Polly J. Price

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Immigration, Health-based exclusions, Undesirable aliens, Mental health exclusions, Sovereignty, Ebola, WHO


Sovereign nations may refuse admission to migrants who are either physically or mentally ill or disabled. Nations have commonly preferred an ideal class-the physically and mentally healthy-to the "undesirable" migrant who is unhealthy or disabled. Both exclusions are traditionally justified as a nation's prerogative to choose its membership. Nations defend exclusionary safeguards by the need to protect their citizens against contagions from the outside world. Immigrants who are physically or mentally disabled do not pose the same threat, but they may require state services and support, what U.S. immigration law terms a "public charge." Mental illness is a different category altogether, in that public safety may be an issue, in addition to the need for state welfare expenditures.

The comparison is between temporarily banning arrivals from Sierra Leone, for example, until the threat of contagion has passed, with long­standing bans on immigrants who are viewed to pose more enduring threats-a complete disqualification on mental health grounds, unrelated to the immediate protection of public health. But these latter disqualifications are still rationalized under the rubric of "health security" by the need to sustain a general level of mental as well as physical health in the public. Mental health and disability exclusions focus on individual, socially undesirable characteristics, not the communicable disease of the moment. Response to the threat of contagious disease is reactive; response to mental illness is more deliberate. Immigration policy has historically taken the category of "communicable disease" into account, just as it does the category of "mental illness," even though the specific diseases (or specific identifiable types of mental illness) change over time. Thus, the nineteenth-century world worried about people with cholera or tuberculosis, and the twenty-first century worries about people with Ebola. But the principle of intercepting migrants with possibly contagious diseases remains the same.

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Kansas Law Review