September 21, 2012 | Posted By Bruce D. White, DO, JD

In a recent article about medical repatriation in a national bioethics journal, philosopher Mark Kuczewski argues that the practice can be an “ethically accepted option” only if three conditions are met:

  1. Transfer must be able to be seen by a reasonable person as being in the patient’s best interests aside from the issue of reimbursement.
  2. The hospital must exercise due diligence regarding the medical support available at the patient’s destination.
  3. The patient or appropriate surrogate must give fully informed consent to being returned to another country.

Surely Dr. Kuczewski knew – when he wrote the article – how completely absurd these three “conditions” or prerequisites are?

All the major stories about medical repatriation which have appeared recently – such as February 2011 Chicago Tribune piece (Quelino Jimenez), the July 2009 New York Times article (Luis Jimenez), and the November 2008 New York Times story (Antonio Torres) – involved patients who didn’t have any available financial mechanisms to cover their extensive medical needs, nor did the transferring US hospitals have any way of assuring a high level rehabilitation program in their home country facilities, nor did the patients agree to the transfer. In each case then, one must conclude that the transfers or medical repatriations – using Dr. Kuczewski’s criteria – were unethical. In fact – again, using Dr. Kuczewski’s standard – one must ask if will ever be possible to repatriate a foreign national to their native country’s medical system without obtaining consent – or what really amounts to permission – from the patient?

Hospital frustration in dealing with the extended care of illegal immigrants has reached a pitched fever. The frustration seems akin to the political angst seen in Arizona and Alabama with their recent legislative attempts to deal with the illegal immigration problem at the state level given the inability of the federal government to better the situation at the national level. Hospital frustration with illegal immigrants’ unmet medical needs may lead to some facilities actually closing in a few communities because of unavailable financial resources (such as the closing of the outpatient dialysis service at Grady Memorial Hospital in Atlanta).

Closing services to all in the community versus sending illegal immigrants requiring prolonged rehabilitation needs back to their home country? That may be the choice that health care providers must face in the future as available financial resources become more scarce. Clearly, ethicists like Dr. Kuczewski should be involved in formulating ethical responses. But developing unrealistic and unworkable solutions such as the three “conditions” he stipulated in his article about ethical medical repatriation of illegal immigrants who require extensive rehabilitation after hospitalization will only add to provider frustration and demonstrate how philosophers are more interested in fashioning arguments about problems than actually solving real-world problems.

Newspaper article references available on request.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Distributive Justice , Health Care Policy , Health Insurance , Illegal Immigrants


sheila otto

sheila otto wrote on 09/21/12 3:33 PM

When one works with this population, each patient has a face and therefore it makes it difficult to agree with Dr. White's harsh recommendations. However, his points are grounded in the numbers of health care costs, the reality that there is NO payer source outside of the hospital, and that as a result, there does exist the possibility of financial ruin for institutions which then impact the larger community. This is one more serious aspect of our current broken system that needs to be addressed. As an American I'd like to think that we are a compassionate society which cares all people. It is hard to argue that as the richest country in the world, we cannot figure out how to get a bigger bang for our buck while maintaining humane care for all.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.