The ethics of withholding healthcare is an important debate that as a society we should be having

Last month, The Guardian reported a story about an elderly lady, Elfreda, who died in pain after a London hospital withheld chemotherapy for almost a year. Without proper palliative care, Elfreda was left to manage her pain with just paracetamol and died following an emergency admission to hospital with sepsis. Her daughter, who bravely shared Elfreda’s story with The Guardian, said “I feel my mother died without dignity.”

Elfreda had been caught up in government’s latest measures to collect money from those deemed ineligible for free healthcare. Her story is heartbreaking—and far removed from the dignified death you would expect in a civilised and wealthy country—but it is not unique. Doctors of the World clinic in London sees cases like this day in-day out. The reason Elfreda’s story is in the press is because Elfreda has sadly passed away and her daughter, Barbara, is a British citizen and feels safe to speak out. They now have nothing to lose.

This is very different to most of Doctors of the World’s patients who are undocumented migrants or people who have been refused asylum. People living in constant fear of being detained, separated from family and loved ones, and possibly returned to an unsafe country. When these patients are denied lifesaving healthcare, they—and their friends and family—are usually too scared to speak out for fear of repercussions.

The hugely inflated charges that irregular migrants are required to pay in order to access NHS care are part of a broader “hostile environment” immigration policy—a series of administrative and legislative measures designed to make staying in the UK as difficult as possible for people without papers. Elfreda’s case highlights one of the key features of this policy: it is very effective at silencing those affected by it.  

This means that the case of a young person with a debilitating, palliative condition, sleeping on a night bus because they could not access a hospice, never made the news. Neither did the case of the person in their twenties with mouth cancer initially refused treatment despite his doctor’s recommendation to start chemotherapy without delay. Nor the case of a man who had chemotherapy withheld for eight months while the hospital argued that the treatment was not urgent.

The government has introduced a range of measures that restrict access to healthcare for people who have been refused asylum and undocumented migrants, most notably an “upfront charging” system by which non-urgent treatment is withheld pending payment in full. This was the justification for withholding Elfreda’s treatment. Doctors of the World is also seeing hospital trusts struggling to apply the complex regulations, incorrectly withholding treatment that, under government guidance, should have been provided.

As these policies are pushed through, the ethics of withholding healthcare is an important debate that as a society we should be having. It is raising questions of human rights, dignity, and social justice. But our ability as a society to properly discuss this moral and ethically loaded topic is severely restricted when the stories and experiences of those personally affected are suppressed by the hostile environment.

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Anna Miller is a policy and advocacy manager at Doctors of the World.

Competing interests: None declared