Undocumented migrants’ right to health care: Physicians’ rejection of law in their gatekeeper roles

Background Legal consciousness theory acknowledges the known gap between law in writing and law in its everyday practical application in society. Limited research has explored legal consciousness in medical contexts, and limited knowledge exists surrounding how the intrusion of law in medical authority impacts applied medical ethics. Conflicts between law and medical ethics can be saliently observed in Sweden, where current law forcibly places physicians in a gatekeeper role in satisfying undocumented migrants' right to health care access, relying on physicians' assessments of whether patients without legal residency status should be provided 'care that cannot be deferred'. Methods In this context, the present phenomenological study sought to explore how legal terminology is experienced, understood, and applied by physicians, contextualising the perceived meaning ascribed to the imposed gatekeeper role. Qualitative interviews were conducted with 42 physicians from five major Swedish hospitals, and analysed through the lens of legal consciousness theory. Results Participants actively rejected law by taking a firm, and often collective, stance against its intrusion in their work. Rejection of law was constructed through: rejecting legal hegemony and government imposed non-medical responsibilities; perceiving professional authority and medical ethics as empowering; considering repercussions of legal non-compliance unthreatening; believing increased legal knowledge would not influence their professions' foundational role. Conclusions The study produced novel findings, contributing to the limited body of work exploring legal consciousness in medicine. Regardless of legal knowledge held, when law conflicted with foundational medical ethics, the intrusion of law in the medical profession lead to the explicit rejection of law. Findings accent the need for laws addressing healthcare access to be compatible with foundational medical ethics and principles of non-discrimination. Key messages Regardless of legal knowledge held, when law conflicted with foundational medical ethics, the intrusion of law in the medical profession lead to the explicit rejection of law. Findings accent the need for laws addressing healthcare access to be compatible with foundational medical ethics and principles of non-discrimination.