Both the USA and Europe limit access to care by undocumented immigrants. In the debate over what level of access to confer to IMs, there are various public policy rationales operating either explicitly, or below the surface, ranging from minimalist humanitarianism to full cosmopolitan equality, with several intermediate positions between these two poles. This article informs the international debate by providing a conceptual mapping of these underlying policy rationales. Each position is based on different lines of reasoning or bodies of (...) evidence, and each leads to somewhat different conclusions about the extent to which IMs should have access to different types of health care. It is unlikely that broad consensus will be achieved in this ongoing debate. However, by articulating the ethical, legal, pragmatic and conceptual reasons to support or oppose various positions, we hope to help determine where in the landscape of reasoned argument various positions lie, and how each position might be best supported or refuted. In particular, we see in this debate an illustration of Michael Walzer’s classic analysis of competing spheres of justice. Various positions depend to a considerable extent on whether their advocates approach this issue from the health policy sphere rather than the sphere of immigration policy, or whether they attempt to blend the two spheres. (shrink)

Although the right to health is universal, many nations that honor it fail to do so in the case of non-citizen immigrants. In this essay, we argue that the reasons typically given for not extending the right to health to immigrants are without merit and that there are good reasons for nations to protect, respect and fulfill the health right of all immigrants. Contrary to the standard view, we argue that health can be understood as a global public good. Two (...) important points follow: because health is non-excludable and non-rivalrous, it is in the health interests of nations to respect, protect and fulfill immigrants’ right to health. Furthermore, meeting the health needs of immigrants is an important way for receiving nations to meet the duties that may be generated by the benefits they incur as a result of health’s global public good dimension, thus ensuring that receiving nations are not free riders. We then argue that because citizens and immigrants dwell together, nations have duties of solidarity to immigrants with respect to health. Using the insights of social psychology, we show that solidarity among diverse people is both a reasonable expectation and a morally desirable one. (shrink)

Do societies have an ethical responsibility to care for and about the health of undocumented migrants? Some people claim that societies have no responsibility to care for undocumented migrants because these migrants have no legal right to be in the country. But this view tends to ignore ethical responsibilities that are independent of legal status. Other people claim that all human beings, in virtue of their dignity and status as human beings, have a right to the highest standard of health. (...) But this view tends to ignore ethical responsibilities that arise out of relationships between a society and the undocumented migrants who are living and working in that society. In this article, I take a different approach. In the case of undocumented workers, I try to show how these workers are used in the economy and why a widely accepted pattern of responsibility should be extended to them. In the case of undocumented young people, I try to show how these people are socialized in a society and why a widely accepted pattern of responsibility should be extended to them. Toward the end of this article, I reflect on the nature and limits of these arguments. (shrink)

In this paper, I consider the question of where illegal immigrants should go once their lives have been saved in hospitals and they are ready to be transferred to long-term care situations. I highlight three recent cases in which such a decision was made. In one case, the patient was kept at the hospital, in another the patient was repatriated to his home country, and in the third, the patient was discharged to his family. I consider the relevant moral values (...) and argue that for reasons of fairness we must develop a policy that treats similar cases in similar ways. In order to best uphold patient well-being and minimize costs, the plan proposed here calls for illegal immigrants to be covered by insurance for long-term care. (shrink)