**4. Existing laws and guidelines**

An examination of ethics is incomplete without a look at current legal provisions. The existing moral code of the people dramatically influences the laws and policies of the state. The United Nations 1951 convention and 1967 protocol had positive outcomes, with 148 countries attending and agreeing to the framework that was laid out. The global policy structure with ramifications for international health security has been recently defined by the World Health Assembly Resolution (2008), the Executive Committee (2007) and the Guiding Principles on Migrants and Refugees Health (2007), and Resolution 70.15 of the World Health Assembly on 2017 on Refugee and Migrants Health.

Other relevant frameworks and resolutions from the past include [7, 8]:


#### **5. Current situation and global trend**

Changes in governments over time and change in the attitudes of people have made it hard to ensure enforcement of the international laws and guidelines on the provision of healthcare to refugees. Some of the countries such as Germany and Canada welcomed several refugees and provided asylum to them, while others such as the United States and Austria have taken a more rigid stance against them and have implemented legal and physical barriers against asylum seekers. These governments were elected based on their border policies, and therefore, the decisions are not those of individual people alone but a collective majority. This general trend based on a narrative of fear, racism, and scarcity is, unfortunately, proving to be an excellent political strategy. Chancellor of Germany, Angela Merkel, who strongly supported an open border for refugees making Germany one of the most refugee-friendly countries in Europe, had a decrease in popularity shortly after the most significant intake of refugees. News articles reported that her decisions were not well received in the country.

Similarly, Donald J. Trump, president of the United States of America who won in 2016, has a strong anti-immigrant and closed border policy, which continues to be popular with many people in the United States. These recent global trends have made it harder to enforce policies to ensure health security for refugees. The British voted, by a significant majority, to leave the European Union for similar reasons. They cited "unacceptable strains on housing, welfare, and education" as one of the prime reasons for this decision [9–11].

Governments supporting closed borders and fueling racism have led to increase in the backlash against immigrants or ethnically different groups. Right wing support correlated with hate crimes in Germany according to a survey analysis. Similary, hate crimes in India had surged by 300% which correlated significantly with the election of the right wing Hindu Nationalistic Party, "BJP" [12]. These changes are concerning as it not only endangers the new vulnerable influx population but also affects the integrated existing immigrants and their future generations. Far right policy changes could leave all refugees, immigrants, and even resident nonimmigrants without basic healthcare.

#### **6. Theories of morality**

Moral theories attempt to determine right and wrong conduct. They allow individuals and, in extension, countries to critically evaluate the decisions they make in terms of impact beyond the social and economic implications. Morality has allowed the human species to survive in mutual harmony and to promote maximum welfare.

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*A Moral Perspective on Refugee Healthcare DOI: http://dx.doi.org/10.5772/intechopen.92110*

casuistry [13].

**6.1 Utilitarianism**

**6.2 Rawls theory of justice**

There are many moral theories. Some of the well-studied ones are utilitarianism, Rawls theory of Justice, Kantianism, virtue theory, four principles approach, and

Utilitarianism holds that morality must aim to maximize human welfare and happiness as a species. John Stuart Mill, a utilitarian philosopher, claimed that actions are right in the proportion they tend to promote happiness and vice versa,

This moral theory supports many actions in medicine, such as triage and social medicine. However, it fails to take into account the age of the person or our obligations toward specific people such as our children or parents. Another reason why this theory is hard to uphold is the degree of self-sacrifice it demands. It obliges us to sacrifice our interests and the interests of the people close to us for the sake of people that we do not know if that is what will maximize good or utility. For example, it is hard to convince a physician in a developed world to move to a developing country while leaving or endangering their family for "utility." It is also hard to convince a physician in a developing country to avoid pursuing opportunities in developed countries. If going by utilitarian analysis for providing healthcare for refugees, the sheer number of refugees justifies spending resources to provide healthcare to this vulnerable population. In other words, the burden of cost is not high when compared to the suffering of the large number of refugees [4, 13, 14].

Rawls' Theory of Justice [15, 16] is unique in that it considers the moral, cultural, and experiential differences among us that account for our current value system. Understanding that social systems distort our views and bias our opinions of morality one way or the other, Rawls suggests that in order to construct a system or solution for a problem, it must be done objectively. He suggested that a solution must be made after assuming that one has full control and that once implemented, they would be placed back in the society with random features such as sex, race, socioeconomic status, or prior experiences of oppression or wealth. For example, in many countries around the world, students from a university in the United States that is not very competitive are given higher status than a student from one of the top-tier Pakistani universities. Although one might argue that the educational system in the United States third-tier university might be better than the education at a top-tier university from a developing nation, this is also not true as evidenced by standard test scores. If used to make a decision about admission criteria, Rawls' theory might work out the best possible moral solution to the question. Considering these ambiguities, Rawls holds that an objective stance called "The Original Position" (OP) might be the best way to ensure that lawmakers and politicians, who are responsible for all those who are residing in that area, make decisions that are not influenced by their biases. The OP is meant to be impartial while logically striving to aim for systems that have a high probability of supporting progress and decreasing distress in society. The assumption that the policymaker will have no control over their features when placed back in the system hopes to negate some of the biases while making system decisions that impact many people. The privilege walk activity [17] famously demonstrated how the less privileged must work twice as harder than the privileged. Rawls' concepts also show how dominant systems, countries and organizations, construct systems that ensure their dominance. Rawls believes that social stability can only be achieved by elevating everyone to equal moral worth. Although

where happiness is intended pleasure and absence of pain.

There are many moral theories. Some of the well-studied ones are utilitarianism, Rawls theory of Justice, Kantianism, virtue theory, four principles approach, and casuistry [13].
