Solitary Confinement in U.S. Immigration Detention: A Bioethical Analysis of the Legal Determinants of Health in a Hidden Population

Abstract: Solitary confinement in U.S. immigration detention represents a critical bioethical concern deeply intertwined with the legal determinants of health for a vulnerable and often hidden population. Despite extensive calls from legal scholars, immigrant rights advocates, and health professionals to end this practice, its use has in fact continued to increase. A recent study found that, between 2018 and 2023, Immigration and Customs Enforcement (ICE) used solitary confinement over 14,000 times, with placements averaging 27 days, going well beyond the limits of what the United Nations considers torture. The health consequences are severe, with detained individuals experiencing profound mental and physical harm, including anxiety, depression, paranoia, and long-term trauma. These effects align with well-documented harms recognized by the U.S. Supreme Court as early as the 1890s, which cited the irreversible mental damage caused by isolation. The persistence of solitary confinement, despite its known health risks, highlights a systemic disregard for detained individuals' well-being, particularly given the availability of more humane alternatives. The recent death of an individual in solitary confinement in ICE custody underscores the life-threatening dangers, particularly for those with pre-existing mental health conditions. In this paper, I discuss the legal determinants of health at play for a detained immigrant in the U.S. who experiences solitary confinement and the lack of clinical and organizational bioethical consideration with respect to this practice. Ultimately, I call for and propose a bioethical reassessment of immigration detention practices, legislative reform, and the prioritization of human rights in addressing the health impacts of solitary confinement.

Keywords: Immigration, Legal determinants of health, Solitary confinement