Historically, conditions for immigrants in the United States have not been problematic. It is mainly due to various social restrictions and pressures. The latter were exerted on immigrants by privileged and powerful groups of citizens, whose interests were largely violated by the arrival of people from other countries who wanted to live and work permanently. The situation has improved over time, and social groups arriving from abroad feel more secure and confident. However, there are still individual cases in which the interests of those in power clash with individual needs, provoking a social contradiction that seems intractable. At the level of young people, the situation is particularly difficult with undocumented immigrants, whose rights in receiving medical care are greatly restricted. Social workers must strive to ensure that people are informed about their legal status within medical care in the United States, to encourage the effective cooperation of doctors, and to guarantee the protection of the right to freedom of religion.
An irregular migrant is a person who has crossed the state border or who is in the country without official permission. Illegal migrants also include people who have officially crossed the state border, but are currently in an irregular situation including refugees awaiting deportation and denied asylum. If migrants has arrived in a state legally, are staying on its territory legally, but are engaged in illegal activities, they are also considered an illegal migrant (Abramitzky & Boustan, 2022). Depending on their status, foreign nationals have the opportunity to take advantage of certain types of medical and social assistance. The scope and procedure of medical care for foreigners depends on their labor and legal status.
The problem of the status of migrant workers in national health care systems is relevant worldwide. Academic approaches focus mainly on the problem of access of migrants’ access to health care and health conditions in the context of human rights. Research has focused on two main areas in which it is possible to manifest, the latter include inequality – the prevalence of disease among migrants and access to health care.
A weak link in the fight against illegal labor migration in the United States is the failure to grant labor rights to illegal workers. They refuse to petition the courts or to be a party to the process. Moreover, U.S. Supreme Court jurisprudence, an illegal migrant found in unauthorized employment in the United States does not have the right to recover wages as well as other payments and benefits. The employer has no right to recover wages or any of the benefits provided by the employer to legal workers. Research in recent years confirms that violations of labor law standards of labor law standards against unauthorized migrants negates sanctions measures against employers.
The tougher sanctions and higher fines do not have a long term effect unless illegal workers and their employers are interested in breaking the “vicious circle. Increased sanctions, higher fines
The losses incurred can always be recovered through a new wave of disenfranchised unauthorized migrants.
For immigrants, barriers to accessing health care pose a complex problem. Major health risks and access problems exist for a diverse group, including newly arrived immigrants as well as incarcerated and undocumented immigrants. In addition, there are many challenges to health care delivery in a multicultural environment. Some of these can be very acute for immigrants who have stayed in the host country for a period of time. Some of these problems are similar to those faced by long-established ethnic minorities, and these may include: lack of knowledge about available services; language differences; and cultural attitudes toward health and health care in general.
Analysis of access problems for different immigrant groups is complicated by a lack of information about their health status, needs, and access to health services. The difficulty in defining a person as an immigrant in administrative documents complicates the collection of data on the epidemiological situation in terms of prevalence and morbidity. Epidemiological data from several countries indicate that large groups of immigrants have poorer health outcomes than natives. Health problems often overlap with deprivation and poor living conditions. Attention must also be paid to the link between poverty, ill health, and lack of access to health care.
Globally, the number of publications on the health of migrants has recently increased significantly. The problems of reproductive health, tuberculosis, mental health, accessibility of primary of medical care, alcohol, drug and tobacco use. Studying the health of migrants is one of the leading areas of work of the Intergovernmental International Organization for Migration. Currently, each state has its own regulations and rules for organizing the health insurance system, and as a result, there are significant deductibles for state health insurance programs. Among the insured population, 64% are insured at the expense of employers, 27% of citizens are insured by state programs Medicare or Medicaid, and 9% purchase it on their own (Abramitzky & Boustan, 2022). In the U.S., the health insurance system is largely fragmented, as medical care is provided by several companies without any coordination.
With the creation of the Accountable Care Organizations model, it is planned to overcome the disintegration of health care delivery processes, and to reduce the costs of health care for migrants and the population. The idea of the model is that individual medical organizations, clinics, hospitals or centers and private physicians in the interest of forming an integrated structure of effective management, focused on the patient are united on a voluntary basis (Aleinikoff et al., 2020). The plan is to create an electronic health record for each patient, with each member physician creating a record on a per-patient basis, which greatly reduces time and labor costs.
Part of the solution to reducing barriers to accessing health care for immigrants will be to increase the level of the supply chain strategy. Health care providers should strive to address the specifics of health care demand among immigrants and provide more loyal services. This may include raising awareness of services, providing translation/interpretation, promoting cultural services, being welcoming, and combating discrimination. It is also necessary to analyze the economic factors by which access to health services will be ensured. In order to improve the situation related to accessibility of health care and social support, it is necessary to:
- develop a system for providing immigrants with medical and legal information; develop a scheme for including immigrants in the health care system;
- establish a system of mandatory health insurance for immigrants through bilateral agreements with immigrant countries of origin (Kennedy, 2018).
