THE RIGHT TO HEALTH CARE ON EQUAL TERMS MUST NOT BE ERODED
Common position statement from the health care professions.
In the Tidö agreement between the parties which form the basis for the Swedish Government, the stated purposes of the proposed changes to health care include increasing access, improving efficiency and equality in health care as well as improving working conditions. At the same time, some proposed measures will lead to significant negative impacts for people without residence permits (asylumseekers and undocumented migrants). In practice, it is proposed that the right to emergency dental care and dental care that cannot wait be abolished for patients who are seeking asylum or are undocumented migrants, which will lead to increased morbidity rates and suffering. Restrictions on the right to an interpreter are
also proposed for people with residence permits, which risks leading to increased medical risks. Another proposal is a duty to report undocumented migrants to the Migration Agency and the Police Authority, and there is no guarantee that health care staff will be exempted from this notification requirement. Introducing
such a notification requirement could entail a risk that fewer people will dare to seek treatment for serious conditions, for themselves or their children. If the Government decides to put these proposals into practice, the health and lives of people who are already vulnerable risk becoming even worse, while the opportunities
for health care professionals to provide health care based on ethics and patient safety will be
The United Nations Universal Declaration of Human Rights states that all human beings are born free and equal in dignity and rights. Under The United Nations Convention on the Rights of the Child, no child should be deprived of their right of access to health care services.
The United Nations International Covenant on Economic, Social and Cultural Rights also states
that its parties, which include Sweden, recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. The universal right to health without discrimination is one of the fundamental human rights.
All health care professions have clear ethical codes and guidelines, based on international
declarations, developed in order to guide health care staff in providing health care to high ethical standards. Their point of departure is that the primary goal for health care staff should be the patient’s health, while never deviating from the principal that all human beings are equal. Every patient, without discrimination, should also have the right to appropriate treatment, and health care staff have a duty to provide health care regardless of the legal status of the patient.
Human rights and professional ethics in health care have been developed based on experiences in which the lack of such guidelines have led to serious abuse, including within health care, towards marginalised and vulnerable groups. There are tragic examples of this within our own country.
Hence, the health care professions are of the view that the following principles should guide
health care staff in their treatment of every human being, without exception. This includes asylum seekers and undocumented migrants.
- The role of health care staff is to provide health care, treatment, care and rehabilitation to every patient on the same terms.
- The assessment of health care staff should be based on each patient’s needs, on science
and best practice, without discrimination.
- The legal status of the patient should not affect health care staff when deciding whether or not to provide treatment, andwhich treatment to provide.
- Patient confidentiality applies to every patient on the same terms.
- Every patient has the right to information which they can understand and which is adapted to their needs and prerequisites.
Several of the international organisations for health care professionals urge health care staff to take a stand against people being refused health care because of citizenship or legal status, and to provide support for everyone’s right to health care based on their needs.
The proposals in the Tidö agreement detailed above risk leading to an increase in medical risks because of a reduction in the use of interpreters, the risk of patients avoiding health care and instead seeking medication and treatment through non-professional channels, seeking health care too late or using borrowed identities, as well as a risk of an increased spread of disease. If these proposals are implemented, they will not only lead to infringements of human rights and reductions in health for some of the most vulnerable groups in Sweden, but also to a risk of reductions in public health through the proposals for changes to migration and integration policies. The proposals contradict professional ethical
codes and the ethical guidelines which have been determined and practised by the health
care profession’s organisations for years. If the Government puts them into practice, they
will also put large groups of professionals who are already under severe pressure under aggravated ethical stress and working conditions in their professional activities.
Adopted in March 2023.
Latest update June 2, 2023.
Signatories of the Right to Health Care initiative’s position statement
THE RIGHT TO HEALTH CARE ON EQUAL TERMS MUST NOT BE ERODED
The Swedish Association of Health Professionals, Swedish Psychological Association, Swedish Association of Occupational Therapists, The Swedish Dental Hygienist Association, Swedish Medical Association, Swedish association of Speech and Language Pathologists, IFMSA Sweden International Federation Medical Students Organisation,The Swedish Society of Medicine, The Swedish Association of Midwives, The Union for Professionals, Swedish Society of Nursing, Swedish Association of Clinical Dietitians, Swedish Association of Physiotherapists, The Swedish Association of School Nurses, Swedish Society of
Radiographers, The Swedish Paediatric Society, Global Youth & Child Health – a section of The Swedish Paediatric Society, Kommunal, Vision, The Swedish Institute of Biomedical Science, 29 counsellors at the The Karolinska University Hospital in Huddinge, Doctors of the World Sweden, Doctors Without Borders Sweden, Hälsa och vård within the Swedish Red Cross, Amnesty Sweden, RFSU.
