Discussing rights and wrongs: Three suggestions for moving forward with the migrant health rights debate

Claims for improving migrants' access to care often draw on universalistic ethical notions, such as the principle of equity as it is specified in human rights law and public health ethics. These claims contrast with political realities across most welfare states. In the underlying public discourses, the frontline arguments against greater inclusion have often focused on practical concerns, such as the costs of healthcare provision. Yet it has also been suggested that ultimately context-specific moral frameworks play a key role in demarcating legitimate right-holders from undeserving others. Hence, is this a conflict between ethical principles and practical concerns? Or between different ethical perspectives? And why would that question matter? We propose that awareness of the nature of the arguments involved and respect for different ethical views are critical for coherent and constructive debates. This paper looks at the ways in which ethical concepts are used to justify exclusionary policy decisions. In particular, it examines the rationales that inform health policies towards documented and undocumented labor migrants in two welfare states, Germany and Israel, through the qualitative analysis of policy documents and 71 in-depth interviews. The study points to the central role of particular concepts of health-related deservingness. These results lead to the proposition that the fundamental clash in the discussion on migrants' access to care is one, albeit not solely, between contrasting ethical perspectives. Drawing on process-oriented approaches to ethical decision-making, the paper concludes with three suggestions for moving forward with the migrant health rights debate.