I feel that in dealing with situations like the first, the principle of transparency should be the immediate ‘starting point’. Laying the cards on the table almost always benefits everyone involved because each person can make his/her decisions in a fully informed manner and thus choose the most ethical answer, which is usually only clear when the whole picture is in view.
The recommender should therefore provide a trustworthy portrait of the candidate and inform the candidate of the letter’s critical content.
Of course, in hearing about the content, the candidate could rescind her request for a review and find more favorable ones. This would deprive the system of valuable information about the candidate’s competence.
On the other hand, giving the bad review may ignore some of the candidate’s merits. It could be that in making those mistakes, the candidate learned and improved so that in the future she may not make the mistake again. This is something the reviewer would never know to put in her review.
I think the Ethicist’s solution is great, but what might be better (if feasible) would be for the recommender to give the candidate a chance to make right what she did wrong, or give her another chance to prove herself. In doing so, the reviewer would be able to give the system a clearer portrait of the candidate: as someone who makes mistakes but is willing to work hard to improve. At the same time, the candidate gets a chance to better herself and show for it.
2
I'm a physician and frequently get new patients coming to me for the purpose of completing some sort of disability paperwork, often requesting additional letters/documentation or even asking me to fill documents generated by their attorneys. I do not do this. There are doctors who specialize in generating disability documentation; I'm not one of them. It is highly problematic, in my humble opinion, for me to presume, after a 20-30 minute appointment (if that...talk to our clinic administrator...) to understand a person's capacity to undertake many of the activities I'm asked to comment upon. The questions are often nebulous, seeking reductionistic answers to layered concerns. (Can the patient sustain attention? How long? Learn new skills? How readily? Work collaboratively with others? Respond appropriately to constructive criticism? Lift 20 pounds? Use fine motor skills?) To do a proper job - actually gathering and reviewing historical data, testing the patient myself, obtaining collateral from family/other providers, etc. - takes considerable time, effort and understanding which I don't have and can't produce on random demand (and for which I am certainly not compensated.) This goofy system only "works" because so many people are willing to trust a doctor's word where they wouldn't trust lawyers or government functionaries. All the more reason for docs to be above reproach and not lend their professional reputation to circumspectly investigated claims.
11
I absolutely agree when the request requires a comprehensive disability form. As you detail, the forms can ask for ability (or impairment) in performing multiple different tasks.
For LW 3, however, the task was simpler: does she have the claimed illness and does it prevent her from taking a citizenship test. His clear answers are yes and yes--so why no form?
5
It seems to me that a lot of the comments show a lack of understanding about benefits. For example, a person might never have worked (and not paid into Social Security) yet can collect on a spouse's Social Security record if they have been married for ten years. This is also true if a couple who has been wed for at least ten years divorces, no matter how many times the paying spouse remarries. So working at a job that pays into the system is not a requirement for collecting legitimately.
Let's not single out this woman. What she is asking the doctor to do is not dishonest, by his own admission; her big mistake was opening up to the doc about any intentions or benefits she is hoping to accrue.
8
Letter 2: It would be entirely appropriate for this couple to call their local Child Welfare office, tell what they hear going on, and ask for a welfare check. The situation sounds severely mentally abusive and could well include physical abuse as well, if the yelling escalates, sober or drunk. Reports to Child Welfare are supposed to remain anonymous. This call can be in addition to or instead of writing a letter of recommendation.
6
To the former employer whose assistant requested a reference for medical school after not disclosing substantial mistakes: When you inform your former assistant of the negative recommendation, please also let her know that she would be better served by admitting to those mistakes and finding ways to correct them. I'd hate to be a patient whose physician made a substantial mistake in my care and left it for me to discover at some later point.
11
Letter writer # 2 should bow out based on the fact that they have almost no knowledge of the family life in that household. they cannot write a meaningful letter because they don't know anything. i also think that being picked to write a letter does not mean that others in the neighborhood are not writing letters as well. sounds like an awfully gossipy place. they should demure and keep their mouths shut as to the reason.
3
Note that an adoption letter of reference is typically not confidential - the letter is shared with the couple that requested it, and may be delivered to them to include in their application package. In addition, Bob and Karen's home appears to be a place of risk for this child - this is an abusive environment. I would encourage these neighbors to call child protective services and report that they hear Karen routinely yelling at the child. Such calls can be anonymous. The child may indeed be removed, or the family may get help, but this is a crisis for the child either way and he deserves protection.