While from an organizational and economic point of view the actions of health workers are defined, the ethical problem of this field remains unexplored. The task of social workers comes down to taking into account the cultural specificities of the lives of foreign citizens. The relevance of certain medical services depends greatly on people’s perceptions of the permissibility of certain interventions (Prieto, 2020). The Halakha of Judaism makes a clear distinction between active and passive interventions, and consequently sees the difference between abstaining from life-sustaining treatment and abolishing it. The Halakha does not prevent the anesthesia of a suffering person, nor does it permit hastening the onset of a sick person’s death. However, moral principles, to alleviate pain and suffering, are placed above the possible shortening of a patient’s life from drugs. Therefore, the use of double-effect methods in medical practice including is viewed positively.
Replacing one form of therapy with another is considered in Judaism to be a completely new treatment, rather than a continuation of the process, and thus one can be turned away from it, which is equivalent to religiously permitted abstinence from treatment. If the permanent form of treatment is respiratory therapy, its withdrawal is forbidden because it brings death closer. But if it involves prolonged suffering, the halakhah permits the permanent process to be replaced by an intermittent one, again the principle applies: not refusal, but abstinence.
In the teachings of Buddhism there is no moral obligation to fight for life by any means and no clear view of the nature of the decisions to be made in the case of the patient’s persistent vegetative state. Artificial maintenance of life is not necessary, pain relief and “double effect” are allowed (Coleman, 2021). At the same time, the use of techniques or drugs that artificially alter consciousness is discouraged, as it is considered important to meet death with a clear conscience.
Moral and ethical principles of medicine presuppose providing medical care to all victims in accordance with the aesculapian competence. This is where the conflict between the humanitarian principles of medicine and the individual’s right to religious freedom can arise (Kennedy, 2018). This is due to the fact that virtually all religions impose restrictions on the scope of medical and paramedical interventions. It is obvious when the situation is not an emergency and it is possible to ask the patient to what extent the doctor’s proposed treatments are permissible in terms of the individual’s religious beliefs. However, in situations, such as an emergency, there is no such opportunity.
If the physician has made the right decision, then the medical treatment provided in an emergency may benefit the patient’s body. But if, for some reason, the measures taken have resulted in the infringement of religious sensibilities, then the question becomes open: to what extent is one of the fundamental precepts of medicine “do no harm” respected? That is, such medical care can have a negative impact on the psychological sphere of the individual. Medical care in emergency situations is aimed at the benefit of society as a whole and should help to reduce the number of human casualties. To this end, medical triage of victims is organized, appropriate care is provided in stages, and anti-epidemic measures are taken.
In this context, the function of the social worker will be to monitor the protection of two basic rights of the immigrant, including the right to medical care and freedom of religion. A key task is to ensure that the particularities of the perception of medical care, which are assumed to be culturally and religiously based, are taken into account. In non-emergency situations, it is necessary to bring the doctor and the foreign citizen to a consensus that will preserve the maximum level of social protection of the person.
Providing medical care on the basis of the doctor’s competence, without regard for the individual’s religious beliefs, can lead to a violation of at least the first three ethical principles. In other words, there is an open question about the permissibility and scope of emergency medical care if there is a possibility of violating the ethical principles of medicine. When emergency medical care is properly organized, it is possible to fully comply with the four basic rules of medical ethics: truthfulness, confidentiality, privacy, and voluntary informed consent (Coleman, 2021). However, this does not remove the issue of the admissibility of medical care in emergency situations.
Thus, when considering the problems of the social minority of migrants, in particular irregular migrants, social workers need to focus their work on three areas. It is important to monitor the implementation of existing programs to provide health insurance and therapy to vulnerable immigrant populations, to ensure the most effective interaction between medical professionals. Another important mission is to see to it that immigrants’ right to religious freedom is guaranteed in situations where the need for therapy conflicts with religious or cultural principles. Finally, it is the task of the social worker to ensure that the social minority is properly informed about the programs and rights provided.
References
Abramitzky, R., & Boustan, L. (2022). Streets of gold: America’s untold story of immigrant success. PublicAffairs.
Aleinikoff, T., Martin, D., Motomura, H., Fullerton, M., Stumpf, J., & Gulasekaram, P. (2020). Immigration and citizenship: Process and policy (9th ed.). West Academic Publishing.
Coleman, S. (2021). The walls within: The politics of immigration in modern america (Politics and Society in Modern America). Princeton University Press.
Kennedy, J. F. (2018). A nation of immigrants. Harper Perennial Modern Classics.
Prieto, G. (2020). Myth and reality in the U.S. Immigration debate.Routledge.