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A Future for Migrants with Acute Heart Problems Seeking Asylum?

Published online by Cambridge University Press:  25 March 2021

GÖRAN HERMERÉN
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Abstract

This paper discusses the future of migrants with acute heart problems and without permanent permission to remain in the country where they are seeking asylum. What does the country they have traveled to owe them? Specifically, what healthcare services are they entitled to? This may seem a niche problem, but numbers of migrants with acute heart problems could increase in the future. Besides, similar problems could be raised by, for instance, traumatized migrants with acute needs for healthcare services for other serious conditions. The paper identifies the issues and some positions on them. Arguments for and against these positions are explored. This particular set of problems in healthcare ethics creates several challenges, at both national and international levels, concerning access to transplantation, public willingness to donate organs, optimal use of organs, justice and fairness, and potential conflicts of law, politics and ethics, as well as issues revolving around interaction and communication (or lack of it) between agencies and professions.

Keywords

migrantsheart transplantationethicspoliticscross-border healthcarerights of asylum seekersIstanbul declarationGeneva declarationhealthcare need
Type
Special Section: Decision Making and Leadership in Crises and Beyond
Information
Cambridge Quarterly of Healthcare Ethics , Volume 30 , Issue 2 , April 2021 , pp. 297 - 311
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Acknowledgment: I want to thank my colleague Nils-Eric Sahlin for helpful comments on an earlier version and cardiologist Björn Kornhall for information about some patient cases involving migrants in acute need of heart transplantation. The paper was originally to be presented at a symposium honoring Professor Inez de Beaufort in connection with her farewell lecture at the Erasmus Medical Center, Rotterdam. However, owing to the Covid-19 pandemic the symposium was cancelled.

References

Notes

1. Justin M Bachmann, Ashish S Shah, Meredith S Duncan, Robert A Greevy Jr, Amy J Graves, Shenghua Ni, et al. Freiberg Cardiac rehabilitation and readmissions after heart transplantation. Journal of Heart and Lung Transplantation 2018;37(4):467–76. doi:10.1016/j.healun.2017.05.017.

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3. French Intensive Care Society, International congress—Réanimation 2016. Annals of Intensive Care 2016;6(Suppl 1):50. doi:10.1186/s13613-016-0114-z.

4. Ángela López-Sainz, Eduardo Barge-Caballero, Gonzalo Barge-Caballero, David Couto-Mallón, María J Paniagua-Martin, Leticia Seoane-Quiroga, et al. Late graft failure in heart transplant recipients: Incidence, risk factors and clinical outcomes. European Journal of Heart Failure 2018;20(2):385–94. doi:10.1002/ejhf.886.Lund HM. Optimizing outcomes after heart transplatation. European Journal of Heart Failure 2018;20(2):395–7. doi:10.1002/ejhf.1026.

5. Council of Europe. The Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine. Strasbourg; 1997 (ETS No 164).

6. European Union. Directive 2011/24/EU on patients’ rights in cross-border healthcare.

7. See e. g., Beyleveld D, Brownsword R. Human Dignity in Bioethics and Biolaw. Oxford: Oxford University Press; 2001.; Macklin R. Dignity is a useless concept. British Medical Journal 2003;327:1419.; Killmister S. Dignity: Not such a useless concept. Journal of Medical Ethics 2010;36:160–4.; McCrudden C, ed. Understanding Human Dignity. Oxford: Oxford University Press; 2013.; Foster C. Human dignity: Be philosophical and European, but not Scottish. Cambridge Quarterly of Health Care Ethics 2019;28(3):534–41.

8. The locus classicus of this fallacy is Moore GE. Principia Ethica. Cambridge University Press; 1903. For later discussion of it, see e.g., the contributions of Frankena, Paton, Edel, McKeon, as well as Moore’s replies, in The Philosophy of G. E. Moore, Schilpp PA, ed. New York: Tudor; 1952.

9. WMA Declaration of Geneva. Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948, amended and revised several times subsequently.

10. European Union. Directive 2011/24/EU on patients’ rights in cross-border healthcare. chap 1, article 1.

11. The declaration of Istanbul on organ trafficking and transplant tourism. Clinical Journal of the American Society of Nephrology 2008;3(5):1227–31. doi:10.2215/CJN.03320708.

12. Council of Europe. The Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No 164).