Abstract
For almost 30 years, until 2012, Spain had benefitted from a public healthcare system with universal coverage. That year, a new law denied ordinary healthcare for undocumented adult migrants. This law is in blunt contradiction to the idea that healthcare is a fundamental human right. We argue in this chapter that not only a deep and flagrant injustice results from that law, but also an ineffective health system, because important population groups remain out of health control, treatment and prevention, and because denying healthcare to undocumented migrants has not been translated into significant savings. This situation has provoked a strong backlash, from the Spanish society at large and, in particular, among health professionals who have decided to become conscientious objectors against the governmental request to withdraw healthcare from undocumented migrants. Interestingly, in this case, claims of conscience are not associated with personal interest or convictions—as they usually are—but rather with an ethical decision by professionals to take care of their patients, regardless of their administrative status. Promoting social justice is a foundational purpose of welfare states. When they fail in this objective, conscientious objection may become an instrument of last resort to uphold people’s rights.
This work has been sponsored by the Spanish Ministry of Economy and Competitiveness through its research projects KONTUZ! (FFI2014-53926-R, www.kontuz.weebly.com), Bioethics and Citizenship (FFI-2012-32827, www.bioeticayciudadania.weebly.com), and The discourse of biorights. Philosophical and legal foundations, features and implementation (DER2014-52811-P).
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Notes
- 1.
Basically, Ley General de Sanidad (1986), Ley de Cohesión y Calidad del Sistema Nacional de Salud (2003) and Ley General de Salud Pública (2011).
- 2.
Regarding migrant people, the Ley Orgánica 4/2000, de 11 de enero, sobre derechos y libertades de los extranjeros residentes en España y su integración social, included in its articles 3 and 12 migrants’ right to health protection under the same conditions as Spaniards.
- 3.
In relation to the evolution and success of healthcare in Spain, see: C. Muntaner et al. 2012.
- 4.
Despite the exceptions that RDL16 includes, it is alarming that in practice, there are abundant cases in which adequate assistance to pregnant women, children or people in emergency situations is not being provided. Since 2012, in the region of Valencia alone, 1,252 cases have been detected in which healthcare access has been illegally denied (ODUSALUD 2015, 5).
- 5.
Since RDL16 came into force, several cases have been reported of health services neglecting and discriminating against patients with curable diseases, such as tuberculosis, including a few cases resulting in the death of the patient directly linked to exclusion. Several professional institutions and NGOs are collecting evidence to denounce the situation and defend migrants. In this regard, see, for example: ODUSALUD 2012–2015; No a la Exclusión Sanitaria-Cantabria 2012–2015; Amnesty International 2013; Médicos del Mundo 2014; Yo Sí Sanidad Universal 2014.
- 6.
Such unfair imbalance between what migrants give to the Spanish healthcare system and what they receive from it is particularly notorious in the domain of organ transplantation: while undocumented migrants can—and often are—organ donors, they cannot legally be recipients.
- 7.
Previous Ministry of Health, Ana Mato, estimated that health costs caused by undocumented migrants amounted to 500 million euros (Prats 2012).
- 8.
About the cost of the healthcare exclusion of irregular migrants, see the recent information from the European Union Agency for Fundamental Rights (FRA 2015). As a sample, the cost of a general emergency in Madrid is 180 euros compared to 39 euros of a primary care consultation without complementary tests, or 57 euros in the event that this consultation includes additional tests. Data from Orden 629/2009, de 31 de agosto, de la Consejería de Sanidad, por la que se fijan los precios públicos por la prestación de los servicios y actividades de naturaleza sanitaria de la red de centros de la Comunidad de Madrid.
http://www.madrid.org/wleg/servlet/Servidor?opcion=VerHtml&nmnorma=5958&cdestado=P. Accessed 12 July 2016.
- 9.
This measure was announced on the 31st of March, 2015, only 2 months before of the elections in several regions in Spain. See Sevillano 2015b.
- 10.
- 11.
Several regions have established legal ways to circumvent the state mandate and to continue providing healthcare to this population (Delgado del Rincón 2014, 221–228). As a result, these differences among Spanish regions introduce additional elements of inequality in the public healthcare system.
- 12.
The Medical Code of Ethics (CGCOME 2011) establishes the following obligations: Art. 5. 3. “The physician’s main loyalty is that one that he owes to his patients and his patient’s health must come before any other convenience (…)”; Art. 6. 1. “All physicians, whatever their specialty or type of exercise, should provide emergency aid to the sick or the injured”; Art. 6.2. “The physician will not abandon any patient requiring his care, even in situations of catastrophe or epidemic, unless he was compelled to do so by the competent authority (…)”.
- 13.
Among others, Platform “Yo Sí, Sanidad Universal”, Médicos del Mundo, Platform “No, Gracias, Amnesty International and Red Acoge.
- 14.
The development of the arguments to justify this unusual form of conscientious objection exceeds the objective of this chapter. About this question, see: Triviño 2014a, 176–191.
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Triviño, R., Rodríguez-Arias, D., Ausín, T. (2016). Exclusion from Healthcare in Spain: The Responsibility for Omission of Due Care. In: Gaisbauer, H., Schweiger, G., Sedmak, C. (eds) Ethical Issues in Poverty Alleviation. Studies in Global Justice, vol 14. Springer, Cham. https://doi.org/10.1007/978-3-319-41430-0_11
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