medical ethics and undocumented migrants Milosz Swiergiel, NORP (IFMSA-Sweden) and Mirte Sprengers, NORP (IFMSA-The Netherlands) Small Working Group on Undocumented migrants access to health care IFMSA August Meeting 2008, Ocho Rios, Jamaica

Medical ethics and undocumented migrants  What is medical ethics?  Declarations of the World Medical Association (WMA)  Declarations of national medical associations  International Federation of Medical Students’ Associations (IFMSA), Access to Health Care for Undocumented Persons Policy Statement  Comité Permanente Médecins Européens (CPME), Access to health care for undocumented migrants: a CPME position paper  References  What is medical ethics?  Declarations of the World Medical Association (WMA)  Declarations of national medical associations  International Federation of Medical Students’ Associations (IFMSA), Access to Health Care for Undocumented Persons Policy Statement  Comité Permanente Médecins Européens (CPME), Access to health care for undocumented migrants: a CPME position paper  References

What is medical ethics?  Ethics is the study of morality – careful and systematic reflection on and analysis of moral decisions and behaviour. The concern of ethics is to provide rational criteria for people to decide or behave in some ways rather than others.  Medical ethics is the branch of ethics that deals with moral issues in medical practice.  Ethics is the study of morality – careful and systematic reflection on and analysis of moral decisions and behaviour. The concern of ethics is to provide rational criteria for people to decide or behave in some ways rather than others.  Medical ethics is the branch of ethics that deals with moral issues in medical practice.

Declaration of Geneva (WMA) “The health of my patient will be my first consideration” “I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, or social standing to intervene between my duty and my patient” “The health of my patient will be my first consideration” “I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, or social standing to intervene between my duty and my patient”

Declaration of Tokyo (WMA) “A doctor must have complete clinical independence in deciding upon the care of a person for whom he or she is medically responsible. The doctor's fundamental role is to alleviate the distress of his or her fellow men, and no motive, whether personal, collective or political shall prevail against this higher purpose.” “A doctor must have complete clinical independence in deciding upon the care of a person for whom he or she is medically responsible. The doctor's fundamental role is to alleviate the distress of his or her fellow men, and no motive, whether personal, collective or political shall prevail against this higher purpose.”

International Code of Medical Ethics (WMA) “A physician shall, in all types of medical practice, be dedicated to providing competent medical services in full technical and moral independence, with compassion and respect for human dignity.” “A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences.” “A physician shall owe his patients complete loyalty and all the resources of his science.” “A physician shall, in all types of medical practice, be dedicated to providing competent medical services in full technical and moral independence, with compassion and respect for human dignity.” “A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences.” “A physician shall owe his patients complete loyalty and all the resources of his science.”

Declaration on the Rights of the Patient (WMA) “Whenever legislation, government action or any other administration or institution denies patients [their] rights, physicians should pursue appropriate means to assure or to restore them.” “Every person is entitled without discrimination to appropriate medical care.” “Every patient has the right to be cared for by a physician whom he/she knows to be free to make clinical and ethical judgements without any outside interference.” “The patient shall always be treated in accordance with his/her best interests. The treatment applied shall be in accordance with generally approved medical principles.” “Whenever legislation, government action or any other administration or institution denies patients [their] rights, physicians should pursue appropriate means to assure or to restore them.” “Every person is entitled without discrimination to appropriate medical care.” “Every patient has the right to be cared for by a physician whom he/she knows to be free to make clinical and ethical judgements without any outside interference.” “The patient shall always be treated in accordance with his/her best interests. The treatment applied shall be in accordance with generally approved medical principles.”

Declaration on the Rights of the Patient (WMA) “In circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.” “Every person has the right to health education that will assist him/her in making informed choices about personal health and about the available health services. The education should include information about healthy lifestyles and about methods of prevention and early detection of illnesses. The personal responsibility of everybody for his/her own health should be stressed. Physicians have an obligation to participate actively in educational efforts.” “The patient is entitled to relief of his/her suffering according to the current state of knowledge.” “The patient is entitled to humane terminal care and to be provided with all available assistance in making dying as dignified and comfortable as possible.” “In circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.” “Every person has the right to health education that will assist him/her in making informed choices about personal health and about the available health services. The education should include information about healthy lifestyles and about methods of prevention and early detection of illnesses. The personal responsibility of everybody for his/her own health should be stressed. Physicians have an obligation to participate actively in educational efforts.” “The patient is entitled to relief of his/her suffering according to the current state of knowledge.” “The patient is entitled to humane terminal care and to be provided with all available assistance in making dying as dignified and comfortable as possible.”

