanks to the previous administration) we either get a tax penalty for only or pay such outrageous premiums to have health insurance (we own a small business) and every year the coverage gets worse and more expensive, but since I’m a taxpayer I pay for these illegals to have healthcare. I don’t think it’s unethical in the least. I do understand they are trying to make a better life for themselves and their families, but do it legally. If you think it’s so unethical etc leave. Good luck because even Mexico has very strict qualifications for becoming a resident, as does every other desirable foreign country. The United States is the only country that doesn’t require you to have a certain amount of money, or own a piece of property for a certain amount of time in that country. Those other countries would not think twice of doing something like dental aging to protect themselves. Why don’t you want more for your country? Most of these immigrants don’t believe in birth control so that is just more people being added to our welfare, Medicare, Medicaid systems. Why are so many Americans such bleeding hearts for illegal immigrants but don’t realize if we stop paying for all of those people we could afford to help our homeless Vets, homeless in general work on the foster care system instead they are getting money that AMERICANS work hard for and should go back to AMERICANS that deserve it!

    • Your comment is so over the top racist that it reads as almost a parody of a typical xenophobic Ugly American. Your patently false claim that the previous administration was “never held accountable for anything negative” would be laughable were it not for the fact that your actual target was the race of President Obama.

      Considering that two children have died because of the shameful treatment they received at the border I sincerely doubt that they are receiving “better FREE for them health care than my son that my husband and I work tirelessly for”. Is your son dead?

      And calling unnecessary exposure to radiation “health care” is moronic. They are not being X-rayed for health reasons but to determine their age. And as the article makes abundantly clear this is not an accurate way to accomplish even that goal. But kudos to you and Vincent for admitting publicly to your hatred of brown and black people, I hope Dr. Tedone informs prospective patients of his racial bias.

    • Ms Ross,

      You crafted a disturbingly misinformed and nasty response. You and your fellow xenophobes and racists are uninformed on the history here. Your paragon of conservatism Reagan, made it Ok to hire UNDOCUMENTED IMMIGRANTS in order to break the labor unions. The conservive news has not covered one case of any employer being in trouble, or breaking the LAw for hiring the UNDOCUMTED. In FACT, president Trump hired UNDOCUMENTED IMMIGRANTS to work at all of his golf courses and properties. This wwas while he demeaned hard working immigrants, and people of color, with his racist speeches. Trump liek otehr wealth Americans made a lot of money hiring UNDOCUMENTED IMMIGRANTS.
      This article was about innocent children, and several have died in US Custody. These children had nothing to do with the decisions of their parents, who were lured here with jobs. People like you repeat talking points and lies that were amplified by our corrupt media, and Russian Troll Farms.
      The people in Guatemala have already faced Genocide, at the hands of American funded Death Squads, and peope like you did not speak up then.

      To direct HATE at Innocent Children, is beyond disgusting. You might need to wake up and ask why your son does not have accesss to medical care, like millions of Americans, instead of blaming innocent children. Millions of American don’t have healthacare, becasue of our greedy corporations and the corrupt politicians that have allowed this.

    • Your argument is clearly based on a foundation rubbish..we see now these are death camps design to cause mass extermination. The history of Donald J.Trump will be the same as Eichman, Von troth, Mengele, Stalin an Andrew Jackson…murderer, Ms Ross

  • No one knows where some of those children are. They were most likely trafficked, by so called ‘Foster Families.” This criminal administration made us all complicit in their Evil. The physicians that released that little boy to his death were complicit too. It sickens me that to many “professionals” were quick to endorse the wholesale detention and Torture of innocent children.

  • I hope you work to get this information broadcast more fully. Perhaps not paying DDS to do this would be an interesting method to see how much avarice plays a role in subverting ethics. By the way, the hippocratic oath, if read in it’s entirety, is basically a business contract; with a few slam dunk phrases like “to do no harm,” or perform no abortions. But, basically, it’s a business contract. So the money concerns started thousands of years ago. I don’t know if taking the payments away will stop this practice, but after 40 years as a nursing professional observing medical and dental practices, I’m sure it will dry up the pool of DDS providers.

  • This is a highly complex issue with many implications for the future
    (vis: https://doi.org/10.1093/biosci/bix125 ). It deserves rational consideration, rather than emotional hyperbole; not just immigrants, but citizens of every country should be practicing birth control. There will be very little chance of survival for many complex living things- including humans-if we don’t manage steady-state equilibrium in this area. What is intelligent or ethical about that?

    • Umm, this sounds like a passion-inflaming red-button topic already, and certainly there are specific decisions to be made about this specific issue before tying it to larger overarching ethical plans for our civilization. I mean, I just read about this here and now, and I don’t think I’m alone in that – it’s not well-publicized (gee, wonder why?) Given my somewhat-importune creativity, the little voice in my head IMMEDIATELY asked “Is she recommending STERILIZATION as a prerequisite for immigration?” Likely not, but there aren’t many cool-buttons, IYKWIM. We need to let the bicycle messangers through before we summon the tank battalions, I think.

    • The Torture of children at our Border is hardly the time to tlak about birht control. If you had any knowldege of this problem, you would know that these people were already subjected to Genocide, and thousands were killed in Guatemala and other countries. You seem pretty ingorant of the Fact that TV Missionaries have been working with our government to spread Evangelical christianity in Central America. They use it to break up communities, and create horrers like this. These Evangelicals use the money they pilfer from Americans to spread their sick version of religion accross the world. In Central America women can be jailed for miscariages, and birth control is forbidden.
      Perhaps you should brush up on few facts, before commenting!

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