"First they came for the communists,
and I didn't speak out because I wasn't a communist.
Then they came for the trade unionists,
and I didn't speak out because I wasn't a trade unionist.
Then they came for the Jews,
and I didn't speak out because I wasn't a Jew.
Then they came for me
and there was no one left to speak out for me."
http://en.wikipedia.org/wiki/First_they_came%E2%80%A6
i'm sorry what follows is so badly translated but I'm sure you'll get the general outline of the picture ....
http://sociedad.elpais.com/sociedad/2012/04/26/actualidad/1335468837_751700.html
SANITARY ADJUSTMENT
"I treat people who are uninsured"
The
clinics appeal to their code of ethics to defend illegal immigrant care
The industry
complains that it can not be vigilant system
IIl treat people who are uninsured." Josep Basra, president of the Spanish Society of
Family and Community Medicine (Semfyc), it is clear. Always
from a personal point of view, the decree that prevents serve illegal
immigrants is not in our ethics. "If I have a person before me, I do
not care whether foreign or not, I have to meet them." he says. A vision
shared by the president of theMedical Association (WTO), Juan Jose
Rodriguez Sendin: "Just as I can not be compelled to perform euthanasia, so they can
not force us to not to treat a patient."
The approach of Rodriguez Sendin and Basra is the same for most concerned health
professionals that appeal to their code of ethics to defend
treatment of illegal immigrants from Sept. 1 who are not entitled to a health
insurance card, as the Royal Decree of settings published this
week by the Government.
"A patient is a patient black, white or
mediopensionista, and we can not abandon them deontologically. It's crazy. We
are not policemen or inspectors, if they ask me to support them as a doctor then I
have to, another thing is you can not use the best technologies that I prefer - and then we'll see the administrative side, "says the president of
the Spanish doctors. And this idea that they are going to have to act as
policemen of the system to avoid suspected fraud or simply enforcing a rule
bother them greatly. Some say they do not agree. Go for it, say, the
insubordinates through some kind of conscientious objection, but in reverse.
The Coordinadora Anti-Privatisation of Public Health in
Madrid has been the one that has lit the fuse. "We
call on the ethics of any and all public health professionals for full
attention to this population [over 150,000], belonging largely to disadvantaged
groups. At the same time, we claim the right to conscientious objection on
the part of all professionals to the effective implementation of Royal Decree,
an immoral law, unjust, and dangerous in terms of public health, "say.
Semfyc, society presiding Basra, more than 20,000 professionals,"expresses its opposition to the
ministerial decision to limit access to health care to immigrants "without
papers". Also, like "warn of health risks" of leaving
"without access to a continuum of care, and to restrict their attention
through emergencies can generate higher spending and hamper disease
control."
Maximo Gonzalez Jurado, President of the General Nursing Council, believes that
professional ethical principles collide with the action taken by the ministry
of Ana Mato. "The legal parentage of the patient is not our problem
when it is a person who has a health problem. It is clear that we
can not deny these children. Especially if we have no guarantee that those
people who have been our patients can receive the care they need by other means", he says. "We do not begin to analyze the problem of illegal
immigration, and who also is a medical tourist," he says. "But
if these people are in Spain and need health care, as professionals we must
give it. It is another thing is to have filters before reaching us," he says.
Jury Gonzalez does not dispute that the health system need measures to
ensure sustainability, but criticizes the Government's health reform has been
produced without the opinion of the professionals who have to implement it. Although
he believes that on that point they will not. "No doctor or nurse will
stop giving a person the assistance they need. We have no obligation to
ask the person the insurance card, "he says.
"Patients are not just a history. There is a person. As professionals, they know we've had a relationship with them, "criticizes Pilar
Navarro, secretary of the Health Sector Public
Services Federation of UGT, which also argues that
"professionally" they can not leave their patients unattended."This
situation must be resolved because it is unfair humanely, if people can
not reach us first, denying them assistance".
A similar idea is repeated from the College of Physicians of Madrid."From the
ethical point of view no physician can fail to respond to any patient in
need," said a spokesman.
A health coordinator
called for disobedience
to the dictate
Altisent Roger, a professor of bioethics at the medical school of
Zaragoza, explains that from the standpoint ofMedical Ethics Code the situation is not
simple. "It's not black and white.We are facing a variety of
situations and very hard. We have served all who pass through the
door without putting ourselves in the position of demanding proof of status", he
says. The expert explained that the Code of Ethics, Article 6, states that
"the doctor will never abandon a patient in need of care", and also
speaks of the doctor to stop treating a patient, ensure the continuity in
attendance. "These are points that are not designed for this, but
that could be applied," he says. Doctors who do take the path of
disobedience: ask to be excused from a legal obligation and not be punished.
To Altisent, that last track is an interesting path to explore. "This
should be done to alleviate dramatic situations," he says. And at
this point criticizes the government places health professionals in a very
uncomfortable situation. "Perhaps the national health system itself
will have to arbitrate for intermediate situations, not their doctors who are in a
very delicate situation deontologically" he says. So much so that the
Medical College will address the issue in assembly. "They are not
scenarios for us, and they must be analyzed," says its president Juan Jose
Rodriguez Sendin.
The nurse Angel Navarro, a spokesman for the coordinator to promote
insubordination, says that his is a "call to the whole system." "We
have only launched the idea. We cannot develop a legal system", he says. For
Navarro, which proposes to deny care to patients they have known and yreated for years
is "inhumane, unjust, it is against our conscience and our code of
ethics."
The problem is to ensure continuity
of treatment
Miguel, a family doctor in Madrid who gives a false name, is sympathetic
to the idea of the objection. "In 25 years I have seen enough
immigrant population, and I have had very painful cases. People who have
fled armed conflict, their family have been killed." "Many, after all,
are in highly sensitive situations of mental health. How will I treat someone
with schizophrenia, depression? If it is difficult for anyone who takes
pills for them in this situation will be even more, "he says. So
Michael's proposal seems "reasonable." "It's in our code of
ethics." "What we are being asked to do is repugnant to morality." "I
work for the patient, and I will maximize flexibility in the criteria of what
is an emergency. Or are we going to become police for the immigration control system? ".
The doctor suggests difficulty at a practical level. "One
thing is early diagnosis and other treatment," he says, with the idea that
once served, there are issues, like getting the drug, yes they can get very
difficult. But he believes that, ultimately, the Government's proposal
will be like "holding back the tide." "The system already
has holes. At primary level there are emergencies, and they either put a
policeman at the door, or admit anyone who comes saying he has something urgent
to be addressed. "The bad thing for him is that in the end, care will
be worse. "It will be desperate to know that a person needs treatment
and it cannot be provided."
