Thread: Denying Care To Illegal Immigrants Raises Ethical Concerns

(quote)

Denying Care To Illegal Immigrants Raises Ethical Concerns


Ruth Faden, PhD, MPH, Director, Johns Hopkins Berman Institute of Bioethics
DEC 31, 2009



The Senate’s Christmas Eve vote makes historic legislation to transform our health care system likely. Politicians, who rightly note that this legislation would affect nearly all Americans, could also point out that the people least affected may not be Americans at all, but those in the country illegally. Under the House bill, illegal immigrants could buy coverage in the bill’s insurance exchange but would be ineligible for federal subsidies; under the Senate version, even that would not be not permitted. The implications are staggering. While the Senate bill would extend insurance coverage to 31 million people, the Congressional Budget Office projects that as many as 23 million people would still be uninsured in 2019, about 8 million of whom would be illegal immigrants.

We don’t need to wait until 2019, however, to witness the human tragedies and policy nightmares at the heart of health care for undocumented immigrants. The closing of the outpatient dialysis unit at Grady Memorial Hospital in October 2009 captures it all.

Grady Memorial, a public hospital and fixture in Atlanta for over 100 years, provides care to the poor and essential services to the whole community, including a Level 1 trauma center and ambulance fleet. It has been seriously in the red for over a decade. Major steps have been taken recently to keep Grady’s doors open, most controversially the decision to close the outpatient dialysis unit. At the time of the decision, the unit, which was using outdated equipment that needed to be replaced, was losing between $2 million and $4 million annually. Two-thirds of its then remaining patients were undocumented immigrants. When the dialysis unit finally closed, there were about 50 patients left, almost all undocumented.

That undocumented immigrants were left behind is hardly surprising. End stage renal disease is the one and only area of medicine where most Americans already have guaranteed coverage. The Social Security Amendment of 1972 ensures access to kidney dialysis, but applies only to U.S. citizens. Another law requires hospitals that receive federal funds to provide emergency care, including dialysis, to any patient regardless of immigration status who presents with a life-threatening condition. At the same time, special federal funds that are used to offset this emergency care cannot be used to provide illegal immigrants with "maintenance dialysis"—regular dialysis treatments that prevent the life-threatening complications of renal failure and keep patients out of emergency rooms. Against this incoherent federal backdrop, a few states fund maintenance dialysis for undocumented immigrants, but a majority, including Georgia, do not.

Disagreements continue about whether closing the outpatient dialysis unit was necessary to save Grady Memorial, and about whether the hospital did everything it should have done to assist patients in finding maintenance dialysis care elsewhere. The hospital has offered to pay for private dialysis for up to one year and to help some patients return to their home countries for care there.

Even with these measures, however, it is likely that some of the unit’s former patients will die for lack of maintenance dialysis and that others will suffer the heartbreak of separation from loved ones. But the tragedy facing these patients and their families, and the tragic choice the Grady Memorial leadership felt it had to make, are hardly unique. A recent study estimates that about 5,500 undocumented immigrants with end stage renal disease currently live in the United States.1 No national data are available about how many of these people are able to secure the lifeline of maintenance dialysis, and how many die for lack of it, but in another recent survey, only 50 percent of nephrologists responded that undocumented immigrants had access to maintenance dialysis.2

Clinicians who understand that refusing to provide life-sustaining care goes against the moral foundations of their profession are constantly forced to confront the realities underlying these dry statistics. In some cases like Grady Memorial’s, institutional decisions are based on financial assessments of the burdens of providing uncompensated treatment to undocumented immigrants, and the impact these costs have on the capacity to provide care to other patients. Depending on the facts, such local decisions may be ethically justifiable, but the same cannot be said for the public policies against which these agonizing choices must be made.

Americans who object to providing health care to those who are in this country illegally make the principled point that people who violate the immigration laws of this country have forfeited any moral claim to assistance and should not benefit from their illegal behavior. They also argue that providing those here illegally with access to regular health care will as a practical matter have the undesirable effect of increasing illegal immigration.

The principled argument in favor of including illegal immigrants in health reform is that decent health coverage is a basic human right. A just nation should support that right for everyone, regardless of why or how a person is in the country. There are also practical reasons to support including undocumented immigrants in health reform. Ethics aside, there is no pragmatic way to deny emergency care to illegal immigrants. As the dialysis story illustrates, in many cases, it is difficult if not impossible to make coherent distinctions between emergency and regular care that make financial and medical sense.

