Ethics for Lunch: Ethical Issues Related to Immigration Status in the Delivery of Healthcare
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Public health researchers and medical providers have, in the last decades, begun to better understand the myriad contextual variables affecting the seeking, provision, and success of medical assessment and treatment. These are understood, among others, to include socio-economic status, educational attainment, geographic location, and race and ethnicity. For immigrant communities, particularly members that are undocumented, the contextual factors often converge, making access to and provision of medical care more difficult. This session will seek to provide a basic overview of some of these issues and the relevant resources available to providers and patients.
Case 1: Patient PBG is a 37 year old female and Salvadoran citizen. Ms. PBG, a former painter by trade, immigrated from El Salvador to the US in 2015. She has often suffered from housing and food insecurity. As a non-citizen, she is not eligible for Medical Assistance but she has been approved for the Hopkins Access (TAP) program. She sees specialists through TAP and obtains primary care at the Esperanza Center Health Clinic.
Ms. PBG has a family history of diabetes and personal history of diabetes, heart failure, active treated tuberculosis. She has had dozens of hospitalizations since 2018, most often for volume overload. She started dialysis in 2020. At a recent clinic appointment, she inquired whether she could be a candidate for kidney transplant.
Case 2: Patient Encanto is a 16 year old female and Honduran citizen. She presented to the Emergency Department with contractions, was admitted to Labor and Delivery, and subsequently gave birth to a baby girl. Encanto reports that she received no prenatal care as she was unable to obtain identification, residency, or income documents required to attend a sliding-scale fee clinic. She is not eligible for Medical Assistance as she has no documentation status in the US.
Encanto entered the country 2 years ago with a group of non-relatives, was apprehended at the border, then held in a detention facility for 11 months. Though she does not offer details, she says she experienced violence during her migration and while in detention. She was released to the care of family members but reports she ran away as she was treated “like a servant”, beaten, and not allowed to attend school. Recently she has been working and renting a room in a boarding house. Her baby’s father is supportive but also has limited financial means. She has few baby supplies.
During her inpatient stay, Encanto shared fear of being returned to detention, deported, or her baby being removed from her care. Friends have told her the government can take her child if she seeks any kind of help. The medical team is concerned that Encanto will be unable to provide appropriate care to her daughter given her immigration status and its effect on her ability to be insured and obtain resources.
- How does immigration status impact an individual’s ability to seek medical treatment?
- What is the dynamic interaction between immigration status, family relationships, socio-economic status, and health?
- What agencies and government entities have possible authority or jurisdiction regarding patient’s immigration status? And how does this relate to medical care?
- How can medical providers give reassurance to patients while recognizing financial, psychosocial and other stresses?
- Participants will be able to identify common stressors and concerns relatively unique to an immigrant population and how those stressors impact access to medical care.
- Participants will describe current medicolegal and ethics guidance regarding documentation of immigration status in the medical record.
- Participants will identify at least three hospital and community resources available to this population.