Doctors must defy ICE to fulfill their duty to heal

Hospitals are meant to be sanctuaries of healing, yet immigration enforcement policies are turning them into sites of surveillance, fear and exclusion.

Health care workers today face a stark mandate: comply with federal policies that permit Immigration and Customs Enforcement agents to operate within medical settings, or resist participation in a system that undermines patient trust and public health. This dilemma is not merely an ethical concern; it is a profound threat to health care access, professional integrity and the moral foundation of medicine itself.

The Trump administration's rollback of protections barring ICE from hospitals and clinics has opened the door for enforcement actions that deter individuals living in the country illegally from seeking care. Reports from across the country show that fear of deportation has led pregnant women to avoid prenatal visits, individuals with chronic illnesses to skip necessary treatments and families to forgo emergency care.

These effects ripple beyond the undocumented population, increasing the spread of infectious diseases, exacerbating health disparities and weakening trust in health care institutions. The erosion of trust in medical spaces due to immigration enforcement disproportionately harms already marginalized communities, further straining an overburdened health care system.

Yet, health care workers are not powerless in this moment. The law provides crucial safeguards that, when understood and enforced, can mitigate the damage of immigration enforcement in hospitals.

The Fourth Amendment protects patients from unwarranted searches and seizures, meaning ICE agents cannot enter private hospital spaces without a judicial warrant.

The Health Insurance Portability and Accountability Act prohibits the unauthorized disclosure of patient information, making any health care worker who voluntarily hands over records to immigration authorities complicit in a breach of federal law.

The Emergency Medical Treatment and Labor Act further guarantees that emergency medical care must be provided regardless of immigration status, making the presence of ICE in hospitals anathema to both medical ethics and legal obligations.

Despite these legal protections, ICE continues to employ intimidation tactics, exploiting health care workers' uncertainty about their rights. Agents may present administrative warrants — documents signed by ICE officials, not judges — to gain access to restricted areas or demand information about patients. However, these warrants carry no legal authority in medical settings.

Health care institutions must equip their staff with the knowledge to recognize and challenge such deceptive practices. Hospitals should establish clear protocols: If ICE appears without a judicial warrant, staff should refuse entry, document the encounter and notify legal representatives immediately.

Beyond legal recourse, history offers a moral precedent for health care workers facing unjust mandates. The biblical midwives Shiphrah and Puah defied Pharaoh’s orders to kill newborn Hebrew boys, instead finding ways to protect life under the guise of compliance. Their resistance was not overt rebellion; it was a strategic assertion of moral duty in the face of state-sanctioned harm.

Today’s health care workers are called to a similar form of ethical defiance — not only by refusing to comply with unjust policies but by actively creating spaces of safety and advocacy within their institutions.

Some hospitals have already taken a stand, enacting sanctuary policies that prohibit cooperation with immigration enforcement and reaffirming their commitment to patient confidentiality. Health care institutions nationwide should follow suit by implementing training programs that educate staff on their legal rights, forming partnerships with immigrant advocacy groups and offering legal support to patients at risk of deportation.

In addition, hospitals must develop emergency response teams trained to manage ICE encounters, ensuring that staff can respond quickly and legally when enforcement officers arrive at their facilities.

Moreover, health care workers should engage in broader advocacy efforts, lobbying for policies that protect patients who are not documented and calling for legislative action that explicitly prohibits ICE presence in medical settings. Physicians and hospital administrators must leverage their positions to speak out against these enforcement tactics, using their collective voice to push back against policies that compromise public health.

The medical community has historically played a vital role in social justice movements, from advocating for civil rights to championing the fight against HIV/AIDS stigma. The current moment demands similar action.

Critics argue that defying federal enforcement policies places health care workers at legal risk. However, history vindicates those who resist unjust laws. From the Civil Rights Movement to medical professionals who opposed apartheid-era racial segregation in hospitals, defiance has often been a necessary precursor to justice.

The presence of ICE in hospitals is not merely a policy issue; it is a moral test for the medical profession. Will we allow the principles of compassionate care to be eroded by the politics of exclusion, or will we take a stand for the sanctity of health care as a universal human right?

The time for passive concern has passed. Health care workers must act now to protect the vulnerable, uphold their ethical commitments and ensure that hospitals remain spaces of healing, not fear. This requires a collective effort, from individual clinicians to hospital administrators to policymakers.

Failure to act will not only harm patients who are in the country illegally but will also erode the foundational trust that underpins the entire health care system. The cost of inaction will not be measured in policy debates or court rulings but in human lives.

The mandate is clear: Resist, protect and reaffirm the duty to heal.

Y. Tony Yang is a professor of health policy at the George Washington University’s School of Nursing and Milken Institute School of Public Health.

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