Resolution on Medical Care for Refugees (WMA) “Physicians have a duty to provide appropriate medical care regardless of the civil status of the patient, and governments should not deny patients the right to receive, nor should they interfere with physicians' obligation to administer, adequate treatment.” “Physicians have a duty to provide appropriate medical care regardless of the civil status of the patient, and governments should not deny patients the right to receive, nor should they interfere with physicians' obligation to administer, adequate treatment.”

Ethical code of the Swedish Medical Association According to the ethical code of the Swedish Medical Association, the physician shall: - have the health of the patient as the primary goal of his deed. - never abandon the principle of equal value of all persons. - never take part in giving patients or groups of patients undue priority or advantages of financial or any other nature.

Access to Health Care for Undocumented Persons Policy Statement (IFMSA) Access to Health Care for Undocumented Persons Policy Statement, Adopted by the IFMSA at the 57th March General Assembly in Monterrey, Mexico, in March 2008 “We would like to draw your attention to, and ask both governmental and non-governmental organisations for support in the promotion and respect of the right to health for all; including our societies’ vulnerable minority groups.” “Today undocumented, or irregular, persons are being denied the same level of access to health care as other residents, which has severe consequences on the health of this group and constitutes a violation of the right to health.” Access to Health Care for Undocumented Persons Policy Statement, Adopted by the IFMSA at the 57th March General Assembly in Monterrey, Mexico, in March 2008 “We would like to draw your attention to, and ask both governmental and non-governmental organisations for support in the promotion and respect of the right to health for all; including our societies’ vulnerable minority groups.” “Today undocumented, or irregular, persons are being denied the same level of access to health care as other residents, which has severe consequences on the health of this group and constitutes a violation of the right to health.”

Access to Health Care for Undocumented Persons Policy Statement (IFMSA) “With existing legislation regulating the access to health care for undocumented persons in many countries we, the doctors of tomorrow, may be forced to discriminate against some of our own patients. This makes it impossible for us to work in accordance with the principles of medical ethics and the human right to health. In conclusion, the IFMSA emphasizes that only the medical needs, and not the legal status, of patients should be the basis from which we guide our actions as the doctors of tomorrow. Therefore, all undocumented persons should be offered the same health care, on the same basis, as other residents.” “With existing legislation regulating the access to health care for undocumented persons in many countries we, the doctors of tomorrow, may be forced to discriminate against some of our own patients. This makes it impossible for us to work in accordance with the principles of medical ethics and the human right to health. In conclusion, the IFMSA emphasizes that only the medical needs, and not the legal status, of patients should be the basis from which we guide our actions as the doctors of tomorrow. Therefore, all undocumented persons should be offered the same health care, on the same basis, as other residents.”

Access to health care for undocumented migrants: a CPME position paper CPME calls upon National Medical Associations to engage in the necessary activities at the national level to ensure that:  in their country doctors and health institutions are free to provide services to undocumented migrants;  restrictions as to the type and/or extent of health care undocumented migrants can receive are lifted;  financial and organizational impediments for doctors and health institutions to provide health care to undocumented migrants are taken away;  both doctors and undocumented migrants are fully aware of (and informed of) all existing possibilities to provide necessary health care;  the health situation in groups of undocumented migrants and their problems in access to health care are adequately monitored and addressed. CPME calls upon National Medical Associations to engage in the necessary activities at the national level to ensure that:  in their country doctors and health institutions are free to provide services to undocumented migrants;  restrictions as to the type and/or extent of health care undocumented migrants can receive are lifted;  financial and organizational impediments for doctors and health institutions to provide health care to undocumented migrants are taken away;  both doctors and undocumented migrants are fully aware of (and informed of) all existing possibilities to provide necessary health care;  the health situation in groups of undocumented migrants and their problems in access to health care are adequately monitored and addressed.

references  Medical Ethics Manual, World Medical Association (2005)  Ethical Codes and Declarations Relevant to the Health Professions; An Amnesty International compilation of selected ethical and human rights Texts, Amnesty International (2000)  Access to Health Care for Undocumented Persons Policy Statement, International Federation of Medical Students’ Associations (2008)  Access to health care for undocumented migrants: a CPME position paper, Comité Pérmanent des Médecins Européens, CPME (2008)