Advocacy and Assessment: Ethical Dilemmas and Practice Considerations in Pediatric Asylum Evaluations

Children and families seeking legal immigration relief may benefit from forensic medical and/or mental health evaluations and affidavits, which are expert medical-legal assessments conducted by pediatric clinicians. When conducting these evaluations, medical and mental health clinicians encounter complex medical-legal, professional, and ethical issues. This article reviews core ethical tensions in legal immigration relief evaluations for children and adolescents including dual responsibilities in neutrality and advocacy, consent and assent, cultural sensitivity and humility, trauma-informed care, minimizing re-traumatization, trainee involvement, mandated reporting concerns, data security, privacy and confidentiality, and funding models. Throughout these considerations, there is a consistent need to identify strategies to preserve child rights by minimizing harm, optimizing connections to care, and promoting the safety and well-being of pediatric clients throughout the evaluation process.