Dialysis, Immigration, and U.S. Law

Since 2007, I've written a series of posts about safety net care issues - most notably, the problem of providing dialysis to undocumented persons.

This week's New England Journal of Medicine has an article from Baylor in Houston describing in some detail what happens when the undocumented are blocked from having scheduled dialysis and rely on emergency room treatment. It's a classical lose/lose situation. The patients suffer, the taxpayers pay more than would be required for "regular" treatment, and the physicians providing care are distressed by the substandard care they are forced to provide.

The authors are not naive. Here's how they pose the basic problem for clinical care, public policy and ethics:

This issue lies at the intersection of debates over the soaring cost of health care and the need for immigration reform. Do we have an ethical duty to provide the same standard of care for all sick patients within our borders? Or would mandating the provision of health care (and of maintenance-dialysis treatments) create an incentive for illegal immigration and worsen the current situation?

There's no easy answer. But we're better off for facing the problem squarely. Thanks to Drs. Rajeev Raghavan and Ricardo Nuila for helping us do that!