Access to health care for migrants is of immediate relevance in the UK following the Department of Health’s (DH) recent introduction of a new charging regulation for ‘overseas visitors’.1 In a stated attempt to maintain a high-quality, efficient, and progressive health system that is free to all British residents, the new policy demands payments even from those who cannot afford it: undocumented migrants and failed asylum seekers.
In Making a Fair Contribution, the DH argues that, for the NHS to be sustainable, regular residents and those who have paid into the common pool must be prioritised.2 However, the notion of an equal input alone fails to guarantee a just and equitable allocation of resources in a decent society.3
Health, whether conceptualised as a ‘good’ or a ‘right’, requires a doctrine for its distribution. There are usually two dominant responses to migrants’ access to health care:
services for migrants should be the same as those given to citizens; or
migrants should only be provided with what is minimally sufficient.
At its core, we are faced with a delicate question of ‘Who is obliged, to whom, to do what?’ 4 These questions also highlight the important role human relationships play in our moral and legal ethics. In particular, this relational paradigm takes on special significance with regard to the duties and rights that play out between migrants, the government of a sovereign state, and the medical community.
Framing the issue of migrant health in terms of our relational obligations highlights how vulnerability and the Rule of Rescue principle (RoR) create special duties …