Ethics, Brighton and Sussex Medical School, Brighton, UK.
Sexual Health and HIV, Royal Sussex County Hospital, Brighton, UK.
J Med Ethics. 2019 Aug;45(8):489-496. doi: 10.1136/medethics-2018-105224. Epub 2019 Apr 25.
Pregnancy care is chargeable for migrants who do not have indefinite leave to remain in the UK. Women who are not 'ordinarily resident', including prospective asylum applicants, some refused asylum-seekers, unidentified victims of trafficking and undocumented people are required to pay substantial charges in order to access antenatal, intrapartum and postnatal services as well as abortion care within the National Health Service. In this paper, we consider the ethical issues generated by the exclusion of pregnancy care from the raft of services which are free to all. We argue that charging for pregnancy care amounts to sex discrimination, since without pregnancy care, sex may pose a barrier to good health. We also argue that charging for pregnancy care violates bodily autonomy, entrenches the sex asymmetry of sexual responsibility, centres the male body and produces health risks for women and neonates. We explore some of the ideological motivations for making maternity care chargeable, and suggest that its exclusion responds to xenophobic populism. We recommend that pregnancy care always be free regardless of citizenship or residence status, and briefly explore how these arguments bear on the broader moral case against chargeable healthcare for migrants.
怀孕护理对在英国没有无限期居留权的移民收费。不“通常居住”的女性，包括潜在的庇护申请人、一些被拒绝的寻求庇护者、身份不明的人口贩运受害者和无证件的人，为了在国民保健制度中获得产前、产时和产后服务以及堕胎护理，需要支付大量费用。在本文中，我们考虑了将怀孕护理排除在所有免费服务之外所产生的伦理问题。我们认为，对怀孕护理收费相当于性别歧视，因为如果没有怀孕护理，性别可能会成为健康的障碍。我们还认为，对怀孕护理收费侵犯了身体自主权，巩固了性责任的性别不对称性，以男性为中心，给妇女和新生儿带来健康风险。我们探讨了使产妇护理收费的一些思想动机，并认为其排除是对仇外民粹主义的回应。我们建议无论公民身份或居住地位如何，怀孕护理都应免费，并简要探讨这些论点如何影响更广泛的反对向移民提供收费医疗保健的道德案例。
