This article examines how U.S. immigration law extends into the health care safety net, enacting medical legal violence that diminishes noncitizens’ health chances and transforms clinical practices. Drawing on interviews with health care workers in three U.S. states from 2015 to 2020, I ask how federal citizenship-based exclusions within an already stratified health care system shape the clinical trajectories of noncitizens in safety-net institutions. Focusing specifically on cancer care, I find that increasingly anti-immigrant federal policies often reshape clinical practices toward noncitizens with a complex, life-threatening condition as they approach a “specialty care cliff” by (1) creating time penalties that keep many noncitizens in a protracted state of injury and (2) deterring noncitizens from seeking care through threats of immigration enforcement. Through these processes, medical legal violence also creates the potential for moral injury among health care workers, who must adapt clinical practices in response to socio-legal boundaries of belonging.

中文翻译：

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二级护理：移民法如何改变安全网中的临床实践


本文探讨了美国移民法如何延伸到医疗保健安全网，实施医疗法律暴力，从而减少非公民的健康机会并改变临床实践。根据 2015 年至 2020 年对美国三个州医疗保健工作者的采访，我询问在已经分层的医疗保健系统中基于联邦公民身份的排除如何影响安全网机构中非公民的临床轨迹。特别关注癌症护理，我发现越来越多的反移民联邦政策经常会重塑针对患有复杂、危及生命的病情的非公民的临床实践，因为他们接近“专业护理悬崖”，方法是（1）设置时间惩罚，使许多非公民无法继续治疗。长期受伤状态；(2) 通过移民执法威胁阻止非公民寻求护理。通过这些过程，医疗法律暴力还可能对医护人员造成道德伤害，他们必须调整临床实践以适应社会法律归属界限。