543 The rise of medicolegal anomie in physicians’ encounters with undocumented migration: the liminal patient, the disoriented guide, and the emergence of legal communitas

Abstract OP 8: Health Services 6, B304 (FCSH), September 3, 2025, 15:45 - 16:45 Aim This study sought to examine how physicians navigate medical, ethical, and legal complexities of treating “liminal patients” —people living as undocumented migrants, seeking medical care. Methods An abductive constructivist grounded theory approach was applied to in-depth qualitative interviews with 46 physicians practicing in seven public hospitals in Sweden. Results The empirical analysis identifies medicolegal anomie: a state of profound disorientation, estrangement, and paralysis, whereby the law, in the lived experience of the physician, is perceived as coercive, unjust, and incompatible with medical care. Reduced to bureaucratic actors, and overwhelmed by the disorder of things, physicians find themselves unable to reconcile the demands of law with their medical compass. Here, they morph into disoriented guides to the liminal patient. Yet, through the collapse of clinical norms, and a refusal to abandon their patient, legal communitas emerges—fragile, informal networks among like-minded clinicians offering solidarity and support. Legal communitas shapes how physicians navigate these encounters; providing solace in collective resistance. In its absence, disorientation and despair consume the physician, leading them outside of formal structures in the search for medical and ethical congruence. Conclusion This study introduces medicolegal anomie, a novel empirically-grounded theoretical concept illustrating how, when caring for liminal patients, legal and institutional pressures estrange physicians from their professional ethos and identity, blurring boundaries between legality and illegality. Depicting the nuanced and sometimes contradictory ways in which physicians guide these patients, this work highlights how opportunities to resolve pathways to care emerge through the collective solidarity of legal communitas. Nonetheless, while ways to circumvent structural constraints exist, by deepening physicians’ sense of ambivalence and complicity in systemic exclusion, these professionals’ lived experience of law renders outcomes for liminal patients profoundly unpredictable. Ultimately, individual physicians’ desperate manoeuvres do not dissolve the broader crises engendered where border enforcement expects the engagement of medicine.