The German Ethics Council turns the spotlight on migration and health

Minister of State Maria Böhmer, the Federal Government’s Commissioner for Migration, Refugees and Integration, noted with satisfaction that the Ethics Council was addressing this issue, especially as health and healthcare were among the principal concerns of the Federal Government in the current electoral term. She laid particular stress on the need for intercultural openness on the part of the healthcare system and for the promotion of intercultural competence in the training of health professionals.

The speakers considered the intercultural aspects of healthcare from the standpoints of their respective disciplines and offered an insight into various medical fields of action. Attention was also directed to legal problems in the doctor–patient relationship and to the health of migrants in the context of social ethics and politics, including the question of whether specific provisions were needed for migrants not in possession of a residence permit.

The practical issues discussed included the optimum configuration of a system of medicine and medical ethics sensitive to the demands of different cultures, and the consequences of such a configuration in terms of improving the medical care of patients with a background of migration. After all, different cultures had differing conceptions of health and disease, and these had repercussions on treatment decisions and on health-related behaviour. However, it had to be borne in mind that the relationship between migration and health was not only influenced by factors specific to migration, but that socioeconomic and educational aspects were also relevant. A point that emerged clearly from the discussion was that, given the extremely heterogeneous nature of groups with a background of migration, a one-size-fits-all approach was inappropriate. The situation needed to be addressed on a differentiated basis, and this would allow people to be perceived as individuals rather than in their generality as migrants.

In view of the potential conflict between solidarity and individual responsibility, structural changes were felt to be necessary. On the one hand, people had a duty to look after their own health, while, on the other, the healthcare system had an obligation to deliver. One implication was that more professional interpreters should be made available in hospitals and doctors’ surgeries, to help overcome language barriers. With regard to the cost of interpreters, Professor Böhmer expressed the following view: “I think interpretation ought to be included among the general benefits provided by the statutory health insurance scheme, so that no one misses out on help because of problems of comprehension.”