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OBSERVATIONS: Iona Heath "A modest thoughtfulness" BMJ 2008; 336: 535 [Full text]

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Medical Justice for Undocumented Migrants

Frank W Arnold   (9 March 2008)

Impractical and unjust

Duncan AH Edwards   (11 March 2008)

Medical Justice for Undocumented Migrants 9 March 2008
Frank W Arnold, Independent doctor 14 College Road, Reading RG6 1QB Send response to journal: Re: Medical Justice for Undocumented Migrants	Conflicts between our professional duties and the orders of the state can bring out the best and the worst in doctors. Until recently these challenges have been mercifully rare in UK practice. Indeed, doctors have usually had to travel overseas to fulfill ambitions to practice human rights medicine. No longer. As Dr Iona Heath points out with alarming precision (1) the government has foisted a serious ethical conflict upon us, regarding the secondary care of undocumented migrants and are planning to extend this to primary care. Existing secondary care restrictions have already contributed to avoidable deaths (for a recent example, see reference 2). There is no evidence that they have saved money, except perhaps by deterring people who are still entitled to care from seeking it. Removal of the right of GPs to register “failed” asylum seekers will extend the damage to individual and public health and the ethos of our profession. These steps will not produce economies or make these patients “go home”, even though government openly intends to use denial of care to coerce their involuntary departure. They will require doctors to act as immigration police. If the state forbids us to investigate, treat and refer certain patients on public funds, we can still examine, document and advise about their medical conditions. We can also inform Ministers and the public of the consequences of these policies. That is the commitment made by over 600 doctors who have signed the petition, Medical Justice for Undocumented Migrants (3). The petition is still open to signatures, and a form letter to document and publicise the consequence of denial of care(4)is available online. Our actions are completely lawful but are unlikely to find favour with our masters. They may also lead to retribution (see competing interests). Many of us believe that the BMA (and the General Medical Council and Royal Colleges) have an obligation to offer practical guidance and protection to doctors who put their duties to patients ahead of government blandishments, and that these bodies have not yet fulfilled it. It would also help if the BMJ could – as a service to evidence based policy making – accept, collate and publish analyses of the consequences of these immodest and thoughtless policies. References: 1) Heath I. “A modest thoughtfulness.” British Medical Journal 2008; 336:535 2) Hospital defends treatment in asylum seeker death. Steven Morris, Eric Allison http://www.guardian.co.uk/society/2008/feb/13/nhs.immigrationandpublicservices 3) http://www.gopetition.co.uk/petitions/medical-justice-for-asylum- seekers.html 4) “Documenting medical neglect” Only to be used with informed consent or suitable anonymisation. Available at: http://www.medicaljustice.org.uk/content/view/319/100/. Competing interests: FWA was reported to the GMC for providing potentially life-saving medical advice to three “failed” asylum seekers on hunger striker in an immigration detention centre, by the managers of that centre. The GMC eventually held that doing so does not violate the duties of a doctor. These patients made a good recovery and were released from detention because of legitimate appeals against the original judicial decisions that labeled them as “failed”.
Impractical and unjust 11 March 2008
Duncan AH Edwards, GP Registrar Cambridge Send response to journal: Re: Impractical and unjust	No matter where you stand on immigration, I find it hard to see how denying primary care to a person can be compatabile with being a doctor. Credit to Iona Heath, and also Frank Arnold, for highlighting this looming injustice. Fairly recently, a politician also highlighted that a policy of excluding "illegals" is as impractical as it is unjust: “One of the consequences of the universality of the British Health Service is the free treatment of foreign visitors. This has given rise to a great deal of criticism, most of it ill-informed and some of it deliberately mischievous. Why should people come to Britain and enjoy the benefits of the free Health Service when they do not subscribe to the national revenues? So the argument goes. No doubt a little of this objection is still based on the confusion about contributions to which I have referred. The fact is, of course, that visitors to Britain subscribe to the national revenues as soon as they start consuming certain commodities, drink and tobacco for example, and entertainment. They make no direct contribution to the cost of the Health Service any more than does a British citizen. However, there are a number of more potent reasons why it would be unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody. Happily, this is one of those occasions when generosity and convenience march together.” (Aneurin Bevan, 1952) Competing interests: None declared