Health Care for Undocumented Immigrants

Jan 2019

Health Care for Undocumented Immigrants

Currently, 800,000 Deferred Action for Childhood Arrivals (DACA) recipients—including many health professionals, students, and patients—face risk of detention and deportation. Loss of DACA status could relegate many of these young people to a life marked by fear and uncertainty. This issue considers the nature and scope of clinicians’ obligations to support and care for undocumented immigrants, refugees, and asylees.

Background image by Nathan Gray.

Volume 21, Number 1: E1-118 Full Issue PDF

From the Editor
Jan 2019

Immigration, DACA, and Health Care
Isha Marina Di Bartolo, MD
Caring for undocumented immigrants, refugees, and asylees requires knowledge of the challenges and barriers to care those patients face. Clinicians should be prepared to help patients address immigration-related fears and anxieties that can profoundly affect their health.
AMA J Ethics. 2019;21(1):E4-7. doi: 10.1001/amajethics.2019.4.
Case and Commentary
Jan 2019

Should Immigration Status Information Be Included in a Patient’s Health Record?
Grace Kim, Uriel Sanchez Molina, and Altaf Saadi, MD, MSHPM
Undocumented patients can be subject to discrimination, reporting, detention, or deportation in violation of the Health Insurance Portability and Accountability Act, so what goes in the record is critical.
AMA J Ethics. 2019;21(1):E8-16. doi: 10.1001/amajethics.2019.8.
Case and Commentary
Jan 2019

Is Organ Retransplantation Among Undocumented Immigrants in the United States Just?
Ruth L. Ackah, MD, Rohini R. Sigireddi, and Bhamidipati V. R. Murthy, MD
Although undocumented immigrants contribute to the pool of available organs and to the US tax base, they are not eligible for organ transplantation in most US states.
AMA J Ethics. 2019;21(1):E17-25. doi: 10.1001/amajethics.2019.17.
Case and Commentary
Jan 2019

How Should Clinicians Respond When Different Standards of Care Are Applied to Undocumented Patients?
Peter Ellis, MD, MPH and Lydia S. Dugdale, MD, MAR
Presenting all, including expensive, options to all patients means advocating not only for individual patients, but also for a just health care system.
AMA J Ethics. 2019;21(1):E26-31. doi: 10.1001/amajethics.2019.26.
Case and Commentary
Jan 2019

Should Immigration Status Information Be Considered Protected Health Information?
Scott J. Schweikart, JD, MBE
Being undocumented is a risk factor for mental illness, and immigration status relates prominently to overall health. That’s enough to consider it protected health information under the Health Insurance Portability and Accountability Act Privacy Rule.
AMA J Ethics. 2019;21(1):E32-37. doi: 10.1001/amajethics.2019.32.
Case and Commentary
Jan 2019

Are Clinicians Obliged to Disclose Their Immigration Status to Patients?
Isha Marina Di Bartolo, MD and Dominic Sisti, PhD
Clinicians’ disclosure of their immigration status could help or undermine patient-clinician relationships. Which factors matter most?
AMA J Ethics. 2019;21(1):E38-43. doi: 10.1001/amajethics.2019.38.
Medical Education
Jan 2019

Best Practices for Teaching Care Management of Undocumented Patients
Robin E. Canada, MD
Going to so-called safety-net clinics could mean being subject to different standards of care than those in other health care delivery settings. Learners who understand social determinants of health might be able to help patients navigate the system and access community resources.
AMA J Ethics. 2019;21(1):E44-49. doi: 10.1001/amajethics.2019.44.
Medical Education
Jan 2019

Resources for Teaching and Learning About Immigrant Health Care in Health Professions Education
Nancy Berlinger, PhD and Rachel L. Zacharias
What's known as the chilling effect means immigrants are not using health services to which they are entitled. Clinicians and students can act to help safeguard immigrants’ rights.
AMA J Ethics. 2019;21(1):E50-57. doi: 10.1001/amajethics.2019.50.
Health Law
Jan 2019

Rights Disappear When US Policy Engages Children as Weapons of Deterrence
Craig B. Mousin, JD, MDiv
US immigration policy contravenes the Convention on the Rights of the Child, which all United Nations member nations have ratified except the United States. The convention recognizes that children need special assistance and legal protection and prohibits deprivation of liberty.
AMA J Ethics. 2019;21(1):E58-66. doi: 10.1001/amajethics.2019.58.
Health Law
Jan 2019

April 2018 Flores Settlement Suit Challenges Unlawful Administration of Psychotropic Medication to Immigrant Children
Scott J. Schweikart, JD, MBE
What should happen when drugs given to detained children without parental consent compromise their best interests?
AMA J Ethics. 2019;21(1):E67-72. doi: 10.1001/amajethics.2019.67.
AMA Code Says
Jan 2019

AMA Policies and Code of Medical Ethics’ Opinions Related to Health Care for Patients Who Are Immigrants, Refugees, or Asylees
Rachel F. Harbut
AMA policy offers guidance about physicians’ duties to provide care and advocate for undocumented patients.
AMA J Ethics. 2019;21(1):E73-77. doi: 10.1001/amajethics.2019.73.
Policy Forum
Jan 2019

