End-of-Life Care for an Undocumented Mexican Immigrant: Resident Perspective

The immigrant population in the United States has grown over the past years. Undocumented immigrants account for 14.6% of the uninsured population in the United States. Decisions about end-of-life treatment are often difficult to reach in the best of situations. We present a 43-year-old undocumented Mexican female immigrant with metastatic sarcomatoid squamous cell cervical cancer and discuss the barriers that she faced during her treatment. Limited English proficiency, living below the poverty line, low level of education, and lack access to Medicare, Medicaid, or other insurance coverage under the Affordable Care Act are major causes of decreased health-care access and service utilization by the immigrant population. Latinos are less likely to be referred to hospice by oncologists, and nearly a third of hospice agencies offer limited or no services to undocumented immigrants. Undocumented immigrants with terminal diagnoses generally do not have access to comprehensive or multidisciplinary follow-up treatment. Instead, one of their few options is to return to their home countries without any long-term treatment. This article discusses the many barriers and proposes areas for reform.