Morals and Mandates: Who Is Responsible For The Healthcare Needs of Undocumented Immigrants?

By: Robyn Perry-Thomas

On January 28^th, the day after President Trump’s executive immigration order was announced, airports brimmed with voices of discontent, disbelief and dismay of its consequences. Since then, a diverse array of stakeholders including teachers, lawyers, policy makers and medics have spoken out both in opposition and favour of what has been coined the president’s ‘Muslim ban’^{1, 2}.

An important yet often-overshadowed concern is whether healthcare rights should be afforded to undocumented immigrants, refugees and asylum seekers. Whilst we may safely assume that access to basic healthcare is an accepted human right, simply recognising something as a right has limited use as it fails to tell us who is responsible for fulfilling that obligation³. There are two important questions that will help to answer this problem. Firstly, is a government morally obliged to provide healthcare to all within its population? And if so, do individuals living in a country illegally surrender this fundamental right?

These questions illustrate the notions of social responsibility and legal accountability- two concepts that are often found at war with one another⁴. The Emergency Medical Treatment and Labour Act of the United States mandates that emergency services must be available to all, irrespective of insurance status and ability to pay⁵. This regulation pertains to ‘legal accountability’ and is largely uncontroversial- it would take the most inhumane of individuals to argue that someone should be left to die at the door of the Emergency Department solely due to their immigration status.

‘Social responsibility’ comes into play with undocumented immigrants who, as with the rest of society, will have a myriad of non-emergency healthcare needs, such as treatment for chronic conditions, infectious diseases and psychological services. Whilst classified as ‘non-emergency’, failure to adequately treat these medical conditions can have a devastating impact on both the quality and quantity of a person’s life. Yet there are minimal provisions available to respond to the non-emergent healthcare needs of undocumented people. Consequentially, members of the medical profession must determine who is eligible for medical attention, directly opposing what the healthcare system should promote: access to medical care and freedom from disease for us all.

A frequent argument against this position is that this societal duty of care does not extend towards undocumented individuals, as they are not viewed as fully participating members of society. However, ensuring basic access to health is an irrefutable and inviolable moral responsibility. Committing a crime does not ordinarily prohibit someone from accessing medical care. If this were the case then anyone who had submitted sceptical tax returns, committed a minor offense or served a prison sentence should subsequently be banned from receiving medical attention. It is difficult to imagine a just society that would support this exclusion from medical care. Therefore, preventing undocumented immigrants from accessing healthcare, solely due to their immigration status, should be intolerable.

The approach above implies that any immigrant, documented or not, should be afforded the same level of basic care as legal residents of that particular country. Yet there is a vast disparity in the availability and extent of care that is provided ‘free at the point of use’ to citizens around the world. These issues are further complicated when we take into account the assumption that even if they were allowed to legally obtain health insurance, a significant proportion of undocumented immigrants would lack the necessary funds to do so.

Partially as a result of the issues raised here so far, we have a situation whereby undocumented immigrants are likely to avoid accessing healthcare all together. The public health consequences of such decisions alone constitute a valid reason for ensuring that these people have access to healthcare that is free from judgement and legal repercussions.

However, medicine in the 21^st century necessitates that we act out of something other than self-protection. Furthermore, whilst emerging technology has provided us with a wealth of medical developments, these benefits remain unattainable to the majority of the global population. This inequality is observed both within and between different countries and social responsibility implores us to ensure that these benefits are extended to the most marginalised in society. Where better to start, than by ensuring that undocumented people receive the healthcare that they need?

References:

1. President Trump’s Executive Order on Immigration, Annotated, NPR. Available at: http://www.npr.org/2017/01/31/512439121/trumps-executive-order-on-immigration-annotated
2. Is this a Muslim ban? Trump’s executive order explaned. Available at: https://www.theguardian.com/us-news/2017/jan/28/trump-immigration-ban-syria-muslims-reaction-lawsuits
3. Universal Declaration of Human Rights. Available at: http://www.un.org/en/universal-declaration-human-rights/
4. Hastings Centre Report: Illegal immigrants, healthcare and social responsibility. January-February 2004. P34-41.
5. Emergency Medical Treatment & Labor Act. Available at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/
6. Image: Immigration Protests- ABC News. Available at: http://a.abcnews.com/images/Politics/GTY-Immigration-Protests01-MEM-170130_mn_4x3_992.jpg