Sunday, August 3, 2008

British GPs Demand Right to Treat Refugees

In January I wrote (here) about GP resistance to a proposed National Health Service directive that they not treat asylum seekers or undocumented migrants. I concluded:
[W]e 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.
Since then a British physician friend told me that many doctors are simply ignoring the NHS policy.

An article in today's Guardian reported that the Department of Health has not revealed the extent of advice it has received criticizing the policy. Typically these advisories are made public shortly after submission. The Global Health Advocacy Project obtained a list of those who had submitted comments and obtained most of the materials. (available here) Among these, the submission from Ken Livingstone, the former Mayor of London is especially interesting. Livingstone agrees that well-to-do foreigners who come to the U.K. to seek free NHS treatment can legitimately be charged for care, but argues that asylum seekers and undocumented migrants should be eligible on the basis of medical ethics and public health concerns.

The intersection of globalization and health care will create ever more ethical challenges. Developed countries are siphoning health professionals from poorer locations. In this situation, the rights of individual health professionals to pursue their own interests clash with the health needs of the home countries. Medical tourists from wealthy countries are travelling for care to all sectors of the globe. In that situation, their rights as individuals to seek care where they want it is distorting access to care in the countries they visit.

The British GPs are right in resisting the NHS policy. While it is understandable that local taxpayers, whether in the U.K., U.S., or elsewhere, are reluctant to subsidize care for foreigners, asking nurses, doctors, and others, to act as immigration police, risks undermining the integrity of our own health systems and health care.