13
To the third letter writer: it's not your job to assess whether the disabled woman is "playing by the rules." That's the job of the USCIS, who have far more experience and tools to detect scammers. It's also worth remembering that your letter is one small part of the application. She will be interviewed by a USCIS agent before the request to skip the citizenship exam will be granted.
To your larger point, the woman who has asked you for a letter certifying her disability IS playing by the rules. Our rules do not require a history of employment within the U.S., and they allow severely disabled people to become U.S. citizens.
21
"My concern is that she is requesting an exemption in order to collect benefits toward which she has contributed absolutely nothing." Aside from sales taxes paid for goods and services she purchases (as was mentioned above), what about the care and emotional support she may provide for those who pay into Social Security and Medicare which they may not themselves survive to use? What about children she may have reared who have come to this country and are now paying into the same Social Security and Medicare that the doctor's own elderly relatives may use? Perhaps Kwame Anthony Appiah (The Ethicist) would consider these questions outside of the purview of this article, but I hope someone will ask the doctor to consider what it really means to "contribute nothing."
21
If she's in the country legally, how could she be deported and since when is a doctor supposed to care about allocation of resources (which in this country are scarce only the way in which they are distributed).
17
For the Doc who may need to repeat Eng 101 as a refresher course the Ethicist nailed the necessary response: "Your job in this process is to certify what, in your professional judgment, is true about her medical condition." Game! Set! And Match!
24
". . . the norm is that you agree to do them only if (a) you have a duty to do so or (b) the person asking for it knows that you’re going to be critical, if you are."
Is "the norm" written down anywhere? Who enforces it?
The whole idea of letters of reference seems outdated and weird to me. (I have a lovely one written in 1904 by my grandfather's employer, a saddlery in Kansas City. A general letter To Whom It May Concern, that he could use repeatedly. Positive. I don't suppose he would have saved it if it had been negative.)
Years ago, I asked two people to write letters for me to help me get a good job in another city. Both knew me well. One was my current employer, and one was a fellow employee. Both had begged me to stay in place. I assumed they would write good/truthful letters, but a few months later my new employer showed me the rotten letters they actually wrote. He said he didn't think I should ask them for letters of reference in the future. I didn't realize they would use the letters to get even with me for leaving.
I think a letter of reference should be shown to the person who is the subject of the recommendation before it's sent. Let the subject decide if s/he wants it sent. And I think companies should stop asking for such letters or make it clear that they show letters to prospective employees or students.
12
Re: "I didn't realize they would use the letters to get even with me for leaving."
If I remember my ethics correctly, the technical word for what they did is "sleazy." I am glad that your new employer recognized the sleaze for what it was, and warned you about the two malefactors.
13
All three letters require the truth, however the letter for the student requires that she be notified that the circumstances have changed based solely upon her behavior. At that point she may decide whether or not she still wants the letter. The other two letters are straightforward requests for information without color. The writers of those letters have no obligation to consider the lifelong consequences of those letters.
6
The original recipients of Social Security benefits had paid nothing into the system: it hadn't existed during the years they were working. Conversely, some people pay into the system and then die before they reach retirement age. This is the nature of insurance.
20
ILW#1 - As Judge Judy frequently says, "Don't tell me what anyone should know." References are tricky. Employers have been sued successfully by employees for providing negative references even when the negative points are accurate. If you never confronted the employee about the costly mistakes and lack written evidence to that effect, you cannot mention this issue in the reference. Just be factual and don't mention the mistakes. Actually you should be asking HR and the company lawyers this question.
LW#2 - Unless you have spent a lot of time in Bob and Karen's home and know them very well, you cannot give an accurate or reliable reference regarding their ability to be adoptive parents. Don't give a reference of any kind. Why are you afraid to say no?
LW#3 - I thought the Trump Administration recently allowed health workers to refuse to provide services that violated their religious or moral convictions. The request seems to violate the physician's morals so he/she should refuse with a clear conscience to provide the letter.
2
Re: "Trump Administration recently allowed..." You misrepresent. Boston Globe: "...the Trump administration announced Thursday a new federal office to protect medical providers refusing to participate in abortion, assisted suicide or other procedures on moral or religious grounds."