Good Sanctuary Doctoring for Undocumented Patients
Mark G. Kuczewski, PhD, Johana Mejias-Beck, MD, and Amy Blair, MD
Patients’ immigration concerns can be addressed when clinicians adopt a public health approach to caring: wearing buttons, distributing brochures, inviting experience sharing, and directing patients to needed resources.
AMA J Ethics. 2019;21(1):E78-85. doi: 10.1001/amajethics.2019.78.
Medicine and Society
Jan 2019

Strategies for Responding to Undocumented Immigrants With Kidney Disease
Jonathan J. Suarez, MD, MSCE
Regularly scheduled dialysis is not standard of care for most undocumented immigrants in the United States, so preventative care, and advocacy for it, is needed.
AMA J Ethics. 2019;21(1):E86-92. doi: 10.1001/amajethics.2019.86.
Medicine and Society
Jan 2019

Why Physicians Should Advocate for Undocumented Immigrants’ Unimpeded Access to Prenatal Care
Rachel Fabi, PhD
Many pregnant undocumented immigrants are ineligible for public insurance covering prenatal care. National and state policies can either help or hinder patients’ access to health care that is universally recommended by professional guidelines.
AMA J Ethics. 2019;21(1):E93-99. doi: 10.1001/amajethics.2019.93.
Medicine and Society
Jan 2019

Is It Ethical to Bend the Rules for Undocumented and Other Immigrant Patients?
Nancy Berlinger, PhD
When combined with motivation to provide good care, uncertainty about how to do so for patients who are excluded from key public insurance provisions can give rise to workarounds. Their practical and ethical complexities should be recognized when considering how to best serve immigrant communities.
AMA J Ethics. 2019;21(1):E100-105. doi: 10.1001/amajethics.2019.100.
Art of Medicine
Jan 2019

Journeys of Immigrant Families Across the Border
Nora Hiriart Litz and Isha Marina Di Bartolo, MD
Four paintings capture unaccompanied children’s experiences of love, loss, and hope during their migration to the United States.
AMA J Ethics. 2019;21(1):E106-110. doi: 10.1001/amajethics.2019.106.
Art of Medicine
Jan 2019

Sofia’s Story: The Sad Reality Behind a Humanitarian Crisis
Rohail Kumar, MD
This graphic storybook portrays an undocumented child in the United States who is denied fundamental human rights to health care, education, shelter, and food.
AMA J Ethics. 2019;21(1):E111-112. doi: 10.1001/amajethics.2019.111.
Viewpoint
Jan 2019

How Should Health Professionals and Policy Makers Respond to Substandard Care of Detained Immigrants?
Rie Ohta and Clara Long, JD, MSc, MA
Medical-legal partnerships can help detainees by motivating health, safety, and human rights standards in detention centers.
AMA J Ethics. 2019;21(1):E113-118. doi: 10.1001/amajethics.2019.113.
Podcast
Jan 2019

Ethics Talk: Compassionate and Respectful Care for Undocumented Immigrants

Undocumented patients are a vulnerable population, since they often lack access to health insurance and can be afraid to present for care. This month on Ethics Talk, we discuss challenges in caring for undocumented patients with Dr. Mark Kuczewski, Scott Schweikart, and Dr. Nancy Berlinger.

Health Care for Undocumented Immigrants

Immigration, DACA, and Health Care

Should Immigration Status Information Be Included in a Patient’s Health Record?

Is Organ Retransplantation Among Undocumented Immigrants in the United States Just?

How Should Clinicians Respond When Different Standards of Care Are Applied to Undocumented Patients?

Should Immigration Status Information Be Considered Protected Health Information?

Are Clinicians Obliged to Disclose Their Immigration Status to Patients?

Best Practices for Teaching Care Management of Undocumented Patients

Resources for Teaching and Learning About Immigrant Health Care in Health Professions Education

Rights Disappear When US Policy Engages Children as Weapons of Deterrence

April 2018 Flores Settlement Suit Challenges Unlawful Administration of Psychotropic Medication to Immigrant Children

AMA Policies and Code of Medical Ethics’ Opinions Related to Health Care for Patients Who Are Immigrants, Refugees, or Asylees

Good Sanctuary Doctoring for Undocumented Patients

Strategies for Responding to Undocumented Immigrants With Kidney Disease

Why Physicians Should Advocate for Undocumented Immigrants’ Unimpeded Access to Prenatal Care

Is It Ethical to Bend the Rules for Undocumented and Other Immigrant Patients?

Journeys of Immigrant Families Across the Border

Sofia’s Story: The Sad Reality Behind a Humanitarian Crisis

How Should Health Professionals and Policy Makers Respond to Substandard Care of Detained Immigrants?

Ethics Talk: Compassionate and Respectful Care for Undocumented Immigrants

Other Issues

Health and Food Ethics

False Beliefs in Health Care

Physicians' Power to Name