Abstract
There are many ethical health care issues that arise within the United States on daily. The purpose of this paper is to give the readers an understanding of forced patient repatriation and how it not only affects the patient, but the patient’s family, and the community as a whole. The four ethical principles autonomy, beneficence, non-maleficence, and justice will be addressed and how forced patient repatriation is affected by these four principles.
Ethical Health Care Issues Paper
One current ethical issue that has been a constant problem within the health care community is forced patient repatriation. Forced patient repatriation is the term used when patients that are sick in the hospital, who have no health care insurance, and whose immigration status is unknown, are moved from the hospital in the United States to a hospital in another country. These individuals are moved from U.S. hospitals to most commonly hospitals that are located in Latin America. These patients are basically being deported by the hospitals because they do not have health care insurance and their immigration status is unknown. The hospitals that participate in forced patient repatriation are not given permission by the patients family, nor are they given the instructions through the United States government. Problems with Forced Patient Repatriation
This is an important health care issue to address because hospitals are required by federal law to provide health care treatment to any individual who is being seen in the emergency room, regardless of whether or not they have health care insurance (Neevel, 2010).
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However, once the patient has been stabilized and moved into more of a long-term care, patients are being removed from the hospital and transferred to another hospital, which could possibly be located in another country. There are four very important negative aspects that need to be looked at when discussing forced patient repatriation. The first is that forced patient repatriation can mean transporting a sick patient a long distance, with limited equipment or personnel during the transportation, causing possible health complications.
The second negative aspect is that repatriation allows hospitals to physically remove patients from one hospital to another countries hospital with fewer resources and protection from federal regulations. The third negative aspect is that repatriation serves as a form of deportation without going through the government and formal deportation proceedings. Finally the last negative aspect is repatriation moves patients from one hospital and takes them to a hospital in another country; where the patient may be unfamiliar with and away from having their family near them for support. Example of Forced Patient Repatriation
In November 2007, a 19-year-old boy by the name of Antonio Torres came to a farm town in the surrounding area of Phoenix, Arizona to be near his father after receiving lawful permanent residents. A few days after arriving into the United States, Antonio Torres was in a horrific car accident that caused him to go into a coma. A few days after being in the coma, the hospital wanted Antonio’s family to pull the plug on his life support. His family refused to end his life support in hopes that he would awake from the coma. The only problem was that Antonio did not have life insurance; therefore, the hospital did a forced patient repatriation, and had Antonio transported by ambulance to the America/ Mexico border where an ambulance was supposed to pick him up.
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Antonio was dropped off at the Mexican border with his father, but the Mexican ambulance was not there to pick him up, so Antonio’s father had to wait with him for ours in the sun before an ambulance arrived. Upon reaching the hospital in Mexicali, Mexico, there was supposed to be a bed ready for him, however, the bed was not available for days, leaving Antonio to have to lay in the emergency department, where he caught infections. Since Antonio was a lawful permanent resident of the United States, and with community support he was finally transferred to a hospital in California. It was in the hospital at California where he received adequate treatment and awoke from his coma, days after arriving (Agraharkar, 2010).
This was an example of how forced patient repatriation can play not only a major effect on the patient’s health, but also on their family and the community.
Since Antonio Torres did not have health care insurance, and the hospital was unsure of their immigration status, they transported him to a hospital that did not have the proper equipment, personnel, or space to properly treat and care for Antonio. He also became even sicker by catching infections, after days of having to stay in the emergency room because there were no available beds in any other departments for him. It wasn’t until he was transported back to a hospital within the United States that he was able to get the proper care and treatment that he needed to get better and come out of the coma. Applying the Four Ethical Principles
There are four ethical principles that are applied in the health care field. These four ethical principles are autonomy, beneficence, non-maleficence, and justice. Autonomy is when respect is given to the patient and they are allowed to make their own decisions in regards to their health care treatment. Beneficence is when the best interest of the patient is determined, and they receive their care in what would be there best interest. Non-maleficence is when actions are used, that have no intentions of harming the patient, rather intended to benefit the patient. The last ethical principle is justice. This is when the patients are treated fairly, exactly how they deserve to be treated (Green, 2012).
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After examining the case of forced patient repatriation and Antonio Torres, it is extremely clear that the hospital did not make good ethical decisions when deciding to transport him from a U.S. hospital to a hospital in Mexico.
Since Antonio Torres was in a coma it was clear that autonomy could not be used in this case, because he did not have the ability to make his own decision in regards to the type of treatment he was going to be receiving and where he wanted to receive care. Therefore, it was up to the hospital to practice beneficence, and act in the best interest of Antonio Torres. It was also the hospital’s responsibility to practice non-maleficence, which is to not cause harm to the patient. It is clear that non-maleficence was not practiced because due to the hospital transporting Antonio from a U.S. hospital to a Mexican hospital he became much more ill; and had Antonio not been moved back to the hospital in California, his chances of never waking up from the coma or even dying would have increased. Therefore, Antonio would not have been given justice, meaning he was not being treated fairly and how he deserved to be treated, because he was moved from a hospital that had all the necessary equipment to provide him treatment to a hospital which had limited equipment and resources. Conclusion
Forced Patient Repatriation is a very unethical way of providing unlawful or lawful immigrants, without health care insurance, care and treatment. How can hospitals feel that they are providing ethical care and treatment to patients, if they are moving these patients from a health care facility that has the capability to provide these patients with the best care, to a hospital in another country that has inadequate equipment, personnel, and training of caring for patient’s. Not only is forced patient repatriation unethical, but it is ripping these sick patients from their families who can provide them with the support they need to get better. Forced patient repatriation is a health care issue that needs to be addressed as soon as possible.
References
Agraharkar, V. (2010, winter).
Deporting the Sick: Regulating International Patient Dumping by U.S. Hospitals. Columbia Human Rights Law Review, 41(2), 569-600. University Library. Green, B. (2012).
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Medical Ethics. Retrieved from http://priory.com/ethics.htm#Ethical Neevel, C. (2010).
At the Intersection of Immigration and Health Care Law: The Lack of Clear Standards Governing Medical Repatriation and Suggestions for Future Oversight. Retrieved from http://gonzagalawreview.org/files/2011/02/Neevel.pdf