Re: "...so he/she should refuse with a clear conscience" No. The physician took an oath to place the interests of his patient above that of his own politics. He/she knows that, which is why he tied to (falsely) establish that "she is not even my patient"--to fashion a loophole to escape from the oath.
Even if bogeyman Trump had made it legal to refuse to write a letter for a patient (was that ever illegal?), its being legal would not suffice to make it ethical.
10
@Loosedhorse - Actually I was premature. The Administration has only released its new rules for comment so nothing has yet taken effect. However, a physician in private practice is within his/her legal rights to deny service to any prospective or actual patient as long the denial is not a civil rights violation. If this patient were to sue, who knows what would happen in the case but in my opinion, the physician should not have to issue the letter if his moral convictions are violated. There are plenty of other physicians in even the smallest towns.
Re: "...if his moral convictions are violated." His moral conviction that he not write a letter that states what he says is the truth?
As long as we're getting third parties involved, I wouldn't take the aggrieved patient's case to a lawyer (to sue under the ADA, perhaps? Or to claim that the doctor is a racist?). Instead, I would file a complaint with the state medical board for failing to act for the benefit of his disabled, indigent patient, based on his political beliefs.
Oh, the Office being set up is to deal with doctors who refuse to participate in "procedures"--letter-writing is now a procedure? I think your desire to insult Trump is distorting your view of the facts.
1
The common thread here is whether what is requested is a letter of reference or a letter of recommendation. It may seem a small point, but a letter of reference merely commits to certifying knowledge of the person and truthfulness in the response. A letter of recommendation, on the other hand, is an endorsement. Thus in both (2) and (3) there seems no issue other than truthfulness. In (1), on the hand, although styled a letter of reference, the assumption seems to be that what was meant was a letter of recommendation.
3
I think you ALMOST have the distinction correct. The problem I have with your formulation is that, when you receive a request even for a "letter of reference" from the subject of that letter, there is a clear expectation that you will provide a moderately good to very enthusiastic reference: no rational person asks for a bad reference.
To me, the difference would be in WHO requests the letter. If, for example, the child welfare agency asked you to provide a truthful statement about your neighbor, your acceptance means you will not neglect to mention either good or bad points.
1
The idea that small parts of the whole don't matter, as presented in the doctor's query and Appiah's claim that votes don't matter (and maybe a couple of others recently), goes against one of the basic guiding principles of ethics: What if everyone did it?
This has nothing to do with the elderly immigrant in question - it's a general observation. What is right is right and what is wrong is wrong. Doing wrong because others will right the wrong, or because it won't be noticeable isn't ethical. It might be practical, it might be malicious, or it might just be laziness. I try to keep mine to the first and last choice there.
6
I do not see anything in Dr. Appiah's reasoning that amounts to saying "This harmful act is morally okay because it causes such a small harm as to be insignificant," a precept that is well known to lead to "Tragedy of the Commons"-type problems. I do see that he sometimes employs a wider or narrower view of context than I do, in terms of the people affected by a given action and the "assigned" role of the actor in the chosen context.
Context matters. Your rule "What is right is right and what is wrong is wrong" argues for a universal morality, unanimously agreed upon and equally applicable no matter which relevant context is considered. That rule does not recognize that moral questions arise because, in a given situation, two different moral principles (say, "greater good" and "fairness") can be in conflict; or perhaps because different definitions of the "same" principle ("fairness" as equality vs. "fairness" as proportionality) can both be applied validly.
1
I agree that Dr. Appiah didn't say that here (this week it was the medical doctor writing the query), but he didn't challenge it either. A lack of challenge isn't an implicit endorsement - I know. But on the heels of "voting doesn't matter", I wonder.
What I meant by "what's right is right and what's wrong is wrong" was focused more on the scale than an absolute sense of morality. Even if the effect of an individual action won't be noticed in the grand scheme of things, such as not voting (or voting twice), or cheating on something, it is still wrong.
1
Regarding the supervisor of the prospective doctor, the duty to be honest dictates that there are two options: (1) do not write a letter, and (2) write an honest letter after explaining the new perspective.
Regarding the excited neighbors, be honest, including keeping comments to hat was actually observed. Don't make any assumptions, inferences, etc.
