Ethox and WEH Seminar - Ethical Medical Repatriation of Migrant Workers

ABSTRACT

Migrant workers face significant barriers of knowledge, language, cost, and status in accessing adequate healthcare in their host countries. Hospitals routinely encounter migrant workers whose need for long-term medical care may trigger the prospect of work termination and repatriation. These workers often lack the knowledge and power to determine, on their own, whether to stay for treatment or how to be sent home safely. While employment contracts and country-specific employment policies offer some guidance, they are not clear on the conditions under which hospitals can support or endorse such medical repatriation. In this paper, I will extend the ethical framework on medical repatriation in Kuczewski (AJOB 2012), by analysing challenging cases in Singapore that involve transient migrant workers with non-work-related health conditions. My analysis will draw on recent research into migrant vulnerability in multicultural contexts and the ethics of just repatriation.

First, I will outline Kuczewski’s ethical framework, which focuses on the medical repatriation of undocumented migrants. Based on the mission and values of hospitals, it specifies three necessary conditions under which repatriation is ethical. These conditions relate to the patient’s best interest, the hospital’s due diligence, and the patient’s informed consent. Second, I will examine the challenges of applying these three conditions to transient migrant workers. The challenges arise partly from the distinctive migration projects and employment conditions of such workers, who are unusually dependent on others and disempowered in host countries. Hospitals also face potential conflicts between their organisational norms, employer practices, and state policies. Through an analysis of a series of difficult cases, I seek to clarify the ethical role of hospitals in repatriating transient migrant workers and propose some practical guidelines.