In this paper I re-state the egalitarian argument against the morality of immigration controls: such limits violate the central ethical commitment to moral equality. This means that immigration controls fail a fundamental moral test and represent the ethical failure of the liberal project of moral equality. I set this re-statement against recent arguments about what moral equality means, specifically Christopher Heath Wellman's use of Elizabeth Anderson's notion of relational equality. Wellman believes that Anderson's ideas seriously damage the egalitarian argument, but (...) I argue that this is a misreading of her account. I conclude that any liberal attempt to morally justify immigration controls must fail through committing the basic logical error of ‘begging the question’. (shrink)

The American Journal of Bioethics, Volume 12, Issue 9, Page 11-13, September 2012.

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)

Access to public healthcare services for Belgium’s undocumented migrants is regulated through a parallel, administrative procedure within the legal framework of Urgent Medical Aid. This imposes several constraints on their access to healthcare services. Drawing on empirical-ethical methodologies, we show how this procedure impacts on the relationship between patients with undocumented status and healthcare workers. We use the concept of relational autonomy to show how the imposed legal constraints reduce the formal treatment options available to healthcare workers, but simultaneously lead (...) to informal care practices, and how the latter increase the discretionary power of the healthcare workers. We argue that in this context, provision becomes unpredictable and arbitrary, with undocumented migrants tending to value strong personal relations with one particular, trusted healthcare worker. Although this leads to increased dependence, it also increases patients’ options and autonomy by providing access to wider professional networks attached to that healthcare worker. (shrink)

Although scholars in bioethics usually consider the exclusion of migrants from basic healthcare as unjust, it remains unclear how health professionals should ethically deal with policies restrictin...