Undocumented and lawfully present immigrants comprise 7% of the total United States population.1 Even so, these individuals face considerable institutional and social barriers to proper health care access. In an article published in the AMA Journal of Ethics, author Rachel F. Harbut delineated care guidelines per the American Medical Association (AMA) Code of Medical Ethics for patients who are immigrants, refugees, or asylees.2

The AMA Code of Medical Ethics describes health care as a “fundamental human good,” and asserts that society is obligated to ensure equitable care access for all.3 Further clauses in the Code — “Financial Barriers to Health Care Access” and “Allocating Limited Health Care Resources” — assert that the primary obligation of clinicians should be the “health and well-being” of patients. The medical community is thus responsible for safeguarding the interests of all patients, independent of “non-medical characteristics,” including immigration status.4

Regarding specific subpopulations of immigrants, the AMA condemns any policies which “punish…[any] health care providers” for providing care to undocumented immigrants.5 Further, AMA Policy H-160.917 supports the expansion of federal funding for “emergency services for undocumented immigrants.”6 The Code further encourages the improvement of care standards in immigration detention centers and recognizes the unique healthcare challenges experienced by unaccompanied and undocumented minors.7,8

Even so, some states — including Alabama, Arizona, and Utah — legally prohibit the harboring of undocumented immigrants, which pressures healthcare systems to verify the immigration status of patients.9 Such state laws are in direct opposition to the ethical assertions of the AMA, wrote Harbut. The AMA Code challenges policies that throttle appropriate care access for undocumented immigrants.

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Lawfully present immigrants also experience considerable barriers to healthcare access, noted Harbut. The AMA recognizes the “unique health needs of refugees and encourages [accommodation] of issues related to refugee health,” per Policy H-350.957.10 The Code also recognizes the significant burden of psychiatric illnesses in immigrant, minority, and refugee populations, and in a similar fashion advocates for increasing access to mental health care. To strengthen overall care availability in these populations, the AMA Code also supports “expanded language offerings” in healthcare programs and better services for immigrant youth.11

The AMA Code supports equitable healthcare access for immigrant and minority patients and advocates for specific programs to accommodate the unique health needs of these populations. The AMA Code has articulated the ethical obligations of clinicians in the United States for more than a century; its guidelines on immigrant health, thus, may be useful for practitioners in titrating care in vulnerable patient populations.

References

  1. Henry J. Kaiser Family Foundation. Health coverage of immigrants. www.kff.org/disparities-policy/fact-sheet/health-coverage-of-immigrants/. Published February 15, 2019. Accessed March 14, 2019.
  2. Harbut RF. AMA policies and code of medical ethics’ opinions related to health care for patients who are immigrants, refugees, or asylees. AMA J Ethics. 2019;21(1):E73-E77.
  3. American Medical Association. Opinion 11.1.1 Defining basic health care. Code of Medical Ethics. www.ama-assn.org/delivering-care/defining-basic-health-care. Accessed March 15, 2019.
  4. American Medical Association. Opinion 11.1.3 Allocating limited health care resources. Code of Medical Ethics. www.ama-assn.org/delivering-care/allocating-limited-health-care-resources. Accessed March 15, 2019.
  5. American Medical Association. Opposition to criminalization of medical care provided to undocumented immigrant patients H-440.876. https://policysearch.ama-assn.org/policyfinder/detail/immigrants. Modified 2014. Accessed March 15, 2019.
  6. American Medical Association. Federation payment for emergency services for undocumented immigrants H-160.917. https://policysearch.ama-assn.org/policyfinder/detail/immigrants. Modified 2009. Accessed March 15, 2019.
  7. American Medical Association. Medical needs of unaccompanied, undocumented immigrant children D-65.992. https://policysearch.ama-assn.org/policyfinder/detail/immigrants. Modified 2015. Accessed March 15, 2019.
  8. American Medical Association. Improving medical care in immigrant detention centers D-350.983. https://policysearch.ama-assn.org/policyfinder/detail/immigrants. Modified 2017. Accessed March 15, 2019.
  9. American College of Physicians. State immigration initiatives affecting access to health care. https://www.acponline.org/system/files/documents/advocacy/state_health_policy/otherissuesofinterest/state_immigration_innitiatives.pdf. Accessed March 15, 2019.
  10. American Medical Association. Addressing immigrant health disparities H-350.957. https://policysearch.ama-assn.org/policyfinder/detail/refugee. Published 2015. Accessed March 15, 2019.
  11. American Medical Association. Increasing detection of mental illness and encouraging education D-345.994. https://policysearch.ama-assn.org/policyfinder/detail/refugeecare. Published 2016. Accessed March 15, 2019.