An Ethical Analysis of the Mandatory Exclusion of Refugees and Immigrants Who Test HIV-Positive

Abstract

Should persons claiming refugee status in Canada to escape danger or persecution be tested for HIV and refused asylum if they test positive? If refugees are admitted to Canada on humanitarian and compassionate grounds, should that compassion not extend to individuals who have the additional misfortune of being HIV-positive? Should persons applying for immigrant status in Canada in order to improve their well-being or enhance their economic prospects be tested for HIV and refused permanent residence if they test positive? Should HIV-positive applicants automatically be excluded on the presumption that they would cost Canadian society more than they could ever contribute? Those are the immediate ethical questions raised by proposals to screen prospective refugees and immigrants for HIV and deny admission to everyone who tests positive. Answering them requires that deeper background issues be addressed: What is the moral status of national borders? Is the sovereignty of the nation-state absolute, so that a grant of permanent residence is no more than a privilege that a nation-state may bestow or withhold for any reason? Do affluent countries have an obligation to help those who are worst-off in the world, or is whatever aid they choose to dispense merely a matter of charity? If prosperous countries have an ethical duty to provide foreign aid, may they admit refugees and immigrants as an alternative way of fulfilling that duty? And perhaps most difficult of all, how much national sacrifice may morality reasonably demand on behalf of people outside a nation’s borders?