Radheesh Ameresekere

Hospitals regularly deport ill and undocumented-migrant patients, largely to avoid incurring the cost of long-term care. Deportation (also called repatriation) occurs when an undocumented patient is removed from U.S. territory and transferred cross-border to their home nation. Little to no attention has been paid to whether these deportations are permissible under international law in general in the contemporary literature on international jurisprudence. Such considerations are particularly salient to the matter at hand as repatriation is effectively the coercive removal of a person from a sovereign territory and relocation to their home country, and thus fits squarely in the context of international law. As such, this piece engages these questions in two parts. In the first part, it argues that extrajudicial deportation and deportation on the basis of cost-saving violates related principles of lawfulness, non-arbitrariness, and non-refoulement under international law. In the subsequent part, it suggests federal oversight must not merely stipulate the legitimate scope of deporting authority but the conditions under which deportations are legitimate under international law, namely when a patient constitutes a bona fide threat to national security.

A new draft budget from the Trump administration proposes to terminate the Substance Abuse and Mental Health Services Administration programs that supply naloxone to health care providers, including first responders, and provide training on administering the drug during an overdose emergency. Naloxone—commonly known as Narcan—effectively and efficiently reverses an opioid overdose by blocking the effects of opioids on the brain and restoring breathing. Distribution programs have thus been instrumental in curtailing overdoses in the United States. Despite congressional support over the past few years, however, the president’s proposed $56 billion cut to these programs leaves the future of overdose intervention uncertain. In this article, I critique the justification of these cuts while tracing their implications.

Why is healthcare ‘special’ to the extent that it should be distributed more equally than other social goods, as a matter of justice? Norman Daniels claims that healthcare is special because it protects the normal range of opportunities available to us, and therefore can be subsumed under a principle of justice which establishes that opportunity ought to be equally distributed. I argue that subsuming healthcare under such a principle leads to de facto discrimination against certain people in virtue of their healthcare needs. This is because—as a critical discussion of health and healthcare needs importantly illustrates—much of the healthcare that people need simply cannot or does not protect normal species function, and therefore does not protect opportunity. And so, such healthcare needs go unfairly unmet on Daniels’ view. Instead, I suggest that we ought to subsume healthcare under a principle of equally distributing the social bases of self-respect. Though the healthcare that many of us need cannot protect opportunity, it can still protect our sense of self-respect; as such, those who need such care are entitled to it as a matter of justice on the self-respect view. The self-respect view thus avoids de facto discrimination and ultimately meets healthcare needs more fairly. And because it does so by eschewing a controversial conception of health and healthcare, instead appealing to a conception that appears freestanding with respect to the doctrines that citizens might reasonably disagree about, it better satisfies the requirements of public justification.