Regarding the prospective citizen, what would the doctor do if any other non-patient asked for [what I'll call] a diagnosis letter? Go from there.
9
In the first case, the employee agreed to write a good letter based on the assumption that the employees work has been as competent as she had made it appear to be. But she had screwed up, not asked for help, tried to patch things up on her own, and never said a word about it. And the outcome was bad, but that wasn’t obvious until after she had left the scene. Does this sound someone who should be treating patients??? I think the employer should write an honest letter and not warn her beforehand. It could be a learning experience for the wannabe-doctor and might help her grow.
6
It would certainly teach her how to find a good lawyer to file against her former employer. This person would be nuts to sandbag the employee in that matter. Don't write the letter, and tell the employee why. DO NOT OPEN THIS CAN OF WORMS.
8
Re letter #1 and a bad recommendation being a learning experience: How would the recommendee learn from this experience if the recommender wrote a bad reference without notifying her? Such letters are frequently confidential, and she would be unlikely to learn, anyway, what sank her application.
7
If people are spending money in this country they are paying taxes. The assumption that an immigrant is not contributing is fundamentally flawed.
74
The family members are responsible for the person they sponsored and want to shift the responsibility to others. The system is broken. And what kind of illness makes it impossible to take a ten question test?
5
ebmem,
Based on this answer and what you said previously, it's obvious that you share the same heartlessness that now informs the U.S. government. What kind of illness makes it impossible to take a ten question test? Let me inform you. Senility or dementia, for instance, which may not develop or become manifest until after the person is here for the required five years. The family members are responsible for the person they sponsored, but situations change and not everyone is as prosperous as you seem to think. And I'll pass along some other info: When my wife applied for citizenship, she studied religiously for the test, which is longer and more difficult than you make it sound. She aced it, only to then have a CIS bureaucrat, who was herself obviously an immigrant, invent some red tape excuse for not approving the application, even though after months and years of working on this, all the paperwork was exactly in order. I became furious and demanded to see a supervisor, who seemed rather intimidated by my justifiable anger. She took the paperwork into another room, then came back and said, "It's OK, she will be approved." There were other people there in the same situation being turned away, rightly or not I don't know, but in any event, they had no one there to fight for them. Someone with illness or language difficulties would be lost in this bureaucracy, but I doubt that anything I say will convince you that you are not right.
5
LW 3: "... she is not even my patient." False. She requires the services of a physician in your specialty, and she came to you. She is YOUR patient.
"...she is asking not to play by the rules." False. The rules allow for a medical exemption where appropriate, and you yourself have stated, "she truly has the illness, and it truly prevents her from taking the exam."
"I’m not 100 percent comfortable doing this for her." That's a flaw in your character; do not turn your problem into a problem for your patient.
93
Exactly!
7
Being someone who has written tens of medical or graduate school letters of reference, I am surprised to learn that it is the norm to do so only if the letter will be favorable. If that is so then it guarantees that the whole enterprise is corrupt. It might as well be okay for a scientist to routinely collect a biased sample.
16
I disagree. Agreeing to write a letter or recommendation means that you will RECOMMEND the person in question. Asking for a letter of reference contains the assumption that you will provide a moderately good to very enthusiastic reference: no one asks for a bad reference.
There is no such thing as an "unfavorable" letter of recommendation: that is a letter of condemnation, which was not what you were asked for, nor agreed to provide. Agreeing to write a letter with the intention of writing an unfavorable letter is an agreement under false pretenses.
...So, how many of your "tens" of medical and grad students did you torpedo? And why did you do that, rather than honestly decline and offer to explain why?
32
Sure, there's an "unfavorable" letter of recommendation - "I recommend that this applicant not be admitted".
5
If by "torpedo" you mean give an unfavorable assessment that was my honest opinion, two that I recall. Perhaps this will put things in perspective. One of these was for a job as a forensic scientist. The candidate had been astoundingly careless and immune to suggestion when he was a student working for me, and the thought of someone's liberty, or life, depending on this fellow doing his job right was scary to contemplate. I felt that I could not in good conscience decline a chance to provide what was in that case a phone interview. Don't know whether he still got the job.
1
Doctor, I have seen the forms in question. Nowhere on them does it ask the physician's opinion about immigration, the social safety net system, or whether the person in question is "deserving." Fill out the form with accurate information about this woman's condition and then feel free to judge her and her family on your own time.
