Whether through work in safety net settings such as public hospitals, near immigrant detention facilities or shelters for child migrants, or in rural agricultural areas, many healthcare professionals will see immigrant patients whose lives are profoundly affected by immigration policies.
Treating immigrants who are excluded from federally funded health benefits can pose an ethical challenge for clinicians who seek to provide quality care to their patients. In an article published in the AMA Journal of Ethics, researchers offered strategies for clinical teaching and learning with respect to the health of immigrants.
One barrier that can prevent clinicians from providing good care to patients whose legal status is uncertain is a “chilling effect,” which can discourage patients from approaching healthcare settings because of fear resulting from policy. Some patients may be hesitant to interact with perceived authorities because of worries about detention, deportation, or other action. For clinicians who encounter these patients, the researchers offered a few resources.
The National Immigration Law Center, an education resource on the legal rights of immigrant patients, can offer guidance for healthcare professionals on how to safeguard rights. Medical-legal partnerships with lawyers who are sometimes included as part of a healthcare institution can also be a valuable resource for clinicians by providing legal information about barriers to healthcare access. For healthcare professionals who provide care to young patients, the American Academy of Pediatrics is another resource that provides information about treating immigrant patients, and specifically children, including recommendations for mental, emotional, and behavioral care.
In some cases, immigration enforcement policies may prove to be direct barriers to healthcare access. Immigrants who come into the United States without authorization or who are living outside the terms of an entry visa or other authorization are likely not eligible for federally funded health benefits such as Medicaid or Medicare. Although their access to health insurance is therefore limited to state-funded provisions or employer-provided insurance, the federal Emergency Medical Treatment and Active Labor Act requires that all patients who present in an emergency department must receive an appropriate screening and must be treated until stable. However, the act does not include funding, and if a patient has no health insurance, the hospital often contributes to the cost of the uncompensated emergency services.
To effectively treat uninsured patients, clinicians must work with medical social workers who are responsible for identifying sources of aid for patients. In some cases, medical-legal partnerships in which attorneys aim to break down legal barriers to healthcare access can be a useful resource for health professionals. In addition to providing immigration-related services to patients, a medical-legal partnership can also provide relevant health law information to support the clinician.
Policies that lead to family separation, open-ended detention, and refusal of asylum to people who are fleeing violence are associated with various threats and harms to health. For clinicians who care for immigrants in these situations to better understand their circumstances, the researchers offer some additional resources. Technological resources such as apps for clinical learning and teaching about immigrants in detention can offer a valuable look into the circumstances some immigrant patients may face. Other informational resources such as The Undocumented Patients, a database of publications compiled by the Hastings Center, can provide clinical teaching on healthcare needs of immigrants through articles, reports, and more.
Healthcare work requires a professionalism that spans the political, social, and economic contexts of healthcare. When treating immigrant patients, healthcare professionals should endeavor to understand the circumstances and challenges their patients face to provide the best care possible.
Berlinger N, Zacharias RL. Resources for teaching and learning about immigrant health care in health professions education. AMA J Ethics. 2019;21(1):E50-E57.