The Hippocratic Oath May Require Doctors to Disobey Trump
Donald Trump's ICE raids on hospitals endanger immigrants and attack the ethical foundations of medicine. Health workers' fundamental duty is to patients, not the law, and they must resist policies that turn care facilities into sites of surveillance.
US president Donald Trump delivers his inaugural address on January 20, 2025, in Washington, DC. (Photo by Chip Somodevilla / AFP via Getty Images)
The Trump administration’s decision this week to overturn rules prohibiting Immigration and Customs Enforcement (ICE) from raiding hospitals and clinics is more than a cruel act of political theater. It is a direct assault on public health and the ethical foundations of medicine. It also forces health care workers to confront an ethical choice that we are trained to ignore: Will we uphold “the law” or will we prioritize the principles of care and solidarity upon which the caregiving professions are ostensibly founded, including when that requires civil disobedience?
Hospitals are meant to be places of refuge. If ICE agents — or police officers criminalizing reproductive or gender-affirming care — are allowed to roam hospital hallways or search emergency departments, this age-old ideal is trampled underfoot. This isn’t a matter of abstract principles; it has major consequences for population-level health. For undocumented people, the threat of being arrested while seeking care can mean the difference between life and death. Fear will drive people away from clinics, emergency rooms, and prenatal care. It will force children to suffer at home rather than risk their parents being taken from them if they go to hospitals for treatment. This will lead to preventable deaths, the worsening of chronic illnesses, and the preventable spread of infectious diseases (including, potentially, of emerging H5N1 bird flu, to which farmworkers have been exposed) — not only among undocumented people but across entire communities and, ultimately, the whole country.
ICE raids also threaten the very functioning of our health care systems. Undocumented workers — nurses, home health aides, janitors, food service staff — are essential coworkers in our medical institutions. Targeting them, or terrorizing their families and communities, will disrupt essential services at hospitals and clinics already stretched thin by widespread labor shortages (tied, in part, to exploitative labor practices in our capitalist health systems), particularly in underserved areas. When these workers are forced into hiding, the consequences ripple outward, destabilizing care for everyone.
Health workers are key actors in our current political context, particularly when it comes to immigrants’ rights. Our fundamental obligation is to patients and communities, not to the law nor to our employers. We should all, from medical and nursing trainees to senior doctors and health administrators, ask ourselves: What will we do when the law contravenes our duty to care for those in need? What happens when following the law and obeying your boss means enabling the persecution of vulnerable people and the suffering of our patients and neighbors?
The answer is clear. Basic medical ethics demands that we prioritize care over compliance. Genuine commitment to caregiving under US health capitalism — where laws and policies routinely prioritize profit over patients — requires breaking rules and laws, something the physician and ethicist Robert Macauley once glossed as “the Hippocratic Underground.” Even traditional authorities in medicine and bioethics acknowledge this, including in the pages of the field’s most prestigious and conservative journals. This is not just an academic point; it is a pressing practical imperative. But too often, whether out of fear or ingrained anticipatory obedience in an intensely hierarchical medical profession that selects for and encourages automatic rule-following while disciplining those who don’t pay deference to corrupt professional norms and institutions, health workers have failed to follow it. As a consequence, the tradition of civil disobedience in the American medical field is shamefully thin, and passively watching thousands of people die each year due to obstructed access to health care has been widely normalized.
Hospital administrators, who are commonly rewarded with millions of dollars in annual pay for prioritizing the financial interests of our health institutions above all else, are pleased by docile doctors and urge continued compliance with unjust rules to protect hospitals’ bottom lines. But health care workers must reject these managerial logics. We cannot allow concerns over institutions’ legal and financial risks to override our personal and collective duty to care for those in need.
The “Hippocratic Underground” in Action
Fortunately, in the case of ICE and protecting our patients from them, breaking the law is, in most cases, not necessary. Given that law is the product of politics and that our nation’s policies are growing crueler and more xenophobic by the day, that may soon change. Until it does, we must know how to use what legal rights we still have.
Preparation is key. Health care workers must be ready to act when ICE targets either our coworkers or patients. All health workers should review succinct “know your rights” materials produced by organizations like the National Immigration Law Center and Interrupting Criminalization, which provides a consult service to health workers and institutions seeking to resist criminalization in health care.
