Ethical medical repatriation of guest workers: Criteria and challenges

Healthcare facilities in receiving countries regularly encounter guest workers whose need for acute or subacute care triggers the prospect of termination of employment and repatriation. In these scenarios, country-specific migration and employment policies and norms of medical professionalism and ethics offer some guidance, but also create tensions. It is not clear under what conditions such medical repatriation is ethically permissible. This paper analyses the application of a previously articulated criteria for the ethical medical repatriation of undocumented immigrants, to the situation of documented guest workers, with focus on the context of Singapore. We examine how these standards could be adapted and applied to the provision of care for guest workers, and argue that healthcare institutions and medical professionals have a duty to intervene in employers' decisions to repatriate guest workers for medico-economic reasons when repatriation essentially amounts to 'patient dumping'. Barriers and challenges in implementing the criteria, and their possible solutions will be discussed.