Illegal immigrants are a significant and contentious population in many countries. Indeed, even the name is debatable. People in this category are known as illegal immigrants, illegal aliens, irregular migrants, undocumented workers, or sans papiers in French. Whatever they are named, their existence presents an essential ethical question: Do societies have an ethical obligation to provide health care and encourage their health?
At the moment undocumented immigrants are only permitted to receive federal benefits that are deemed necessary to protect life or ensure safety in emergency situations, such as emergency Medicaid, access to treatment in hospital emergency rooms, or access to healthcare and nutrition programs through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Undocumented immigrants must meet all of Medicaid’s other nonfinancial and financial eligibility requirements in order to be eligible for these emergency treatments.
Illegals’ Medical Care Is an Ethical Issue
This question frequently produces two distinct answers. Some people, dubbed nationalists, argue that the answer is unquestionably no. They claim that persons who have no legal right to be in a country should not be entitled to benefits there. Others, known as humanists, argue that the answer is unquestionably yes. They contend that everyone should have access to health care. It is a fundamental human right.
Both of these responses, in my opinion, are incorrect. The first is overly concerned with what we owe people based on legal standards and formal citizenship. The other solution is too broad, focusing on what we owe people as human beings. We require a middle-ground perspective that effectively responds to the problem of illegal immigration while also reflecting the complexities of moral discourse. There may be significant ethical differences, for example, between U.S. citizens who lack health insurance, undocumented workers who lack health insurance despite working full-time, medical visitors who fly to the United States as tourists to receive care at public hospitals, foreign citizens who work abroad for American firms as subcontractors, and foreign citizens who live in impoverished countries. I believe that we, as Americans, have ethical obligations in all of these situations, but I perceive significant distinctions in what these obligations entail and how they should be presented.
I’d want to focus on the situation of illegal immigrants in this piece. I’ll go over a number of various answers to the subject of what ethical obligation we have to offer health care to illegal immigrants.
A sound ethical solution to the issue of illegal immigration, in my opinion, necessitates some awareness of the job that illegal immigrants accomplish. The majority of undocumented employees labor in jobs that many citizens avoid. They do arduous and unpleasant tasks for tiny businesses in the informal sector of the economy for low pay. In general, they have the worst employment and labor in the poorest conditions in industries like agriculture, construction, manufacturing, and food processing. They gather fruit, clean dishes, move dirt, stitch garments, clean bathrooms, and so on.
A Question of Deserving
The abstract ethical question of whether countries owe it to illegal immigrants to provide health care becomes an actual political issue at times. Rising healthcare expenses, budget-cutting programs, and discontent can all turn an ethical matter into a political one. This has occurred on multiple occasions in the United States. In 1996, the United States Congress debated and enacted the “Illegal Immigration Reform and Immigrant Responsibility Act.” This bill rendered all immigrants ineligible for Medicaid, although it did allow the federal government to compensate states for illegal immigrants’ emergency treatment.
Although it is true that illegal immigrants have broken the law by entering or remaining in the country, the moral impact of this argument is unclear. The mere fact that illegal immigrants have broken the law has no bearing on access to healthcare. Many people violate a variety of laws. Whether a violation of a law should prohibit someone from receiving public services is likely to be determined by the nature and purpose of the services, the type and gravity of the offense, and a variety of other factors.
Consider one example of a legal infraction. People occasionally violate tax regulations by operating off the books. They work for money in order to avoid paying taxes or losing benefits. Furthermore, this behavior is most likely extremely frequent. I recently asked students in two of my classes if they or anyone in their extended family had earned money that they did not record as taxable income. All but two students in one class raised their hands. Every student in the opposite class raised their hand.
What is wrong is the notion that we must choose between providing basic health care to illegal immigrants and providing basic health care to residents.
Nobody has urged that healthcare providers refuse care to persons suspected of working illegally. However, undocumented labor is also illegal. Furthermore, it raises concerns about fairness because it shifts obligations to others while decreasing financing for critical reasons. Working off the books and working without a visa is not the same in every way. But, without additional discussion, there isn’t much to say about whether it’s right to withhold benefits to people who have broken the law.
I’d want to restate the argument as follows: Given the limited public healthcare budget, U.S. citizens and lawful permanent residents are more deserving of benefits than illegal immigrants. This approach portrays the problem as a choice between competing goods with limited resources.
This approach to framing the issue is both correct and incorrect. What is right is the notion that in all aspects of life, both personal and governmental, we must choose between competing goods. A society cannot have it all: comprehensive and universal health care, high-quality public schools, huge public parks and beaches, public services, and extremely low taxation. What is wrong is the notion that we must choose between providing basic health care to illegal immigrants and providing basic health care to residents. Many other tradeoffs are available, such as increased government spending.
The debate’s restricted framework sets disadvantaged citizens against illegal immigrants in a battle for healthcare resources. The question is framed within this paradigm as one of deservingness, who is most deserving of receiving a reward? It is hard to avoid the concept of deservingness. After all, justice is about giving people their due – giving them what they are entitled to. A restricted view of deservingness, on the other hand, appears to be most at home when allocating specific products that go beyond fundamental necessities, in instances when the criteria of performance and effort are quite obvious. For example, if we are asked to recognize the best chemistry student, a narrow definition of deservingness is appropriate and useful. However, publicly funded health care is different and necessitates a larger definition of deservingness.
