Caring for the Trafficked Patient: Ethical Challenges and Recommendations for Health Care Professionals

Abstract

Human trafficking is an egregious human rights violation with profound negative physical and psychological consequences, including communicable diseases, substance use disorders, and mental illnesses. The health needs of this population are multiple, complex, and influenced by past and present experiences of abuse, neglect, and exploitation. Effective health care services for trafficked patients require clinicians to consider individual patients' needs, wishes, goals, priorities, risks, and vulnerabilities as well as public health implications and even resource allocation. Applying the bioethical principles of respect for autonomy, nonmaleficence, beneficence, and justice, this article considers the ethics of care model as a trauma-informed framework for providing health care to human trafficking victims and survivors. IntroductionHealth care is an important component of broader anti-trafficking efforts, since profound physical and psychological illnesses and injuries can be results of human trafficking. While in captivity, trafficked persons might seek or be brought for health care for myriad injuries, infections, and chronic conditions, including burns, penetrating wounds, fractured bones, traumatic brain injuries, chemical exposures, heat exhaustion, dehydration, malnutrition, communicable diseases, substance use complications including overdoses, sexually transmitted infections (STIs), unsafe abortion complications, chronic pain syndromes, and chronic untreated conditions and their sequelae [1][2][3][4]. Acute episodes of intense anxiety, depression, traumatic stress, dissociation, self-injury, and suicidality as a result of the psychological trauma can also prompt victims or survivors to present in health care settings [1][2][3][4]. Research suggests that up to 87.8 percent of trafficked persons access health care [3,[5][6][7]. Health care visits represent unique opportunities for health care professionals to provide clinical care and offer assistance to victims and survivors of trafficking.

Caring for trafficked and unidentified patients in the EHR shadows: Shining a light by sharing the data

“…Pennsylvania, New Jersey, and North Carolina (the geographic area served by the study sites) are recognized source, transit, and destination states for HT, having ranked in 2015 among the top 12 states for number of calls to the National Human Trafficking Hotline [16] and the top 15 states for reported HT cases [17]. Scholars have estimated 37–50% of trafficked persons encounter healthcare professionals during their captivity [18], with one extensively cited report finding as many as 88% of trafficked persons having contact with a healthcare provider during their exploitation ([19]; see also [18, 20–21]). Ongoing efforts aim to improve the training of healthcare professionals to recognize indicators of HT [22–24], improve the identification of trafficked persons [25], apply victim-centered and trauma-informed care consistently [26], improve healthcare system responses to HT [22, 27], and develop specific materials for healthcare settings [28–29].…”

Trauma Informed Care: Trafficking Out-Comes (TIC TOC Study)

“…The trauma-informed approach to care is relatively new 13 and has a limited evidence base although is widely supported as a valuable strategy for working with vulnerable populations. 44 - 47 Studies of those who have obtained health and mental health care during periods of exploitation attest to the importance of the nonjudgmental, empathic, empowering, and transparent approach to patient interactions. 16 , 22 , 23 Individuals report that barriers to seeking healthcare and disclosing details of exploitation often center around concerns of healthcare provider bias and judgment, intolerance, and insensitivity as well as potential lapses in confidentiality.…”