Daca and the White Coat

Standing on the steps of the Memorial Church on the Harvard University campus, listening to impassioned speeches by professors, custodians, and students, I took a moment to consider my white coat. How interesting that coat seemed now that my classmates and I—normally far off on the medical campus, absorbed in a veritable ocean of other white coats—were standing in solidarity with, yet distinguishable from, the students and faculty around us. How different it felt to be wearing our coats not simply to blend in with other medical professionals but to add force to our greater community and its demands for justice. On that gray afternoon in November of 2019, my classmates and I were standing in support of recipients of the Deferred Action for Childhood Arrivals (DACA) program, individuals whose work, health, and lives were, at the moment, wrapped up in the deliberations of the U.S. Supreme Court. DACA was implemented in 2012, providing renewable deferral from deportation for individuals brought to the United States as minors. In 2017, the Federal Government attempted to end the program, stating that the creation of DACA was, in effect, an overreach of authority.1 Many states and legal groups found this rescission “arbitrary and capricious,” and it was quickly challenged. Hence that day, when the Supreme Court began hearing arguments for the case, I stood listening to the people for whom the stakes were highest, providing them with what support I could and reflecting myself on advocacy and the white coat. “I know I am not the only one impacted by this decision,” one medical student spoke into the microphone, calmly yet forcefully. “There are so many people scared to access health care, scared to see their doctors, because they don’t know who they can trust. I entered medicine because I want to uplift underserved communities and individuals. But that’s not possible if we—especially all of us wearing these white coats—don’t fight for those people.” I looked at my own white coat and wondered. What obligation do we, as medical students, physicians, and educators, have to people like the Dreamers, whose health, well-being, and livelihoods are affected by policies and decisions which are, technically, nonmedical? Should physicians be working to effect social change? Or must our improvements be restricted to the clinical and scientific realms? There is, in some circles, a notion that health and illness can be understood outside of social structures and public policy. But, as one of my medical professors once said to our class, “All medicine is social medicine.” Housing, work status, food security, and the like are powerful determinants of health, and as long as structures and policies produce injustice in these areas, physicians cannot expect justice in health and health care. To find it, they must take their white coats beyond the clinic. And so, for nearly an hour, my classmates and I listened to a wide host of speakers—including several medical faculty—question the reality of our medical and nonmedical, social and nonsocial, categorizations of life and responsibility. In listening to them, I realized that to be a physician is to care for the well-being of all people, not merely those who have the means and security to walk through one’s clinic doors. If all medicine is social medicine, perhaps all social issues in the end affect medical care. This means that medical students like myself must begin learning to leverage our skills, knowledge, and social positions to effect change, whether through our research, writing, policymaking, medical care, or simply our presence in our white coats. Shortly after returning to the medical campus that day, I considered my own skills, position, and responsibilities. I had long been fascinated by psychiatry and had nurtured a burgeoning interest in law and health policy. I contacted a professor at Harvard Law School and began participating in his work on trauma, psychopathology, and asylum evaluations at the U.S.–Mexico border. It was a small but intentional step toward what I hope will be a lifelong involvement in social advocacy. In June of 2020, the Supreme Court delivered its 5-4 ruling against the rescission of DACA, providing momentary respite for 700,000 Dreamers across the country.1 However, this is not the end of the matter, and as issues like immigration reform continue to remain near the forefront of our public and political consciousness, medical professionals will be called to consider and address the social nature of their work. After the DACA rally, I learned to respond to that calling. Now, as in much of medical education, it is simply a matter of putting that learning into practice

Political science · Sociology · Supreme court · Ethics and Legal Issues in Pediatric Healthcare · Law