{"id":94,"date":"2009-03-31T15:00:24","date_gmt":"2009-03-31T14:00:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=94"},"modified":"2009-04-01T09:11:11","modified_gmt":"2009-04-01T08:11:11","slug":"failed-asylum-seekers-and-the-nhs","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2009\/03\/31\/failed-asylum-seekers-and-the-nhs\/","title":{"rendered":"Failed Asylum Seekers and the NHS"},"content":{"rendered":"

The Court of Appeal has ruled today (Monday) that those who have not resided lawfully in the UK for at least a year are not entitled to receive free health service treatment<\/a>.<\/p>\n

Lord Justice Ward said: “Failed asylum seekers ought not to be here.\u00a0 They should never have come here in the first place and after their claims have finally been dismissed they are only here until arrangements can be made to secure their return.\u00a0 In some cases, like the unfortunate YA, that return may be a long way off. The result may be most unfortunate for those in ill-health like YA for they may now be at the mercy of the hospitals’ discretion whether to treat them or not.”<\/p><\/blockquote>\n

Righty-ho.\u00a0 I just have a couple of queries before I accept that.\u00a0In the first place, by what standard ought failed asylum seekers not be here?\u00a0 Because a lot of them are here simply because they haven’t yet left (if you get my drift), and they obviously weren’t failed asylum seekers when they arrived.\u00a0 So, while they’re waiting to get back to their poverty and fear<\/span> the land of milk and honey that they inexplicably left,\u00a0the fact that they’re in the country has less to do with them than with us and our inefficiency.\u00a0 And that seems like a poor reason to deny someone healthcare – and yet this seems to be at the core of Ward’s reasoning.\u00a0<\/p>\n

Second, his use of the words “ought” and “should” is curious, since – as I hinted just now – it seems to indicate that the permissibility of their coming here is something that depends upon whether their application was successful.\u00a0 That’s very strange, not least because it gives those who’re supposed to decide on asylum applications godlike powers to determine the validity of an application by fiat.<\/p>\n

It’s also a red herring when it comes to NHS treatment.\u00a0 Imagine that, one night, someone tries to mug you.\u00a0 However, it’s icy, and your would-be assailant slips and cuts himslef badly.\u00a0 One would hope that someone – if not you, then some representative of the society to which you belong – would call for medical help.\u00a0 Of course, he should not have been doing what he was doing – attempting to nick your wallet – and he would not be injured but for the attempt.\u00a0 But that’s quite aside from the fact that he needs help now; and we can do something about his criminality later.\u00a0 Something like that seems to apply to asylum seekers – even if we concede to the red-faced little Englander that they should not be here, it’s not obvious what this has to do with their entitlements in time of need.<\/p>\n

What of those putative entitlements, though?\u00a0 Here, Ward is interesting – because it strikes me as plausible to say that even if someone has no right<\/em> to treatment, we still have a duty to provide it.\u00a0 To see why, consider the case of the needy newborn.\u00a0 It’s hard to see why a “native” newborn would have any rights that are not possessed by an immigrant.\u00a0 It certainly won’t have earned its keep, so any rights it does have are either based on the fact that it’s human (which is a status shared by the immigrant) or native (which, absent any further explanation, strikes me as a morally flimsy, not to say question-begging,\u00a0sort of predicate).\u00a0 Indeed, the immigrant’ll probably earn his keep a lot sooner than a sick child – and, of course, the immigrant wants<\/em> to be here, unlike the baby, who’s a citizen simply by virtue of the geographical location of someone else’s genitalia.<\/p>\n

Where was I?\u00a0 Oh, yes.\u00a0 The point is that treating the baby seems to have more to do with our duties to it (qua<\/em> someone in need, or whatever) than with its rights – or else to do with some account of virtue on our part (which amounts to the same sort of thing in this context).\u00a0 And, if that goes through, then the same applies to the immigrant, legal or not.<\/p>\n

Call me a misty-eyed cosmopolitan if you want – why, yes… yes I am – but even if a person has no right<\/em> to NHS treatment, I do tend to think that, where possible, we ought to provide it; or, at the very least, we may still have a good moral reason to do so.\u00a0 I’ve argued for this (badly) elsewhere, so won’t rehearse the point here.\u00a0 Of course – there might be a pragmatic problem with health tourism.\u00a0 But that simply seems to speak to the scope of our duties: they’re much wider than we might expect, and they sure as Hell don’t stop at the nearest customs post.\u00a0 (There’s nothing startlingly original about that thought: it’s the sort of claim that Peters Singer and Unger have been making for ages.)\u00a0 But bear this in mind, too: people don’t migrate unless they feel they have to.\u00a0 It’s a lot of hassle.\u00a0 The ill are even less likely to do so.\u00a0 So I wonder wheather health tourism really is likely to be as big a problem as all that – and, if it is, then there would seem to be at least some reason to spend a lot more on foreign aid so that people don’t feel they have to migrate.\u00a0 That would seem to be the decent thing.<\/p>\n

One other thing:<\/strong>\u00a0 There was a time when the NHS’ website proclaimed that healthcare was a basic human right.\u00a0 That would obviously fly in the face of this ruling – and, anyway, that’s not what it says now.<\/p>\n

What it does say<\/a> is that<\/p>\n

The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. At its launch by the then minister of health, Aneurin Bevan, on July 5 1948, it had at its heart three core principles:<\/p>\n

– that it meet the needs of everyone,<\/p>\n

– that it be free at the point of delivery, and<\/p>\n

– that it be based on clinical need, not ability to pay.<\/p>\n

These three principles have guided the development of the NHS over more than half a century and remain. However, in July 2000, a full-scale modernisation programme was launched and new principles added.<\/p><\/blockquote>\n

There’s nothing in the original statement about providing health care to those who’re in the country legally, regardless of wealth.\u00a0 Rather, the thought seems to be that healthcare should be available to all, and here we are doing our bit to realise that ideal.\u00a0 Neither does adding new principles in the last decade do anything to militate against that.\u00a0 That is to say: even the NHS thinks that Ward is wrong.<\/p>\n

\u00a0<\/p>\n

Sorry.\u00a0 I do seem to have gone off on one.\u00a0 Again.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

The Court of Appeal has ruled today (Monday) that those who have not resided lawfully in the UK for at least a year are not entitled to receive free health service treatment. Lord Justice Ward said: “Failed asylum seekers ought not to be here.\u00a0 They should never have come here in the first place and […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[511,475],"tags":[],"class_list":["post-94","post","type-post","status-publish","format-standard","hentry","category-in-the-news","category-politics"],"yoast_head":"\nFailed Asylum Seekers and the NHS - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2009\/03\/31\/failed-asylum-seekers-and-the-nhs\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Failed Asylum Seekers and the NHS - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"The Court of Appeal has ruled today (Monday) that those who have not resided lawfully in the UK for at least a year are not entitled to receive free health service treatment. 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