Education And Debate Ethics in practice

Eligibility of overseas visitors and people of uncertain residential status for NHS treatment

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7461.346 (Published 05 August 2004) Cite this as: BMJ 2004;329:346
  1. Andrew J Pollard (andrew.pollard@paediatrics.oxford.ac.uk), senior lecturer in paediatric infectious diseases1,
  2. Julian Savulescu, director2
  1. 1 Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU
  2. 2 Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford OX1 1PT
  1. Correspondence to: A J Pollard

    Current UK regulations deny free treatment for HIV to illegal immigrants and failed asylum seekers. Is this policy resulting in unjustifiable harm to infants who are born to infected mothers?

    Introduction

    A pregnant woman from Africa who has been in the United Kingdom for six months is found to be HIV positive on antenatal screening performed by her general practitioner. Testing by an HIV physician shows that she has a high viral load. The physician plans to start antiretroviral therapy to reduce the risk of transmission of HIV to the fetus. In the meantime, the woman attends the hospital antenatal clinic and is asked to prove her eligibility for treatment. She is unable to provide her passport and is then denied access to the consultant. The woman defaults from further follow up by HIV or obstetric services.

    The issues

    Although fictional, this case reflects cases that have occurred recently. Do doctors who discover a pregnant woman is infected with HIV have a duty to provide antiretroviral treatment, without seeking to determine her right to reside in the United Kingdom, when intentionally denying therapy would allow as many as one in three babies to be born with HIV?

    More generally, what are the rights to free NHS treatment of overseas visitors and people of indeterminate residential status? This is the subject of a current Department of Health consultation,1 which proposes further restricting access of “overseas visitors” to NHS care. We argue that, far from restricting care, we should provide access to free NHS care for overseas visitors and people of uncertain residential status.

    Background considerations

    Asylum situation

    In 2002, there were 84 130 applications for asylum in the United Kingdom, but only 10% of requests were granted.2 3 Asylum seekers come to the United Kingdom to escape adverse economic, cultural, or social circumstances or because of …

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