We support the healthcare in this:
Caritas Sweden, Center for Support and Treatment at Save the Children Sweden, HMR The Swedish Association for Health and Human Rights, The Rosengrenska Foundation, Alsike monastery, Posithiva Gruppen, The Trade Union Center for Undocumented Migrants, Swedish Refugee Law Center, SKAIS
The right to healthcare on equal terms
Statement from the Right to Care Initiative
The health care provided today to Undocumented Migrants and EU-migrants is characterized by
significant disparities in knowledge about the legislation and its application. The health care
therefore varies considerably throughout the country. Consequently, people with clear healthcare
needs are still denied treatment to which they are entitled. This is incompatible with basic medical
ethics and unacceptable under the rule of law.
From a patient safety approach, the same basic requirements must be put on all care. To introduce
legal barriers to timely healthcare for the right patient can endanger the patient’s safety and should
for that reason not be accepted.
The present, ambiguous and difficult-to-interpret legislation in Sweden disfavours specifically
vulnerable groups of people. The organizations behind the Right to Care Initiative have in a
statement in November 2013 rejected the term ”care that cannot be deferred” as medically
unserviceable and unethical.
EU-migrants who do not have health insurance in their own country are not entitled to subsidized
care at all. In practice, this makes it impossible for them to receive healthcare in Sweden. This is not
humanitarian and is incompatible with Sweden’s human rights commitments.
The current situation daily puts healthcare professionals in conflict with the ethical codes of the
professions and amounts to that the prevailing, contradictory legislation may constitute a work
environment hazard, which was also emphasized by the official government inquiry Health Care for
Undocumented Migrants et al. in the year 2011. There are obvious, substantial humanitarian
arguments, as well as a from a public health perspective and national economics, reasons to offer
healthcare on equal terms to each and every one in need of care.
Sweden has committed to respecting the fundamental human rights. The right to the highest
attainable standard of health applies to everyone who resides within the jurisdiction of each state
regardless of legal status. Sweden is obliged to respect, protect and fulfil this right for all.
We therefore call on the Swedish Parliament and Government to immediately ensure that asylum
seekers, undocumented migrants and vulnerable EU-citizens residing in Sweden are entitled to
healthcare as needed and on equal terms regardless of origin or legal status. We expect more
coherent legislation and a clarification of how the legislation is to be applied at the national level.
Sweden has a long tradition of solidarity with vulnerable peoples and communities. In this spirit, it is
consequential, right and decent that a rich, humanitarian and democratic society does not limit
vulnerable people’s right to the best possible health through a healthcare or dental care on equal
- Audionomerna Swedish Association of Audiologists
- Dietisternas Riksförbund Swedish association of clinical dietitians
- IBL The Swedish Institute of Biomedical Science
- Svenska Barnläkarföreningen The Swedish Paediatric Society
- Sveriges Farmaceuter Swedish Pharmacists Association
- Sveriges läkarförbund Swedish Medical Association
- Svenska Barnmorskeförbundet The Swedish Association of Midwives
- Sveriges Psykologförbund Swedish Psychological Association
- Svensk förening för röntgensjuksköterskor Swedish Society of Radiographers
- Sveriges Tandhygienistförening The Swedish Dental Hygienist Association
- Sveriges Tandläkarförbund Swedish Dental Association
- Akademikerförbundet SSR The Union for Professionals
- Svenska Logopedförbundet Swedish association of Speech and Language Pathologists
- Svenska Läkaresällskapet The Swedish Society of Medicine
- Vårdförbundet The Swedish Association of Health Professionals
- Sveriges Arbetsterapeuter Swedish Association of Occupational Therapists
- Svensk Optikerförening Swedish Optometrist Association
- Svensk Sjuksköterskeförening Swedish Society of Nursing
- Fysioterapeuterna Swedish Association of Physiotherapists