Introduction
Care for immigrants remains one of the emotionally charged subjects in the United States. Effective care for this vulnerable population requires knowledge of the barriers and challenges faced by these individuals. Most of them are homeless, poor, and lack health insurance (Beck et al., 2017). Immigrants, especially from the non-English speaking communities, face a major challenge in communication, a factor that denies them the much-needed opportunity to speak to the healthcare officials. Therefore, it is incumbent upon the clinicians to not only treat the patients but also assist them in overcoming immigration-related anxieties and fears that have a significant effect on their health. Since immigrant patients are at a point of vulnerability, the ethical practice should inform their treatment by focusing on aspects such as autonomy, justice, beneficence, and uncompromised care.
Background
Statistics has placed the number of undocumented immigrants at about 10 million as of 2016 (Beck et al., 2017). The policies surrounding immigration remain one of the most hotly debated issues in America. With the unprecedented number of illegal aliens, questions have always centered on whether the country should devote its resources to assisting them. On their parts, the immigrants have to grapple with a host of barriers including their low socioeconomic conditions and the lack of diversity in the care facilities among others (Hacker et al., 2015). Ethically speaking, many immigrants have been denied an opportunity to equal treatment in different care facilities across the nation. This is contrary to the provisions of the American College of Physicians Ethical Manual which outlines that all patients must receive appropriate treatment. The physicians, nurses, and any other health professional has a moral duty of applying justice in treatment by avoiding cases of discrimination irrespective of the patient’s background and insurance status.
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Synopsis
The case study focuses on an immigrant from Mexico known as Mr. Villalobos. Although he has been diagnosed with a serious medical condition affecting the heart, he does not have medical insurance because his employer does not provide one. The prognosis is that he requires a heart valve replacement, but unfortunately, Mr. Villalobos was not in a position to afford the treatment. Most importantly, Villalobos is an undocumented immigrant and therefore does not qualify for Medicaid. The two doctors that he visits including Dr. Graham and Dr. Greene are aware of his precarious situation, but due to his situation, they fail to engage him in decision-making regarding his situation.
Ethical Principles
The first ethical principle highlighted in the text is patient autonomy. Autonomy remains one of the most significant aspects that determine the relationship between the physician and the patient. Patient autonomy refers to the freedom of self-determination given to the patient where they are at liberty to determine medical decisions even if they are conflicting with their caregiver (Dunn & Hope, 2018). It is also about informing the patient of the medical options at their disposal. In the case study presented, Dr. Graham appears to have breached this ethical provision by failing to discuss the treatment options with Villalobos at his time of discharge. The second ethical concept discussed is justice. Percival, (2014) pointed out that justice is about preventing discrimination and enhancing equality in healthcare distribution. It calls on Physicians and nurses to disregard race, immigration status, and gender among others in availing the healthcare needs. Beneficence is about ensuring that all health interventions are for the benefit of the patient.
Healthcare Laws
The first law highlighted in the text is “8 U.S. Code § 1601. Statements of national policy concerning welfare and immigration.” The law is used to disqualify Mr. Villalobos from applying for the Medicaid insurance to cater for his treatment. The second healthcare law that has been applied regards the examination and treatment of emergency medical conditions found in 42 U.S. Code § 1395dd. It is used to ascertain whether Mr. Villalobos’ valve replacement merits an emergency situation.
Recommendations
Two fundamental aspects need to be done to ensure that Mr. Villalobos attains the much-needed care for his serious heart condition. First, he needs to receive insurance under Medicaid care. The medical intervention prescribed is expensive and being a US resident at the moment, he needs to be considered for the insurance in fulfilling the justice principle of ethics. Secondly, legal action should be taken against the employer who does not want to take responsibility for the health of his workers. As a basic need, employers must remain keen to provide workers with different insurance policies to reduce the associated healthcare barriers (Viladrich, 2012).
Learning points
From the project, I have learned and appreciated the importance of ethics in caring for vulnerable groups. Immigrants, despite their illegal status, are humans and are entitled to care irrespective of the prevailing laws. Secondly, undocumented immigrants need to strive to acquire legal status in the country. Failure to do so put them in a risky position because they are unable to enjoy privileges such as the Medicaid which is granted based on the citizenship status of the person. Thirdly, physicians and other allied health professional workers must remain keen to regard the ethical provisions of healthcare such as autonomy and beneficence for the overall health of the patient.
Conclusion
Immigration policies continue to cause a polarizing debate in the country. Whereas undocumented immigrants are technically illegal citizens, they tend to face myriad health challenges that cannot be ignored. It requires ethical rather than illegal thinking to help solve the problem. From the case of Villalobos, it remains vital for illegal aliens to seek legality and avoid putting themselves in a precarious position.
References
Beck, T. L., Le, T. K., Henry-Okafor, Q., & Shah, M. K. (2017). Medical care for undocumented immigrants: national and international issues. Primary Care: Clinics in Office Practice, 44(1), e1-e13.
Dunn, M., & Hope, T. (2018). Medical ethics: a very short introduction. Oxford University Press.
Hacker, K., Anies, M., Folb, B. L., & Zallman, L. (2015). Barriers to health care for undocumented immigrants: a literature review. Risk management and healthcare policy, 8, 175.
Percival, T. (2014). Medical ethics. Cambridge University Press.
Viladrich, A. (2012). Beyond welfare reform: reframing undocumented immigrants’ entitlement to health care in the United States, a critical review. Social Science & Medicine, 74(6), 822-829.
