Criteria Possible Points Points Earned

Introduction (Why is this an ethical issue?) 10

Exploration of the issue (pros, cons, critical 20
examination of the issue)
Implications for the APRN 15
Economic implications 15
Summary reflective of organization, 20
development, clarity, fluency, readability
Grammar and syntax 10
APA (margins, spacing, citations, etc.) 10
TOTAL 100

Module II Ethics at the Systems Level: Immigration and Perinatal Care

Maegan Bell

Auburn University

Every life matters, and access to adequate health care should not be denied to

any person. It is a human right. According to the World Health Organization (2013), the

right to health has been enshrined in international and regional human rights treaties as

well as national constitutions all over the world and governments have a responsibility

to ensure availability of health services. In the United States, undocumented

immigrants are not eligible for federally funded public health insurance programs,

including Medicare, Medicaid, and the Child Health Insurance Program (CHIP) (The

Hastings Center, 2012). In certain states, funding for non-emergent medical coverage of

undocumented immigrants is provided. A case study by Milstead (2013), reported

Nebraska would no longer provide government-reimbursed health care through

Medicaid or other state programs to undocumented pregnant women.

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The denial of health care coverage to any individual, based upon gender, race,

religion, or immigration status is immoral. It goes against the basic laws of humanity to

put a life at risk, especially the life of an unborn child. It is a well-documented fact that

without adequate prenatal care, the risks of pregnancy and delivery complications are

much higher. A cost and benefit analysis performed by Lu and Lin (2000) explored the

elimination of public funding for undocumented illegal immigrants in California. This

study showed for every dollar cut from public funding of prenatal care for

undocumented women we would expect an increase of $3.33 in the cost of postnatal

care, with an increase of $4.63 when the incremental long-term morbidity cost (Lu &

Lin, 2000, p. 237). Although the cutting of health care coverage for undocumented

pregnant women would save the state money upfront, the long-term cost incurred from

post-natal care would surpass those savings exponentially.

According to the case study, Advanced Practice Nurses (APNs) in Nebraska,

responded to this anti-prenatal care legislature by petitioning to the states senators for

change, actively providing prenatal care to these women themselves, and helping to

assemble any information needed for the states efforts to reverse the legislation

(Milstead, 2013). Some APNs in the state organized volunteer clinics, and provided care

for these women. The refusal of healthcare to a certain population has a myriad of

implications for the APN, which are evident in the case study. In addition to a moral and

ethical responsibility to assume care for these women, APNs will also incur the

responsibility of emergent medical care of the high-risk deliveries, which will ensue.

APNs will have to witness the increased mortality rates of the infants, unable to be

cared for prenatally. The APNs will also provide care for the mothers, who endured the
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33
high-risk delivery, and are suffering the long-term complications in an inpatient treatment

environment. APNs will additionally have to devote their free and spare time to volunteer

clinics, in efforts to try and reduce the unavoidable fall out of this legislation.

As discussed above, denying coverage to undocumented pregnant women may

save money upfront, but this benefit does not save money overall for the state or federal

government. In California, elimination of public funding of prenatal care could

potentially save the state $58 million dollars up front but could cost $194 million in

additional expenditures for postnatal care (Lu & Lin, 2000, p. 237). The healthcare

community, including APNs, understands this perfectly, but many government officials

and regular citizens may not understand the economic repercussions of the passing of

this legislature long term on the community. APNs have a responsibility to help voice

these issues, both the ethical and economic, to the community, stakeholders, voters,

and government officials.

The case study surmises this law passed in part due to the geographical voter

demographics. The state highlighted in the case study, Nebraska, is majority republican

and conservative. Due to the conservative nature of the voters, anti-immigration

legislature tends to pass in this state. Since, the state has majority support for this anti-

prenatal care policy to undocumented women, it is the duty of the parties who are

opposed to these type of anti-immigration laws, and anti-healthcare laws, to step

forward and lead the battle for change. APNs can be lobbyist for the political movement

to stop further laws restricting the care of certain populations, like undocumented

immigrants, and also reverse such legislation, like the anti-prenatal care law.
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44
Even republican nurses, would have to acknowledge the infringement of human

rights taking place here. As republicans, these nurses can petition within their own

political party for change, based on human rights and the recognized, documented

benefits of prenatal care. Health care providers must unite against the violation of

human rights and unethical treatment of any person, documented or not.

Anti-immigration laws and policy reform is an ongoing debate in American. It has

been a topic upon which many candidates have addressed and platforms have been

based. This topic is not going to be resolved anytime in the near future. In the interim,

America has thousands of documented and undocumented immigrants living in the

country in need of healthcare. If governments dictate laws disregarding the right of

certain groups to health care in order to save money, then this country is facing not only

financial and economical consequences, but also moral and ethical, as well as medical.

Without access to adequate health care visits, screenings, prescriptions and

treatment options, diseases will both spread and conditions will worsen. The

populations denied health care will be directly and most obviously affected, but other

populations will also suffer. Communicable diseases will spread. Hospitals will have to

deal with more emergency care, far more comprehensive in nature than the annual

physical denied by the government. The cost of care on the backend will far exceed the

cost of routine medical visits refused by the legislation, as witnessed with the anti-

prenatal care policies.

This issue, immigration and access to healthcare, is not going away. The refusal

of prenatal care to undocumented women only exemplifies the worsening of ideals and

legislation within the government, in regards to human rights and access to affordable
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55
healthcare for all. The lives of infants are lost everyday by this legislation in many

states, not only Nebraska. The APNs in the case study rallied together to make a

change and provide support for these women and their unborn children. The actions of

the APNs against the moral turpitude of the government officials in Nebraska, who were

in favor of this law, epitomize the leadership role and responsibilities of APNs

nationwide.

The legislation in this nation must be more accepting of individuals, both citizens

and non. The economic and ethical implications of supporting such anti-immigration

laws, in which basic health care is denied to individuals, will have long standing

ramifications for the nation. The role of APNs in health care legislation can have a

significant impact on the outcomes of patient care, quality of life, access to affordable

health care, economic strategies, and laws in favor of providing non-emergent care to

all individuals in this country. The leadership of the APNs in this particular case study,

with regards to lobbying and filling in the gaps in the healthcare system to ensure no

person goes without care, is an extraordinary achievement.

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Reference

Lu, M. C., & Lin, Y. G. (2000). Elimination of public funding of prenatal care for

undocumented immigrants in California: A cost/ benefit analysis. American

Journal of Obstetrics and Gynecology, 182(1), 233-239.

Milstead, J.A. (2013). Health policy and politics: A nurses guide (4th ed.). Burlington,

MA: Jones & Bartlett Learning.

The Hastings Center. (2013, October). Undocumented immigrants in the United States:

U.S. health policy and access to care (Issue Brief). Garrison, NY: Gusmano, M.K.

Retrieved from http://www.undocumentedpatients.org/issuebrief/health-policy-

and-access-to-care/

World Health Organization. (2013). The right to health (Fact Sheet No. 323). Retrieved

from http://www.who.int/mediacentre/factsheets/fs323/en/