109
Well done! Excellent response.
5
About Letter No. 3: Dr. LW3 is concerned that an elderly lady is becoming a citizen to get benefits. It seems much more likely to me that she wants to make her legal status more secure to protect herself against anti-immigrant attitudes like those of the letter writer.
73
I would hardly call the doctor's attitude "anti-immigrant". He might think we are being taken advantage of by this particular immigrant, but that doesn't say anything about the rest of his views. As for the rest of his views, he does say that he's not interested in deportations of illegal/undocumented immigrants).
7
This is a very rare occasion - I agree with the Ethicist's thoughts on each of the queries!
But! The assumptions made about safety net programs are dreadfully incorrect.
Facial, everything is true. Yes, the doctor has been asked to perform a task anticipated by their duties, and should give an opinion free of extraneous concerns And yes, social programs should not be based on the amount you put in, and, as is stated, there are even native-born Americans who have paid nothing to receive benefits. Verily, the system has to be that way and should be that way. But this is a system developed to help our friends, neighbors and country[wo/]men. This is to provide social security, a term that means both for people to be secure in society AND for society to be secure -- the programs are utterly indifferent to the outcomes of other societies. It does not encompass the notion nor did the creators of the programs foresee providing services to those become citizens only to partake of the services.
Being an accessory to undercutting the purpose of social services is an unethical act in itself, as doing so wears down support for the programs for those for whom the programs were intended.
7
She has family here, who perhaps would not be able to work, or to stay in the US if she is not able to stay and be cared for. They are part of our society, and so is she.
5
A problem with chain migration is that the sponsor states that he will ensure that the person will not become a charge of the government and then reneges on his obligation. The sponsor is responsible, not the state.
6
astonishing! in most of the world, the family takes care of grandma. only in America do we ship her off to assisted living at great expense. But to leave her back home alone is unthinkable. Who doesn't know that?
3
What rules is LW3 referring to when he says the lady is not "playing by the rules?" Of course she is if she qualifies for citizenship and whatever benefit she may apply for. For sake of argument, suppose it is SSI disability benefits. MANY citizens at birth with a qualifying disabilit, low income and resources who have never worked or have not worked long enough to meet the substantial work requirements for Social Security Disability Insurance benefits get SSI-which is funded by general revenues not a trust fund they paid into. Same is true for Medicaid, perhaps some state benefits, older adult benefits such as home delivered meals. General revenues fund the Dept. of Education, the FDA, the FAA, the military and on and on... We ALL benefit from these services, whether we pay taxes or not.
Consider this too: even those paying into trust funds may derive benefits exceeding, or far exceeding, what they pay in--Medicare being a very good example, and Social Security retirement benefits if you live long enough. Are people who benefit from general revenues or get more than they paid in stealing?
Doctor:This lady is asking you solely and legally to attest to a condition preventing her from taking the citizenship test, NOTHING more. Whatever benefits she might or might not derive has NOTHING to do with what she is asking. If you outlive your SS contributions, or get very ill and Medicare pays more than your contributions, Maybe we should come after you, huh? Shame on you.
43
In order to be eligible for Social Security Disability, an elderly lady would have to have worked under social security for twenty years.
If she were a citizen, and had not participated in social security, and she were poor, she would be eligible, if poor, for supplemental security income [SSI], which is not part of Social Security, although it is a federal welfare program that is administered by the Social Security Administration.
The family is intending to game the system. Although grandma is living with her prosperous family, they are going to contend that although she has no living expenses, she is entitled to a $750/month SSI payment plus $193/month in food stamps and free Medicaid.
3
NO!To be eligible for SSDI, you have to have generally worked for TEN years, or to be fully insured:40 quarters. Of coverage, with twenty of those being from recent work.
For SSI, you need to be a citizen except in very rare circumstances, Andrew have limited income and resources.
The medical rules to determine if one is disabled are the same for each.
There are plenty of adults who are receiving SSDI OR SSI and living with affluent, comfortable, working class or poor family, depending on circumstances. People disabled before age 22 may draw benefits on their parents earnings record as adults and have never worked. Kids of poorer parents may draw SSI benefits as children whether or not they their parents worked or are working. As adults they can drwa SSI whether or not they worked and rules on whether younger adults may be considered emancipated for purposes of collecting SSI. This is applicable to native born citizens as well as naturalized citizens.
