Press Release


(Gar­ri­son, NY) The Hast­ings Cen­ter is explor­ing the eth­i­cal chal­lenges that clin­i­cians and orga­ni­za­tions face when pro­vid­ing med­ical care to undoc­u­ment­ed immi­grants in the Unit­ed States. The project is sup­port­ed by a grant from the Over­brook Foun­da­tion Domes­tic Human Rights Pro­gram.

Most of the esti­mat­ed 11 mil­lion undoc­u­ment­ed res­i­dents of the U.S. have no health insur­ance and are inel­i­gi­ble for pub­lic insur­ance pro­grams. They are pro­hib­it­ed from obtain­ing insur­ance under the 2010 Patient Pro­tec­tion and Afford­able Care Act.

When they become sick or injured, these low-income patients have lim­it­ed access to health care. Orga­ni­za­tions that are fed­er­al­ly man­dat­ed to pro­vide some lev­el of care on the basis of med­ical need, such as emer­gency depart­ments, fed­er­al­ly qual­i­fied health cen­ters, and health pro­grams for farm work­ers, face dif­fi­cult resource allo­ca­tion chal­lenges when undoc­u­ment­ed patients’ med­ical needs exceed avail­able resources.

Health care pro­fes­sion­als can be deeply trou­bled when they encounter sit­u­a­tions that seem unfair,” says Nan­cy Berlinger, a Hast­ings Cen­ter schol­ar who is co-direc­tor of the project. “How to pro­vide good care to patients who can­not afford to pay for care is one of those sit­u­a­tions. When a patient is also undoc­u­ment­ed, the sit­u­a­tion becomes even more com­plex. This project aims to help clin­i­cians and orga­ni­za­tions by explor­ing the dif­fi­cult ques­tions of how eth­i­cal oblig­a­tions com­pete with eco­nom­ic con­straints, con­flict­ing man­dates, and polit­i­cal con­sid­er­a­tions.”

Michael Gus­mano, the oth­er co-direc­tor of the project, adds, “We will review exist­ing poli­cies and reg­u­la­tions and iden­ti­fy how they shape access to care for undoc­u­ment­ed patients.

We know that some laws and pro­grams are designed to pro­vide access to health care for this pop­u­la­tion and oth­ers explic­it­ly for­bid the use of pub­lic funds to pay for care for this pop­u­la­tion,” he says. “This cre­ates a com­plex pol­i­cy envi­ron­ment that caus­es dif­fi­cul­ties for the patients, health care pro­fes­sion­als, and health care orga­ni­za­tions. Our project seeks to clar­i­fy, as much as pos­si­ble, these pol­i­cy choic­es and iden­ti­fy their con­se­quences.”

At a meet­ing in Sep­tem­ber in New York, the project’s advi­so­ry group dis­cussed sev­er­al ques­tions: Is there a right to health care implic­it in the U.S.? In a soci­ety with a large immi­grant pop­u­la­tion like the U.S., how are our social val­ues expressed in how we view undoc­u­ment­ed patients? What eth­i­cal guid­ance may help health care orga­ni­za­tions and state and fed­er­al pol­i­cy­mak­ers in a chal­leng­ing eco­nom­ic envi­ron­ment at a time when the reg­u­la­tions are chang­ing under the ACA.

The project’s advi­so­ry group includes clin­i­cians and health care lead­ers from orga­ni­za­tions that serve com­mu­ni­ties that include undoc­u­ment­ed patients. Project advi­sors also include experts in human rights law and the­o­ry, health care ethics, and safe­ty net health pol­i­cy. The project will pro­duce a spe­cial report, a Web site with resources for the pub­lic, and jour­nal arti­cles.

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