Access to Life: Advanced Heart Failure Therapies for Undocumented Immigrants

The U.S. healthcare system systematically excludes undocumented immigrants (UIs) from life-sustaining treatments for advanced heart failure (AHF), creating profound ethical violations and health disparities. This thesis demonstrates how excluding UIs from AHF therapies breaches justice, autonomy, beneficence, and non-maleficence by restricting access to mechanical circulatory support, inotropic therapy, and heart transplants. Analysis of Medicaid restrictions, legal barriers, and a representative patient case study reveals how current policies institutionalize preventable harm. Contrasting these failures with successful state-level expansions for end-stage renal disease (ESRD), the work proposes actionable solutions to redress inequities exacerbated by immigration policies. The findings underscore that structural reform is both ethically imperative and financially viable, with critical implications for public health, equity, and clinician moral distress. This thesis calls for immediate policy changes guided by the ESRD model and further research to address healthcare exclusion.

Grantor dc:publisher

Temple University. Libraries

Year dc:date.issued

2025

Author dc:creator

• Brenner, Caitlyn

Advisor dc:contributor.advisor

• Tuohy, Brian

• Medical ethics
• Health sciences
• Public health
• Advanced heart failure
• Health equity
• Justice
• Undocumented immigrants
• Urban bioethics

Statement dc:rights

• IN COPYRIGHT- This Rights Statement can be used for an Item that is in copyright. Using this statement implies that the organization making this Item available has determined that the Item is in copyright and either is the rights-holder, has obtained permission from the rights-holder(s) to make their Work(s) available, or makes the Item available under an exception or limitation to copyright (including Fair Use) that entitles it to make the Item available.

Licence dc:rights.uri

• http://rightsstatements.org/vocab/InC/1.0/

Language dc:language.iso

eng

Repository record dc:identifier.uri

https://scholarshare.temple.edu/handle/20.500.12613/11088

OAI identifier oai:identifier

oai:scholarshare.temple.edu:20.500.12613/11088