Taken from Hastings Center Report1997; 27(6): 48.
People from developing countries face ever growing hurdles in their attempts to migrate into developed countries. Anti-immigration strategies that try to close all possible loopholes find support across the political spectrum. A broad anti-immigration coalition exists in the United States, including egalitarians such as Diane Feinstein of California and ultraconservatives such as Patrick Buchanan. Similarly in Europe, outright xenophobic policies have found broad support among both Conservative and Labour Parties across major European powers such as Germany and the United Kingdom.
A recent conference held by the Greater Manchester Immigration Council, an organization assisting immigrants in the northwest of the United Kingdom, addressed the topic of health and immigration control. The council brought together medical professionals, immigration lawyers, social workers, medical ethicists, and last but not least immigrants to discuss issues arising in this area.
A variety of means have been introduced to prevent sick migrants from entering developed countries. For instance, Proposition 187, which was passed in 1994 in California, demands that health care providers who rely on 'public funds not care for illegal immigrants. In Canada, the identification of potential immigrants who might cause costs to taxpayers has become one of the main purposes of the country's immigration medical procedures. In the United Kingdom, prospective immigrants have to undergo a medical examination designed to determine whether they might be unable to support themselves or their dependents or require medical treatment.
The United Kingdoms Home Office can grant immigrants permanent leave of stay for compassionate reasons. One would expect that a serious, even life-threatening illness of a person from a developing country should be sufficient to grant her permanent leave of stay on compassionate grounds. Yet the opposite is the case. Medical doctors will be called in to prevent immigration. Among the reasons they could offer to justify the refusal are contagious diseases such as pulmonary tuberculosis, but also senility, mental disorders, sexual aberration, physical disability (including bodily deformity), and other conditions that might prevent the person from supporting herself or her dependents. In other words, vulnerable people from countries that can reasonably be assumed to have insufficient health care facilities are most likely to be denied entry into our countries, and access to our health care facilities. Medical professionals across the Western world are continuously involved in medical examinations designed to prevent the most vulnerable of potential immigrants from entering societies with fully functional medical systems. Indeed, doctors within the public health care system have been encouraged to report sick, illegal immigrants to the authorities to help them deport such people.
The obvious question is whether health care professionals have moral obligations to their patients that preclude participation in such practices. Unsurprisingly, immigrants' organizations have suggested that doctors should have the health of their patients in mind, and support their attempts to immigrate into a country that has a functioning health care system. It is disturbing that sick immigrants, for instance in the United Kingdom, cannot even rely on their general practitioners to keep confidentiality, as immigration lawyers reported at the Manchester conference. At least some immigrants have been reported to immigration authorities after having sought medical assistance.
The participation of medical professionals in immigration control measures is ethically problematic and deserves closer scrutiny by medical ethicists as well as national medical associations. Too, an inquiry is called for into the professional ethics of doctors who join forces with immigration authorities in order to trace down illegal migrants. Clearly, this issue needs to be situated within the context of distributive justice. After all, it is western pharmaceutical companies that charge prices for their drugs that make lifesaving medications effectively inaccessible to people in the developing world. Is it so unreasonable, then, to suggest that we have a moral obligation to support sick migrants from such societies, who seek medical support in the developed world?