Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France
Abstract Background France has long been a country of immigration and in some respects may be seen to have a generous policy with respect to asylum seekers and access to health care for migrants. The French state notably provides healthcare access for undocumented migrants, through state medical aid...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | BMC Medical Ethics |
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| Online Access: | http://link.springer.com/article/10.1186/s12910-020-00500-7 |
| _version_ | 1818925484320227328 |
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| author | Johann Cailhol Marie-Christine Lebon William Sherlaw |
| author_facet | Johann Cailhol Marie-Christine Lebon William Sherlaw |
| author_sort | Johann Cailhol |
| collection | DOAJ |
| description | Abstract Background France has long been a country of immigration and in some respects may be seen to have a generous policy with respect to asylum seekers and access to health care for migrants. The French state notably provides healthcare access for undocumented migrants, through state medical aid and since 1998 has had a humanitarian policy for granting temporary residence permits for medical reason (TRPMR) to migrants. Within a context of political debate, reform and tightening immigration control we will examine this latter policy focusing especially on the dilemmas that arise for physicians of migrant patients when they are requested to write medical certificates as part of a TRPMR application. In a 2017 reform the key role of making recommendations on the granting or not of permits was handed over to Ministry of the Interior health inspectors. Recommendations are made after perusal of medical certificates established by the migrant’s physician and complementary evidence. Main body The writing of medical certificates by a physician would seem straightforward. This is far from the case since it raises a number of ethical dilemmas. These occur within a physician-patient relationship embedded within a social contract between the State, the physician and the migrant patient. To clarify the ethical issues arising 3 vignettes based on practice within an infectious disease unit at a large Paris hospital have been developed. The vignettes highlight ethical dilemmas in the care for migrants with tuberculosis (dilemma in defining health and disease), chronic hepatitis (dilemma between beneficence and do not harm), and HIV / AIDS (issue of deservingness). We will go on to reflect on issues of social justice and responsibility for the health of migrants within a globalized world. Conclusions Criteria for residence permit delivery appear less than clear-cut and are interpreted in a restrictive way. Neither are the consequences of refusing a residence permit taken into account. We call for an empirical transnational ethics study involving countries implementing similar TRPMR policies. We also call for inclusion of lobbying competences into the medical undergraduate curricula, in order to breed future generations of physicians skilled in defending social justice. |
| first_indexed | 2024-12-20T02:41:57Z |
| format | Article |
| id | doaj.art-e57d861aee4a4e5fb08ce8a3236f301e |
| institution | Directory Open Access Journal |
| issn | 1472-6939 |
| language | English |
| last_indexed | 2024-12-20T02:41:57Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Ethics |
| spelling | doaj.art-e57d861aee4a4e5fb08ce8a3236f301e2022-12-21T19:56:17ZengBMCBMC Medical Ethics1472-69392020-07-0121111010.1186/s12910-020-00500-7Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in FranceJohann Cailhol0Marie-Christine Lebon1William Sherlaw2Laboratoire Educations et Pratiques de Santé, Université Paris 13Infectious diseases unit, Avicenne teaching hospital, APHPLaboratoire d’Etudes et de Recherche en Sociologie, Université de Bretagne OccidentaleAbstract Background France has long been a country of immigration and in some respects may be seen to have a generous policy with respect to asylum seekers and access to health care for migrants. The French state notably provides healthcare access for undocumented migrants, through state medical aid and since 1998 has had a humanitarian policy for granting temporary residence permits for medical reason (TRPMR) to migrants. Within a context of political debate, reform and tightening immigration control we will examine this latter policy focusing especially on the dilemmas that arise for physicians of migrant patients when they are requested to write medical certificates as part of a TRPMR application. In a 2017 reform the key role of making recommendations on the granting or not of permits was handed over to Ministry of the Interior health inspectors. Recommendations are made after perusal of medical certificates established by the migrant’s physician and complementary evidence. Main body The writing of medical certificates by a physician would seem straightforward. This is far from the case since it raises a number of ethical dilemmas. These occur within a physician-patient relationship embedded within a social contract between the State, the physician and the migrant patient. To clarify the ethical issues arising 3 vignettes based on practice within an infectious disease unit at a large Paris hospital have been developed. The vignettes highlight ethical dilemmas in the care for migrants with tuberculosis (dilemma in defining health and disease), chronic hepatitis (dilemma between beneficence and do not harm), and HIV / AIDS (issue of deservingness). We will go on to reflect on issues of social justice and responsibility for the health of migrants within a globalized world. Conclusions Criteria for residence permit delivery appear less than clear-cut and are interpreted in a restrictive way. Neither are the consequences of refusing a residence permit taken into account. We call for an empirical transnational ethics study involving countries implementing similar TRPMR policies. We also call for inclusion of lobbying competences into the medical undergraduate curricula, in order to breed future generations of physicians skilled in defending social justice.http://link.springer.com/article/10.1186/s12910-020-00500-7FranceIll-migrantsPhysiciansEthical dilemmaTemporary residence permit |
| spellingShingle | Johann Cailhol Marie-Christine Lebon William Sherlaw Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France BMC Medical Ethics France Ill-migrants Physicians Ethical dilemma Temporary residence permit |
| title | Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France |
| title_full | Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France |
| title_fullStr | Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France |
| title_full_unstemmed | Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France |
| title_short | Will my patients get their residence permit? A critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in France |
| title_sort | will my patients get their residence permit a critical analysis of the ethical dilemmas involved in writing medical certificates for residence permits in france |
| topic | France Ill-migrants Physicians Ethical dilemma Temporary residence permit |
| url | http://link.springer.com/article/10.1186/s12910-020-00500-7 |
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