Friday, January 18, 2008

Civil Disobedience in the British National Health Service

This week the UK government considered ruling that GPs in the National Health Service will no longer be allowed to provide treatment to asylum seekers or undocumented migrants.

During the same week, in a highly publicized case, the UK deported 39 year old Ama Sumani to Ghana. Ms. Sumani had come to the UK on a student visa, but had overstayed and was working when, in 2006, she developed multiple myeloma. She developed kidney failure and was on dialysis in Wales when she was deported. Immigration officers escorted her back to Ghana, but the supposed plan for continued dialysis collapsed when Ms. Sumani was not able to make the required $5,000 deposit. The payment was made by a concerned individual in the UK, so three months of dialysis is now assured.

A Lancet editorial described the deportation as “an atrocious barbarism,” and chided medical leaders for not coming forward against it. In response, a petition signed by 276 GPs declared:

This would impose serious health risks on [undocumented migrants] and on the general public. It would also interfere with our ability to carry out our duties as doctors. It is not in keeping with the ethics of our profession to refuse to see any person who may be ill, particularly pregnant women with complications, sick children or men crippled by torture. No one would want such a doctor for their GP.

We call on the government to retreat from this foolish proposal, which would prevent doctors from investigating, prescribing for, or referring such patients on the NHS.

We pledge that, in the event this regulation comes into effect, we will: (a) continue to see and examine asylum seekers and to advise them about their health needs, whatever their immigration status; (b) document their diagnoses and required clinical care; (c) with suitable anonymisation and consent, copy this documentation to the responsible ministers, [members of parliament] and the press; (d) inform the public of the human costs, to harness popular disgust at what is being ordered by the government in their name; (e) campaign to speedily reverse these ill-advised policies.

The European Union is facing a real problem. Citizens of poorer countries, not surprisingly, are coming to EU countries in hope of receiving needed treatment that is not available at home. Others, like Ama Sumani, become ill after their [illegal] migration. As we are seeing in the U.S., there is a public backlash against undocumented migrants.

But we should cheer for the petition signers. Refusing to care for sick people – whatever their status – violates fundamental medical, and human, values. A policy that orders health professionals to abandon their historical commitment to provide care is not acceptable.


Anonymous said...

If the GPs are so concerned about caring for the individuals, perhaps they should offer to treat them for free.

Maybe they could all agree to devote one of their weekend days to provide free care to all migrants legal or illegal who require care.

Jim Sabin said...

Dear anonymous -

I agree with one part of your comment. IF the GPs were primarily complaining about not being paid, it would be quite correct to argue, as you do, that they could be expected to carry out acts of charity for the non-citizens.

But apart from the fact that the GPs were agitating about expulsion, not their payments, charity wouldn't be enough for patients like Ama Sumani. She needed dialysis and medications, not just office visits.

Since my original posting, she has died, in Ghana, on March 19. While a donor from the U.K. had paid for dialysis, her medication, thalidomide, was not available.

Thank you for addressing these issues.