Journal of Social Philosophy, EarlyView.

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)

The article outlines the distributive demands of relational equality in the form of a dynamic corridor of legitimate distributive inequality. It does so by complementing the already widely accepted sufficientarian floor with a limitarian ceiling, leading, in a first step, to a "corridor" of limited distributive inequality as a necessary condition for relational equality. This corridor alone, however, only provides necessary distributive conditions for relational equality and still allows for degrees of distributive inequality that would risk undermining egalitarian relations. Thus, (...) in a second step, intra-corridor distributive inequalities must be regulated by two further constraints: a (context- dependent) ratio between the best- and worst-off, and a demand for equality of opportunity so that inequalities result from people’s responsible choices. This set of demands spells out the distributive conditions that are not only necessary, but sufficient to provide a sound distributive basis for relational equality. After presenting this view, the article defends it against several objections. (shrink)

Claims for improving migrants’ access to care often draw on universalistic ethical notions, such as the principle of equity as it is specified in human rights law and public health ethics. These claims contrast with political realities across most welfare states. In the underlying public discourses, the frontline arguments against greater inclusion have often focused on practical concerns, such as the costs of healthcare provision. Yet it has also been suggested that ultimately context‐specific moral frameworks play a key role in (...) demarcating legitimate right‐holders from undeserving others. Hence, is this a conflict between ethical principles and practical concerns? Or between different ethical perspectives? And why would that question matter? We propose that awareness of the nature of the arguments involved and respect for different ethical views are critical for coherent and constructive debates. This paper looks at the ways in which ethical concepts are used to justify exclusionary policy decisions. In particular, it examines the rationales that inform health policies towards documented and undocumented labor migrants in two welfare states, Germany and Israel, through the qualitative analysis of policy documents and 71 in‐depth interviews. The study points to the central role of particular concepts of health‐related deservingness. These results lead to the proposition that the fundamental clash in the discussion on migrants’ access to care is one, albeit not solely, between contrasting ethical perspectives. Drawing on process‐oriented approaches to ethical decision‐making, the paper concludes with three suggestions for moving forward with the migrant health rights debate. (shrink)