Ethical Basis for Excluding Unauthorized Immigrants from the Affordable Care Act

Health Law, Ethics & Policy Workshop Series
David Asper Centre for Constitutional Rights & International Human Rights Program

present

SPEAKER:  Norman Daniels, Harvard School of Public Health

Ethical Basis for Excluding Unauthorized Immigrants from the Affordable Care Act

COMMENTATOR:  Audrey Macklin, University of Toronto Faculty of Law

The Affordable Care Act (“Obamacare”) is intended to close the insurance gap in the US but the single largest group it excludes from coverage is the group of unauthorized (“undocumented” or “illegal”) immigrants, some 12 million people. Should they have been included? After all, in the U.S., even unauthorized immigrant cannot be excluded from emergency room services. Two arguments, one based on reciprocity the other on community membership, support a presumption for inclusion, and the ground for exclusion do not warrant their omission. We examine these arguments after first arguing that some claims of global justice, for example, that national borders should be “open,” fail an important test of feasibility on claims of justice.

Norman Daniels is Mary B. Saltonstall Professor and Professor of Ethics and Population Health at Harvard School of Public Health. Formerly Goldthwaite Professor, Chair of the Tufts Philosophy Department, and Professor of Medical Ethics at Tufts Medical School. He has published over 150 articles in anthologies and journals. His books include Just Health Care (Cambridge, 1985); Am I My Parents’ Keeper? An Essay on Justice Between the Young and the Old (Oxford, 1988); Seeking Fair Treatment: From the AIDS Epidemic to National Health Care Reform, Oxford, 1995); Justice and Justification: Reflective Equilibrium in Theory and Practice (Cambridge University Press, 1996); (with Donald Light and Ronald Caplan) Benchmarks of Fairness for Health Care Reform (Oxford, 1996); (with Allen Buchanan, Dan Brock, and Dan Wikler) From Chance to Choice: Genetics and Justice (Cambridge, 2000); (with Bruce Kennedy and Ichiro Kawachi) Is Inequality Bad for Our Health? (Beacon Press, 2000); and (with James Sabin) Setting Limits Fairly: Can We Learn to Share Medical Resources? (Oxford, 2002; 2nd edition 2008). His Just Health: Meeting Health Needs Fairly (CUP, 2008) is a sequel to Just Health Care and integrates his work into a comprehensive theory of justice for health.