Features And Flaws Of A Fair Hospital Policy For Allocating Expensive Charity Care To Noncitizen Patients

Commentators have asserted that "the existence of a genuine medical need constitutes a moral claim on those equipped to help." However, this professional duty is sharply limited by the fact that resources are not available to help all the world's patients with each of their problems. At some point, boundaries are drawn implicitly and by force; these boundaries can exacerbate inequalities and injustices, or they can contribute to making the medical system more fair for everyone it serves. To achieve a more just result, distributive justice must be employed, but any systematic way of allocating resources depends on being able to define who belongs to a public and thus deserves treatment, as well as what any minimum basic right to treatment should entail. By examining closely a case of an adolescent undocumented immigrant who traveled from her home country explicitly for treatment of a fast-growing tumor, we will explore a variety of ethical concerns related to this dilemma in its historical and political context. Finally, a pragmatic hospital-based policy to guide microallocation of expensive charity care will be proposed in hopes of seeking a reasonably fair process to adjudicate this increasingly common dilemma of politics, economics, and professional ethics.