Ethics

How can physicians care, and advocate for, undocumented immigrants?

About 11 million undocumented people are living in the U.S. today. This is one of the country’s most vulnerable populations because they frequently do not have access to health insurance and can be afraid to present for care.

Physicians should understand the ethical issues that arise when supporting and caring for undocumented immigrants, refugees and asylees. Just as important, physicians and other health professionals should be aware of how to advocate for these patients, including through self-education, education of trainees, in the exam room and on Capitol Hill.

The January issue of the AMA Journal of Ethics® (@JournalofEthics) features numerous perspectives on health care for undocumented immigrants and gives you an opportunity to earn CME credit.

Articles include:

Is It Ethical to Bend the Rules for Undocumented and Other Immigrant Patients? Physicians and other health professionals who work in hospitals and clinics serving low-income populations will encounter undocumented immigrants as patients, family members, community members, and persons whose health-related rights can be overlooked, imperiled or difficult to use.

The routine uncertainty arising in how to provide good care to patients who are excluded from key public insurance provisions, together with the desire to be a good advocate for this patient population, can give rise to workarounds as problem-solving strategies. This article explores the ethics of workarounds in the care of undocumented patients and considers how advocacy by health professionals and organizations can assist immigrants in communities they serve.

Best Practices for Teaching Care Management of Undocumented Patients.” Different standards of care for undocumented Latino patients raise ethical questions for teachers and learners. This lack of parity can cause moral distress for both and prompts consideration of whether decisions made on a patient’s behalf are ethical. Teaching advocacy and creating projects and partnerships to improve access and quality of care for this vulnerable population can help fight burnout and improve health outcomes.

Are Clinicians Obliged to Disclose Their Immigration Status to Patients? Undocumented immigrants are part of the health care workforce, whether they are eligible to work in the United States through the Deferred Action for Childhood Arrivals (DACA) program or other visa programs or permits. This case commentary considers whether—and if so, when—a physician should reveal her immigration status to patients.

After reviewing the literature on clinician self-disclosure, this commentary discusses how sharing immigration status could benefit the patient—particularly if the physician has an immigration status that could interrupt care—but could also draw the focus away from the patient, possibly eroding trust between patient and physician. This article also addresses mental health burdens experienced by undocumented and “DACA-mented” trainees and considers the roles that hospitals, residency programs, and health professions schools should play to support them.

How Should Clinicians Respond When Different Standards of Care Are Applied to Undocumented Patients? A challenge in caring for patients in resource-poor settings is the ethical discomfort and discouragement clinicians might experience when they’re unable to provide optimal care due to lack of resources. This article argues that physicians should identify and advocate for optimal care for each patient.

Moreover, physicians should advocate to improve the health system that allows for substandard care. Physicians should disclose to patients all available evaluation and treatment options, even those that seem cost prohibitive or unrealistic for some other reason. Transparency and objectivity in the patient-physician relationship require good communication skills and are central to avoiding harm.

Listen and learn

In the journal’s January podcast, guests include:

  • Mark Kuczewski, PhD, director of the Neiswanger Institute for Bioethics and Healthcare Leadership at Loyola University Chicago Stritch School of Medicine in Maywood, Illinois. He is an advocate for undocumented medical students and immigrant patients.
  • Scott Schweikart, a senior research associate for the AMA Council on Ethical and Judicial Affairs and legal editor for the AMA Journal of Ethics.
  • Nancy Berlinger, PhD, a research scholar at the Hastings Center in Garrison, New York. She studies ethical challenges in health care work, including health care access for undocumented immigrants.

These experts discuss challenges in caring for undocumented patients. Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other services.

Submit manuscripts and artwork

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

A look ahead

Upcoming issues of the AMA Journal of Ethics will focus on artificial intelligence in health care and health care organizations and community development. Sign up to receive email alerts when new issues are published.