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Illegal Immigrants Pose Ethical Dilemma for US Nurses Citizenship status of patients should not be obstacle to emergency treatment

Note From Mary:

This is interesting. This is more than ethical dilemma—it’s a legal dilemma. ED nurses would have obligations under Hipaa, EMTALA, to treat, protect patient privacy etc—but can run up against immigration and other federal and state law re disclosure, Medicaid eligibility, the big catchall of knowledge of illegal acts possibly requiring them to disclose, etc—all of which could present licensure/discipline problems also.

THURSDAY, March 19 (HealthDay News) — Even though under federal law illegal immigrants in the United States for less than five years are not eligible for Medicaid, emergency department nurses have a range of ethical and legal obligations that require them to protect the safety of all patients regardless of their citizenship status, according to an article published in the March issue of the Journal of Emergency Nursing.

Jason W. Grimm, R.N., of the U.S. Air Force, Lackland Air Force Base in Texas, and colleagues conducted a literature review to examine the ethical and legal dilemmas facing nurses when dealing with illegal immigrants in the emergency department.

Nurses have a legal obligation to give appropriate examination and treatment to anyone who presents at a hospital emergency department, in order to determine whether or not they have an emergency medical condition, Grimm and colleagues note. If necessary, patients must be treated or transferred elsewhere for treatment, the authors note. Nurses also have an ethical obligation to uphold the principle of confidentiality, including a patient’s citizenship status, and non-malfeasance, meaning their duty to do no harm, the authors add.

"In conclusion, nurses frequently encounter ethical dilemmas, regardless of their practice setting," Grimm and colleagues write. "Advice and guidance can be sought from multiple sources such as colleagues, codes of ethics, legal principles and hospital ethics committees. The nurse’s ultimate obligation, though, is to provide safe and effective health care to all patients while remaining within the confines of the law."

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