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Published on: January 12, 2018
Prenatal Care for Undocumented Immigrants: Professional Norms, Ethical Tensions, and Practical Workarounds
Rachel E Fabi1, Holly A Taylor1
1Rachel E. Fabi, Ph.D., is an Assistant Professor at the Center for Bioethics and Humanities at SUNY Upstate Medical University in Syracuse, NY. She received her B.A. from Yale University in New Haven, CT, and her Ph.D. in health policy and management with a concentration in bioethics from the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD. Dr. Fabi works at the intersection of bioethics and public health policy, and her research focuses on access to health care for non-citizens. Holly A. Taylor, Ph.D., M.P.H., was Associate Professor in the Department of Health Policy and Management (HPM), Bloomberg School of Public Health and Core Faculty member of the Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD when this work was completed. Dr. Taylor received her B.A. from Stanford University, her M.P.H. from the School of Public Health at the University of Michigan and her Ph.D. in health policy with a concentration in bioethics from the Bloomberg School of Public Health, Johns Hopkins University. Dr. Taylor is trained as a social scientist and uses both qualitative and quantitative methods to explore topics in the ethics of human subject research and ethical considerations in public health approaches to infectious disease.
Abstract:
This paper examines the practice implications of various state policies that provide publicly funded prenatal care to undocumented immigrants for health care workers who see undocumented patients. Data were collected through in-depth interviews with purposively sampled health care workers at safety net clinics in California, Maryland, Nebraska, and New York. Health care workers were asked about the process through which undocumented patients receive prenatal care in their health center and the ethical tensions and frustrations they encounter when providing or facilitating this care under policy restrictions. Respondents discussed several professional practice norms as well as the ethical tensions they encountered when policy or institutional constraints prevented them from living up to professional norms. Using Nancy Berlinger's "workarounds" framework, this paper examines health care workers' responses to the misalignment of their professional norms and the policy restrictions in their state. These findings suggest that the prenatal policies in each state raise ethical and professional challenges for the health care workers who implement them.
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