Clinical Ethicists Awakened: Addressing Two Generations of Clinical Ethics Issues Involving Undocumented Patients

Abstract

Because the United States has failed to provide a pathway to citizenship for its long-term undocumented population, clinical ethicists have more than 20 years of addressing issues that arise in caring for this population. I illustrate that these challenges fall into two sets of issues. First-generation issues involve finding ethical ways to treat and discharge patients who are uninsured and ineligible for safety-net resources. More recently, ethicists have been invited to help address second-generation issues that involve facilitating the presentation for care of undocumented patients. In the current environment of widespread fear of deportation in the immigrant community, ethicists are working with health care providers to address patient concerns that prevent them from seeking care. I illustrate that in both generations of issues, values implicit within health care, namely, caring, efficiency, and promotion of public health, guide the strategies that are acceptable and recommended.

Keywords:

• public health
• ethics committees
• health policy
• population
• race and culture/ethnicity
• right to health care
• undocumented immigrant

This article is referred to by:

Pediatricians Awakened: Addressing Family Immigration Status as a Critical and Intersectional Social Determinant of Health

The New Colossus: Clinical Ethics, Empathy, and Grace

Caring for the Undocumented: A View From the Safety Net

Don’t We Need Something More in These Extraordinary Times? Response to the Commentaries

Undocumented Migration and Evolving Health Care Ethical Issues

Moving Beyond Moral Revulsion: A Deeper Analysis of Social Justice Within Clinical Ethics Training

The United States as an Isolationist in Global Biomedical Ethics and Human Rights

What Is a Clinical Ethicist?