PLENTY of older adult citizens by birth draw MEdicaid and may never have worked. There are folks who get both Medicaid and Medicaid. SSI and Medicaid are not funded by payment into a trust fund. Many citizens by birth are in exactly the same situation as this lady. They are not gaming the system. Nor she. maybe she even worked but not long enough to get SS.Heck the family may not be right. And maybe we are not talking disability But not one iota relevant to the legitimate request being made nor should be to the doc"
6
RE: the elderly lady who cannot pass the citizenship exam.
After she gains her papers she can sponsor an elderly aunt with a very expensive illness and it can be treated here. Gratis.
The money can be taken out of our children's or grandchildren's health and schooling budgets.
13
Then it would also be taken out of funding for the education of HER children and grandchildren. There is nothing wrong with what she is doing.
3
Maybe the money will be taken away from fighting that never-ending war in Afghanistan. That would really be something!
8
No- it is not ok to surprise someone with a negative reference. Did this person even think about their situation? They claim an ex-employee held back negative information. Their response? To do the same in return- intentionally.
And this: Our child-welfare-and-adoption system is notoriously imperfect...
That is an understatement. Unless a child is in a situation that will result in death they are almost always better off in their home environment that our child-welfare-and-adoption system.
Coming into contact with yelling and arguing versus years of extreme mental and physical abuse? This is a no-brainer.
10
It has been well established that an environment of yelling, arguing, slamming doors, breaking objects is psychological abuse that affects children for the rest of their lives in many ways. PTSD is just one example. Sadly, foster care may not be any better or may be even worse. The child welfare agencies are woefully inadequate or just plain negligent and certainly can't be counted on to make a decision that will in any way benefit this child. This is a heart-breaking lose/lose situation.
2
That's it? A child could figure these out. Advice to tell the truth is now sufficiently interesting to be the basis for a major newspaper article? Good Grief.
8
1) You have agreed, as a favour, to provide someone with a voluntary supporting reference. Writing a bad reference is clearly not a favour and not what you agreed to. In addition making accusations of misconduct to a third party without letting your ex-employee have the opportunity to defend herself is itself highly ethically dubious. Withdraw the offer of the reference and let her find someone else to do it.
2) Your obligations here are to the child not the foster parents, but as you say, you don’t know what is in the child's best interests. All you can do is give an objective, fair report about the little that you do know to help other people make the best decision. You would be entitled to refuse to provide a reference if you felt that you knew nothing that would be of use.
3) What on earth are you thinking? It’s not your job to prevent your patient obtaining any benefits that she is legally entitled to- what happened to the principle of “first do no harm”? The system relies on doctors providing accurate reports about their patients, not refusing to certify people’s genuine illnesses for political reasons.
34
"Is It O.K. to Surprise Someone With a Negative Reference?"
Answer: No.
"...should I just complete the reference informed by my new understanding?"
Answer: No.
"We can say no..."
Then do that.
30
The final letter writer should not be obligated to write a spurious letter for a patient that is not even his.
4
Please read the article again; the doctor is not being asked to write a "spurious letter." Instead, he acknowledges that the woman's illness is real and that under the law, she probably qualifies for the exemption. The immigration authorities are asking for the doctor's medical opinion, not for his views on our country's immigation policies.
49
BB, why would the letter be spurious? LW 3 says that the patient indeed has "a medical illness that would enable her to apply for citizenship without taking the exam", and that "the illness is real, and I am not being asked to falsify anything; she truly has the illness, and it truly prevents her from taking the exam."
32
Rare responses for me. I actually agree with The Ethicist.
6
You have given opposite advice about giving a reference. In the first instance, you told the reference writer to withdraw the offer because the letter would not be complementary and could hurt the chances of getting into med school, which is what the person wants. The second reference writer is told to write the letter even though it will hurt the chances of the couple's adopting the child, which is what they want. They are not looking for "the" right decision; what is best for the child, but "their" right decision; adopting the child. I don't think surprises are right in either case. You are right about one thing, we a have a very flawed social services system.
4
I agree in all three cases. As for the third one (the doctor), another way to put it is: We made the rules; the patient can't be blamed for following them.
