Accessing health care resources in the United States often proves to be a difficult task for vulnerable populations. Immigrants, in particular, face barriers and difficulties in obtaining continuous medical care, which negatively impacts both patients and clinicians. The AMA Code of Medical Ethics offers guidance on how physicians and health care systems can best support undocumented and lawfully present immigrants alike to promote the best possible care for all who need it. Health-Related Challenges Facing Vulnerable Immigrant Populations Undocumented and lawfully present immigrants alike regularly find themselves in difficult financial and social situations that complicate access to the US health care system. These groups consist of an estimated 23 million persons, representing a large (7%) and largely underserved portion of the total US population. 1 The considerable social, institutional, and personal barriers to obtaining health care might exacerbate preexisting health conditions and rule out typical treatment plans, forcing immigrants without access to safety net clinics to seek care in already-strained emergency facilities. 2 Providing sanctuary doctoring, which focuses on meeting the medical and social needs of undocumented immigrants, 3 is supported by a number of American Medical Association (AMA) opinions and policies. These guidelines speak to the general concept of health care as well as the care of specific populations including refugees, asylees, victims of human trafficking, and other categories of both undocumented and documented immigrants.
The AMA Code of Medical Ethics offers guidance on topics related to prescription drugs, including access, stewardship, and professionalism. Physicians' traditional role as stewards of limited health care resources is being reinterpreted in terms of their relationships with key players in the health care sector. While physicians still assess risks and benefits when prescribing medications for patients, rising drug prices, 1 formulary restrictions, and quantity limitations 2 introduce new complications to stewardship decisions. Physicians must not only prescribe clinically appropriate treatments but also coordinate 3 and advocate 4 for patients' access to needed interventions. Additionally, multidisciplinary care teams, necessitated in part by an expanding pharmacopeia and growing demands for access to quality health care, introduce new fields of expertise to clinical encounters. The American Medical Association (AMA) Code of Medical Ethics offers guidance to physicians making care plans with colleagues and offering treatment recommendations to patients that are relevant to physicians' stewardship role. Availability of services and benefits covered by patients' insurance plans, for example, can influence clinical judgment. 5 Opinion 11.2.1, "Professionalism in Health Care Systems," states: Structures that influence where and by whom care is delivered-such as accountable care organizations, group practices, health maintenance organizations, and other entities that may emerge in the future-can affect patients' choices, the patient-physician relationship, and physicians' relationships with fellow health care professionals. 6
New and emerging life-extension technologies require careful consideration of ethical implications related to resource scarcity and justice, prompting an analysis of what, if anything, is intrinsic to experiences we define as human. Furthermore, extended lifespans suggest the importance of reinterpreting traditional roles of health care professionals as the needs of patients, communities, and clinicians shift.
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