The Ethics of Advocacy for Undocumented Patients

Nancy Berlinger and Rajeev Ragha­van, “The Ethics of Advo­cacy for Undoc­u­mented Patients,” Hast­ings Cen­ter Report 43, no. 1 (2013): 14–17. DOI: 10.1.002/hast.126

Abstract: Approx­i­mately 11.2 mil­lion undoc­u­mented immi­grants have set­tled in the United States. Pro­vid­ing health care to these res­i­dents is an every­day con­cern for the clin­i­cians and health care orga­ni­za­tions who serve them. Uncer­tain how to pro­ceed in the face of severe finan­cial con­straints, clin­i­cians may impro­vise remedies–a strat­egy that allows our soci­ety to avoid con­fronting the clin­i­cal and orga­ni­za­tional impli­ca­tions of pub­lic pol­icy gaps. There is no sim­ple solution-no quick fix-that will work across orga­ni­za­tions (in par­tic­u­lar, hos­pi­tals with emer­gency depart­ments) in states with dif­fer­ent con­cen­tra­tions of undoc­u­mented immi­grants, vary­ing pub­lic and pri­vate resources for safety-net health care, and dif­fer­ing approaches to law and pol­icy con­cern­ing the rights of immi­grants. How­ever, every hos­pi­tal can help its clin­i­cians by address­ing access to health care for undoc­u­mented immi­grants as an eth­i­cal issue. We offer some rec­om­men­da­tions for doing this in a struc­tured, fair, and trans­par­ent way. We also describe the prob­lems that may result when clin­i­cians are forced to grap­ple with this issue on their own.