Autonomy Without Borders? Understanding the Impact of Undocumented Residence Status on Healthcare Relationships in Belgium.

This article examines how Belgium's Urgent Medical Aid (UMA) law regulates access to public healthcare for undocumented migrants through a complex administrative procedure, and how this framework affects their autonomy and relationships with healthcare workers. Using empirical-ethical research and the concept of relational autonomy, the study finds that legal and structural barriers mark undocumented migrants as "others," impose burdensome administrative controls, and limit formal treatment options, leading healthcare workers to develop informal, discretionary care practices. These informal networks can enhance undocumented patients' access and autonomy but also create dependence on trusted healthcare providers, raising concerns about unpredictability and potential discrimination in care. The authors argue for integrating undocumented migrants fully into the public healthcare system to better support their autonomy and recommend that healthcare workers engage in committed relationships while advocating for policy changes addressing structural exclusion.