13
LW3 illustrates one of the bizarre things about how many Americans think about the law these days. Setting aside the emotional factor of the woman's age and health (something apparently almost impossible for some people to do), I find it odd that on the one hand the writer states "I have no interest in seeing a person without a valid status be deported..." (in other words, even if she is not legally entitled to be/remain here, it matters not) and then lamest that he/she is "uncomfortable" with the patient receiving benefits to which she has not contributed. This muddled thinking is one reason we seem to have so much difficulty in formulating how to legislate and enforce laws in this country today - either we have laws and follow them, acknowledging that sometimes certain outcomes may not be the prettiest, or we don't have them at all. Simply ignoring the law on a case by case basis is neither ethical or logical.
19
Prof. Appiah makes sense. But I wonder if the answer to LW1 is too tainted by custom in the academy, and might veer too far from morality. Simple honesty could rule the day in the service of all parties.
In this particular case, the LW had already (prematurely) told the student that her/his letter of recommendation (LoR) would be favorable ("I told her I was happy to give a good reference"), so I suppose this does obligate the LW to inform the student of a change of opinion.
However, in general… Why, exactly, is a student entitled to know whether or not a LoR will be positive ("the person asking for it knows that you’re going to be critical, if you are.")? This can be a recipe for problems - for the student, the recipient(s) of the LoR, and for the LoR writer. The student may suffer for not hearing and feeling the consequences of behavior. The recipients of the LoR will receive only positive reviews (of all applicants!) which, coupled with grade inflation, simply narrows real distinctions in qualifications and assessments of character and maturity that are likely to be meaningful. And this establishes a cultural problem - as the burden of bad and unqualified actors is then forced on others, e.g., all the people who have to deal with these folks as they are positively "recommended" to others down the line over time (to rid them and make them someone else's problem). The LoR writer suffers from a loss of reputation, to an extent, because the LoRs, all positive, lose meaning.
3
Astonishing to me how much weight continues to be placed on personal written references, and how the life of a young person, or an old person, can be made miserable by these references. Surely the fact that persons are paying the bills and leading a purpose-filled life should be enough, rather than hoping for the best when asking for written references from professionals.
12
With respect to the physician who was asked to vouch for the elderly woman: she's NOT HIS PATIENT. How does he know anything about her is true??? I am not a xenophobe, but I am a physician and I would never dare to write about someone who's not my patient who is claiming a medical inability to sit for a short test. That is not appropriate.
8
BA, LW 3 says that he/she believes that "the illness is real, and I am not being asked to falsify anything; she truly has the illness, and it truly prevents her from taking the exam." That tells me that she/he has either examined the patient (very likely, as she is not under the care of anyone else in his specialty) or at least reviewed the patient's record and is satisfied that the diagnosis is true and the disability valid.
I do not understand the basis of LW 3's claim that "she is not even my patient", as she requires the services of a physician in his/her specialty, came to her/him for that service.
21
Dr. BA, the proper terminology is "she is not his REGULAR patient". That may have given Dr. LW3 the right to turn her away, but nothing in his medical license prevents him from providing the requested examination and letter. I have been in similar situations, so I appreciate that Dr. LW3 provided the exam, and I hope he provides the letter.
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BA - You may or may not be a physician, but you are surely someone who does not thoroughly read a column.
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I agree with everything you said to LW#3, the physician although you forgot to mention the Hippocratic Oath. But I have a couple of questions.
The first is whether the LW knows for a fact that her family wants her to be a citizen in order to collect benefits, I'm not a benefits lawyer either but I wonder what benefits would be available to a citizen but not a legal resident. (If she weren't a legal resident she would not be able to apply for citizenship.
That much I do know.) Given the zenophobic state of things here many immigrant families are applying the belt and suspenders approach to legal status out what may not be an abundance of caution. I know of such a case in my extended family.
Second, in addition to your point about citizens who were not wqge earners receiving benefits, I wonder whether he has considered that her family as a whole are almost certainly increasing our "scarce resources".
The doctor should do his or her job.
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Re. Benefits available to citizens but not legal residents--examples--
--except in EXTREMELY rare circumstances--SSI: https://www.disability-benefits-help.org/faq/non-citizen-social-security...
--Medicaid: which may be available immediately to some legally present non-citizens but for most requires a five year waiting period: https://www.healthcare.gov/immigrants/lawfully-present-immigrants/
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