Ethical issues and obligations with undocumented immigrants relying on emergency departments for dialysis

J Am Coll Emerg Physicians Open. 2021 Dec 29;2(6):e12590. doi: 10.1002/emp2.12590. eCollection 2021 Dec.

Abstract

Undocumented immigrants with end-stage renal disease in the United States are uniquely disadvantaged in their ability to access dialysis. This article examines the unique circumstances of the medical condition and healthcare system, including the relevant legal and regulatory influences that largely relegate undocumented immigrants to relying on emergency-only dialysis through a hospital's Emergency Medical Treatment and Labor Act obligations. We explore the ethical implications of this current state, emphasizing the adverse effects on patients and staff alike. We also review necessary actions that range from the actions an individual emergency physician to changes needed in federal policy.

Keywords: EMTALA; dialysis; emergency‐only dialysis; end state renal disease; ethics.