Good Sanctuary Doctoring for Undocumented Patients

Kuczewski, Mark G.; Mejias-Beck, Johana; Blair, Amy

doi:10.1001/amajethics.2019.78

Cited by 13 publications

(5 citation statements)

References 7 publications

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“…The range of policies and actions described in this study highlights the ways in which health care facilities can implement both active and reactive measures that address risks to the health of immigrants. Previously discussed efforts to improve the health of these patients after the 2016 presidential election have focused on individual patient-practitioner communication or policy changes at the federal or state level. However, these approaches did not capture the role of health care facilities and the health systems in which they are embedded.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

et al. 2020

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IMPORTANCE Increases in the enforcement of immigration policies, deportations, and rhetoric critical of immigration during and after the 2016 US presidential election have been associated with a decrease in health-seeking behaviors and an increase in adverse health outcomes among immigrants. Efforts to address the health care needs of immigrants after the 2016 presidential election have centered on individual-level patient-practitioner strategies or federal-and state-level policy changes. However, these approaches have not captured the role of health care systems and the range of health care facilities encompassed within them.OBJECTIVE To characterize policies and actions implemented by health care facilities to address immigration status-related stressors. DESIGN, SETTING, AND PARTICIPANTSThis exploratory qualitative study involved semistructured interviews in a purposive sample of health care facilities across 5 states (California, Texas, New York, Florida, and Illinois) with the largest populations of individuals with undocumented immigration status. Data from media sources and informational interviews with local immigration advocacy leaders were used to identify health care facilities that had implemented welcoming policies and strategies. Stakeholders, including administrators, frontline clinicians involved in policy implementation, and senior executive leaders, were interviewed. Interviews were conducted between May 1 and August 9, 2018, and were recorded, transcribed, and coded using constant comparative analysis. Data analysis was performed from MAIN OUTCOMES AND MEASURES Stakeholder perspectives on the range, scope and content of policies and actions implemented to address immigration-related stressors at health care facilities.RESULTS A total of 38 in-depth interviews were conducted spanning 25 health care facilities in 5 states; these facilities included 13 federally qualified health centers, 7 academic or private hospitals, and 5 public institutions. Interviewees described policies and actions that mitigated one or more of the following perceived risks: (1) risk of exposure to immigration enforcement personnel at or near facilities, (2) risk of immigration status-related information disclosure, (3) risk associated with patient-level stressors, (4) risk associated with practitioner-level stressors, and (5) coordination of risk mitigation. Most personnel at health care facilities emphasized that their policies and actions fit within a larger mission and history of addressing the social needs of diverse patients and mitigating risks for patients. CONCLUSIONS AND RELEVANCEHealth care facilities can implement both active and reactive measures to address perceived immigration-associated risks among patients and practitioners.Population health and immigration policies are at the forefront of current policy debates. An (continued) Abstract (continued) understanding of the ways in which health care facilities can serve to mitigate perceived risks among their patients and employees can be one step toward ...

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Section: Discussionmentioning

confidence: 99%

Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

et al. 2020

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“…Resources to these medical-legal partnerships and information about legal rights could also be incorporated into the After Visit Summary paperwork that is handed to every patient before discharge from the clinic or ED. At a time when Latino patients feel stress around their immigration status, physicians can play an important role and offer resources to provide emotional support to their patients and immigrant parents [41].…”

Section: Discussionmentioning

confidence: 99%

Opportunities for Supporting Latino Immigrants in Emergency and Ambulatory Care Settings

2020

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Toughened immigration policies exacerbate barriers to public benefits and health care for immigrants. The objective of this study is to examine the impact of the immigration climate on the utilization of pediatric emergency and ambulatory care services and elucidate ways to best support Latino immigrant families. This is a cross-sectional study involving surveys and interviews with Latino parents (≥ 18 years) in the pediatric emergency department. Forty-five parents completed surveys and 40 were interviewed. We identified two themes on health care utilization: fear of detention and deportation in health care settings, and barriers to pediatric primary care; and two themes on how pediatric providers can best support Latinos: information and guidance on immigration policies, and reassurance and safety during visits. Despite immigration fears, Latino parents continue to seek health care for their children. This highlights the unique access that pediatric providers have to this vulnerable population to address immigration fears and establish trust in the health care system. Health care providers are also perceived as trusted figures from whom Latino families want more information on the latest immigration policies, immigration resources, and education on legal rights during medical visits.

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“…Medical professionals have faced increasing expectations of competencies related to engaging with social, cultural, and structural features of everyday life that directly or indirectly bear on their patients’ health. For instance, doctors are urged to adopt guidelines for “sanctuary doctoring,” learning about immigration law enforcement practices and how to care for immigrant patients such that the patient care process minimizes patients’ exposure to adverse law enforcement contact (such as avoiding recording immigration status in electronic health records) 89 . Meanwhile, variations on “structural competency” curricula are gaining traction in U.S. medical schools, 90 offering a framework for teaching the impacts of social structures in patient health disparities and offering guidance on how to help patients accordingly.…”

Section: The Need For Bioethics Engagementmentioning

confidence: 99%

“…For instance, doctors are urged to adopt guidelines for "sanctuary doctoring," learning about immigration law enforcement practices and how to care for immigrant patients such that the patient care process minimizes patients' exposure to adverse law enforcement contact (such as avoiding recording immigration status in electronic health records). 89 Meanwhile, variations on "structural competency" curricula are gaining traction in U.S. medical schools, 90 offering a framework for teaching the impacts of social structures in patient health disparities and offering guidance on how to help patients accordingly. Racially inequitable policing is one of the structural factors highlighted in template curricular materials.…”

Section: The Need For Bioethics Engagementmentioning

confidence: 99%

Fifty Years of U.S. Mass Incarceration and What It Means for Bioethics

Valles

2023

Hastings Center Report

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A growing body of literature has engaged with mass incarceration as a public health problem. This article reviews some of that literature, illustrating why and how bioethicists can and should engage with the problem of mass incarceration as a remediable cause of health inequities. “Mass incarceration” refers to a phenomenon that emerged in the United States fifty years ago: imprisoning a vastly larger proportion of the population than peer countries do, with a greatly disproportionate number of incarcerated people being members of marginalized racial and ethnic groups. Bioethicists have long engaged with questions of health justice for incarcerated people, including consent issues for those participating in research and access to health care. This article provides an overview of the individual and public health impacts of mass incarceration. The article argues that mass incarceration is a bioethics issue that should be addressed in medical education, identifies opportunities for bioethicists to guide hospitals’ interactions with law enforcement officials, and calls on bioethicists to be in conversation with medical and nursing students and health care professionals about these groups’ advocacy efforts concerning structural racism, police violence, and mass incarceration.

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Good Sanctuary Doctoring for Undocumented Patients

Cited by 13 publications

References 7 publications

Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States

Opportunities for Supporting Latino Immigrants in Emergency and Ambulatory Care Settings

Fifty Years of U.S. Mass Incarceration and What It Means for Bioethics

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