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.

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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.

  • It is also unethical to cross a national border without following established procedures. If x-ray of teeth can determine actual age of individuals it can also determine extent of dental problems. With large amounts if people attempting to come across this appears to be the most efficient and indeed, ethical method, of addressing two needs with one procedure. It is time for educated people to consider the long-term impact on this nation’s environment as well as the global warming climate from large numbers of immigrants who are not much interested in practicing birth control.

    • But, that’s not how we do medicine. If our goal is to screen for and treat all dental issues, I’m all for it. I’m sure we’re screening for TB, hepatitis and the flu as well (aren’t we?). Even if our intentions are noble, we never ever use medical information for other purposes *without clearly stated informed consent. Also, just be clear, committing an unethical, illegal or immoral act does not give people a an open door to be unethical to you. In fact, in the US prisoners have EXTENSIVE medical and human subjects protocol protections. Feel free to read the Nuremberg Code and Belmont Report in your free time.

  • Dental X-ray = 5 microsieverts of radiation. Background dosage received per person per day = 10 microsieverts. Radiation worker’s limit for one-year dose = 50,000 microsieverts = 10,000 dental X-rays. https://xkcd.com/radiation/
    Somehow I’m not worried about the “extra” radiation these alleged minors are subject to.

  • Nice article. I hope these dentists are censured.
    I’m new to the forum and expected the comments to be well-informed and on point. Not so much. Arguing about the accuracy of determining age, the perceived harmlessness of a single dental x-ray and bringing up abortion (where did that come from?) misses the point entirely…

    • Where do you come from? Who is “we”? Do you use straw man arguments for topics other than ethics? My biggest question concerns the missed point. You have three of them at the end of your comment. Should there be another? Or are you referring to another missed point?

  • The writers are ethics experts not experts in the toxicity of radiation on individuals or groups. Radiation exposure for panoramic x-rays is about 0.010 mSv. This will cause an extra cancer in 1-4 children per million for no health benefit.

    This is unethical and should result in the suspension or revocation of dental license. All x-rays increase individual and population cancer risk.

  • The dental practice being challenged as violating a standard cited as “…not only absurd but flies in the face of the Royal College of Pediatrics and Child Health, appears to be a standard from a college in the United Kingdom. Perhaps America has a similar dental practice standard and if so the author of this critique has a duty to stipulate the American code of dental practice regarding this alleged unethical practice.

  • Looking at the issue from another perspective, arriving in the USA illegally but under the age of 18 apparently qualifies one for privileged treatment. Therefore, if the dental exam determines an illegal immigrant is under the age of 18, it would be in their best interest. Absent a reliable birth certificate, some method must be used to determine age. Had the author suggested an alternative, I would take his argument seriously. This is the kind stuff that gives applied bioethics a bad rep. I wonder how many angels can balance on the point of a pin.

    • So you think children under the age of 18 are qualified for privileged treatment? Like Felipe Gómez Alonzo, an eight-year-old boy from Guatemala who died a preventable death on Christmas Eve? Or Jakelin Caal, a seven-year-old Guatemalan girl who crossed the border with her father, and died less than two days after being apprehended by the border patrol?

      It’s not just children. In 2018 an additional twelve adults died in ICE custody. In over half of the deaths inadequate medical care contributed or led to the death. Why is this acceptable to you?

  • I find it interesting that these “ethics” specialists/professionals come from New York, the state where you can kill babies up to birth, but an X-ray… OH MY GOD! You’re harming these poor little ILLEGAL immigrant children. YGTBKM!!!

    • Great point! No matter what one’s overall view on abortion might be, it’s a bit hard to imagine how killing a perfectly healthy baby the day before it is to be born can possibly be squared with the Hippocratic oath.

    • New York? Abortion? The article I read was about dental x-rays on immigrants at the southern border. Maybe my computer is on the blink, but where I come from dentists don’t perform abortions and we don’t use straw man arguments to argue ethics.

    • Sioa, are you distressed by the deaths of Felipe Gómez Alonzo, age 8, or Jakelin Caal, 7 years old, or is your concern strictly for the unborn?

      What about a 19-month-old girl, Mariee Juárez, who died after she developed a fever of 104.2F, vomiting and diarrhea at a family detention center in Dilley Texas?

      You sneer at these children, calling them “poor little ILLEGAL immigrant children” and say that people who express concern about the deaths of these children have “got to be kidding me!!!” I assure you that no one is joking about the preventable deaths of infants and children. It’s sad that you think their lives have no value.

  • It’s also unethical to sneak into a country illegally. I can’t legally go to Canada with out going through customs. If I do I would be obtained

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