The debate over restrictive measures frequently centers on deservingness, taxation, and rewards. Proponents sometimes depict illegal immigrants as freeloaders who take advantage of public services without contributing to government funds. Opponents point out that illegal immigrants pay taxes. They pay sales, gas, and value-added taxes. They frequently pay income and property taxes. Do they, however, pay enough tax to offset the cost of the services they use? Alternatively, are illegal immigrants a net economic gain or loss for society?
Instead of attempting to answer the economic question, I’d like to highlight a flaw in the question itself. The subject of taxation and benefits tends to portray society as a for-profit enterprise. According to the business model, investors should profit in proportion to the amount of money they put into the enterprise. This approach may be appropriate for some corporate operations, but it is insufficient for all social institutions and benefits. The corporate model is insufficient for considering voting, legal defense, library services, minimum salaries, workplace safety, and a variety of other social advantages.
A Question of Professional Ethics
Some of the most vehement opposition to limiting restrictions has come from individuals who view the issue through the lens of professional ethics. According to Tal Ann Ziv and Bernard Lo [in the New England Journal of Medicine], “cooperating with Proposition 187 [a proposal to deny health care to illegal immigrants in California] would undermine professional ethics.” They contend, in particular, that participating with such a limiting policy violates physicians’ “ethical responsibilities to protect public health, care for persons in medical need, and respect patient confidentiality.” Restrictive measures may have a negative impact on public health. Measures that deny care to illegal immigrants or make them hesitant to seek care, for example, may lead to an increase in tuberculosis. Furthermore, physicians have a professional obligation to oppose policies that would seriously endanger public health.
A Question of Social Responsibilities
By framing the issue in terms of social responsibility, one of the most prominent elements of illegal immigration is highlighted: the employment pattern within society. As I have stated, illegal immigrants frequently perform the poorest work for the lowest wages. Illegal immigrants are part of an older and deeper pattern than the present economic globalization. Societies have frequently assigned the most distasteful and hardest tasks to the most vulnerable and marginalized members of society. Slaves, indentured servants, castes, minorities, orphans, destitute children, internal migrants, and foreign migrants have all been exploited by societies. Of course, the pattern is not the same in every civilization, nor in every industry within a society, but the parallels are striking.
I regard the use of illegal immigrants as a modernized version of an old pattern. However, it is not a natural occurrence beyond human influence. It is the outcome of societal laws, conventions, institutions, habits, and conditions, as well as global factors. We could try to recreate it as a social construction.
Some may argue that no one forces illegal immigrants to work in low-wage occupations and that they can return home if they so desire. This objection is overly simplistic. Although most undocumented workers chose to leave their home country voluntarily, they frequently had insufficient information and few choices, and voluntary repatriation is not an appealing option when they have significant debts and little earning potential at home. Furthermore, even a fully educated and voluntary choice does not resolve the issue of social fairness and accountability.
We must take responsibility for stopping the old pattern from repeating itself, and the crucial concept is “taking responsibility.”
A Societal Perspective That Is Inclusive
Why should society bear responsibility for those it has worked hard to keep out of its territory, for persons who are not social members? Because illegal immigrants are social members in many ways. Despite the fact that they are not citizens or legal residents, they may be hard workers, nice neighbors, attentive parents, and active members of the community. They are workers who are involved in intricate social cooperation initiatives. Many of the most exploited employees during the industrial revolution -children, women, and men without property – were not complete citizens as well, but they were vulnerable people doing frequently undesired work for whom society needed to take some responsibility. Because undocumented workers play a comparable function in society, the social responsibility to care for them differs from the responsibility to care for medical visitors.
Providing health care for all workers would boost the benefits received by workers and reflect social and societal esteem for them.
If a society had the ethical conviction and political will, it could devise real methods to modify the worst features of some jobs, empower the most vulnerable workers, and shape the background conditions under which the labor market operates. The interests of the poorest residents and illegal immigrants do not have to be in comparison. Practical actions should raise labor expenses and raise the price of goods and services. We cannot rely on unauthorized labor to keep prices down on everything from strawberries to sex.
Good health care can prevent death and suffering, promote health and well-being, respond to basic needs and vulnerabilities, express care and solidarity, contribute to equality of opportunity, monitor social problems (such as child abuse or pesticide exposure), and achieve other important goals. However, health care is only one method to achieve aims, and it is not necessarily the most successful. Focusing on access and cost of health care narrows our ethical concerns.
I believe that societies that attract illegal immigrants should pursue policies and practices that (1) improve the pay and working conditions of the lowest-wage jobs; (2) structure and organize work so that workers have more voice, power, and opportunities to develop their capacities; and (3) connect labor to unions, associations, and communities in ways that increase social respect for all workers. I cannot justify these arguments here, but I would like to highlight how they relate to health care. Providing health care for all workers and their families is a great approach to improving workers’ benefits for the worst types of jobs, making workers less vulnerable, and showing social and civic respect for them. These are compelling arguments in favor of providing health care to all workers, documented and undocumented equally. They also reflect ethical issues that are not adequately addressed by discussions of human rights, public health, or civil rights.