While the practical arguments on both sides are important, this is one debate that can and should be settled on principled grounds. The problem of illegal immigration should be solved by immigration policy, not health policy. People who are in this country illegally have broken our laws, but the magnitude of their crime does not justify depriving them of the basic right to health care coverage while they are in our midst. The most extraordinary thing about health reform is that it finally enshrines the principle that America is committed to universal access to health care. It will take time, but eventually, as with other American declarations of rights, universal will come to mean universal. The House’s proposal for illegal immigrants is a good first step.


________________________________

1 G. A, Campbell, S. Sannoff, and M.H. Rosner, "Care of the Undocumented Immigrant in the United States with ESRD, " American Journal of Kidney Disease, 55:1, 2010, 181-191.

2 L. Hurley, A. Kempe, L.A. Crane, et. Al., "Care of Undocumented Individuals with ESRD: A National Survey of US Nephrologists," American Journal of Kidney Disease, 53:6, 2009, 940-949.

___________________________

http://www.kaiserhealthnews.org/Columns ... Faden.aspx


Psalm 91

I see this "bioethics" expert just happens to know everything, doesn't she?

She obviously thinks so Captainron. I ran across this article while searching for information about illegal aliens and dialysis treatment across the nation, since Grady Hospital in Atlanta,GA was forced to close its clinic because of the numbers of illegal aliens and the uncompensated costs. The illegals even filed a lawsuit, however it was dismissed. Grady sent some illegals home to their nations, paid for some treatment, and still the news articles tell of their unfortunate situations, and not of the burden for those Americans now left without Grady treatment center. Information about Grady is posted here on Alipac for others who have not read it. It still faces financial problems, and illegal aliens are still part of that problem - emergency room treatment.

It is amazing how much theft of tax payer dollars that politicians and elitists, such as this doctor will allow for illegal aliens, even if it results in total closure or collapse of hospitals and our health care system.

Compassion does not mean take everything that we have and leave our citizens with nothing or the bill for your needs. The media, and the elite are so out of touch. If we secure our borders, if nations and their governments know that their citizens can not crash and take our dollars and our compassion for granted, then they will be required to step up to the plate or face their own citizens in their own streets and at their own polls.

Psalm 91

Americans who object to providing health care to those who are in this country illegally make the principled point that people who violate the immigration laws of this country have forfeited any moral claim to assistance and should not benefit from their illegal behavior. They also argue that providing those here illegally with access to regular health care will as a practical matter have the undesirable effect of increasing illegal immigration.

While few of us will deny emergency care for illegals, that emergency care should not necessarily an on-going thing for the rest of their lives. Their lives are the responsibility of their home countries, not ours at the expense of indigent citizens who need care and who have probably been deprived by illegals filling the slots.

In any other country if you are illegal then you have to pay at least something for your care.

http://www.kaiserhealthnews.org/ContactUs.aspx

That little piece of biased garbage pissed me off so much I HAD to comment on how hyprocritical they are! I had to ask how much of her PERSONAL money and time had gone into treating the illegals of Grady Hospital , or how much she had donated to keep the unit open?

Hey, I got an idea! Let's make healthcare FREE for everyone! Make hospitals and doctor's work for FREE! Then everyone's covered, no? Then it's ethical, right?

People who are in this country illegally have broken our laws, but the magnitude of their crime does not justify depriving them of the basic right to health care coverage

The part they are missing here is, that is not always the ONLY LAW they break while in this country. and I am still seeing illegals out here doing plumbing work and such without a license and probably without the education to [perform these specialty jobs. Not to mention the costs are on our tab as taxpayers!

If they are that worried about these people get them the hell out of this country. That would take care of a lot of our problems and headaches.

Enough talk ,now some action.

Does anyone out there know if these hospitals and/or clinics report to or confront politicians on the problems and financial burdens these ILLEGAL ALIENS create with their presence and use of healthcare in emergency rooms?

[quote="swatchick"]

In any other country if you are illegal then you have to pay at least something for your care.


If you're around long enough to even SEE a doctor or visit a hospital.

And in Mexico, the police and military prefer to skip the middleman and send illegal aliens straight to the undertaker.

IF You give free healthcare to illegals than you have to give it to everyone across the globe...Ummm we cant be responsible for everyone. These people have their own countries and leaders who are responsible for them...You CANT make us pay for everyone....no way