Here are some essential steps that every health worker should implement when ICE shows up at your hospital or clinic.
First, stay calm. Remember your rights and the limits of ICE’s authority. Firmly refuse entry to ICE to any private spaces of a hospital or clinic unless they can produce a verifiable judicial warrant with “United States District Court” or the title of a state court clearly printed at the top of the warrant. Under the Fourth Amendment, ICE cannot enter private areas of a hospital or clinic — such as patient care spaces — without a valid judicial warrant. A proper warrant must be issued by a US district court or state court and must clearly specify the particular areas to be searched (e.g., “hospital” is overly vague and insufficient) and the particular materials or individuals to be detained (e.g., “any undocumented people” is not specific enough). Administrative warrants from ICE are inadequate to grant entry to private spaces, even as officers may lie and tell you otherwise. Deception is a key part of ICE tactics and is an explicit part of ICE agents’ training, during which they are often instructed to misrepresent themselves as local police, for example, in order to trick people into giving them information, letting them into private spaces, or lure people out into public spaces where they can arrest them.
Second, alert all staff. If ICE agents appear, notify coworkers and activate a preestablished response plan. Rapid communication is critical to ensuring a coordinated response. A system-wide page or text message, for example, can be arranged to be sent upon an ICE sighting at one’s medical facility.
Third, document everything. Record the names and badge numbers of ICE agents. Use phones or other devices to capture video evidence of their actions, while taking care to protect patient privacy. Documentation can be used to hold ICE accountable for violations.
Fourth, stay silent. Health care workers are not obligated to share information about themselves, patients, or coworkers. Exercise the right to remain silent and encourage others to do the same. You are not required to produce any identification or documents, and in fact you should remove identifying badges and place them in your pockets while ICE is present. Do not, however, provide false information or documents, as this can open you to subsequent legal jeopardy.
Fifth, do not physically obstruct ICE agents. Physically interfering with ICE agents can put you in legal jeopardy. Instead, voice your rights firmly and document any potential violations by ICE agents.
We should make full use of all available legal protections to protect our patients, but we must also recognize the law will not save us. Law is, as it has always been, a political tool and product. When it is controlled by the powerful — as it is under conditions of US oligarchy and our rigged two-party system, in which both parties are beholden to billionaires rather than workers — it serves their interests, not ours.
A Culture of Ethical Clarity
Our real strength lies in collective education and action via strategic preparation and constructive mass movements. Health care workers must organize, prepare, and contribute to networks of mutual aid and solidarity to assist those under threat and to support families after loved ones have been seized or deported. Hospitals and clinics should implement clear protocols, train staff to respond to ICE, and partner with immigrant rights groups, legal advocates, and immigrant aid organizations in our local areas.
To fuel and sustain this work, we must cultivate a culture of ethical clarity that unabashedly distinguishes between genuine ethics — such as action-oriented commitment to the principles of care, solidarity, and autonomy and to collectively fighting for policies that advance these principles — and simply following the demands of legal or professional authorities.
ICE raids, and simply the threat of them, often achieve destructive effects less by targeting specific people than by enforcing terror on entire immigrant communities and causing people to avoid schools, workplaces, and medical care. In light of that, we must take care to avoid being alarmist, which plays into Donald Trump’s hands and spreads harmful fear and distrust throughout our society. Trump’s threats have time and time again proven to be empty, and we shouldn’t overestimate his power or competence, but we must be ready for when action and harm actually manifest.
As the socialist intellectual Antonio Gramsci wrote during his decade-long political imprisonment for opposing fascism in Italy, when encountering state violence, “we need to create sober, patient people, who do not despair in the face of the worst horror and who do not get excited about every little thing. Pessimism of the intellect, optimism of the will.”
Health workers must embody this ethos. We cannot allow fear to divide communities and undermine a basic principle upon which effective care and public health depend: trust. By turning hospitals into sites of surveillance and punishment, the threat of ICE incursions into health care attacks the very heart of public health and caregiving. It’s time for health workers to collectively push back and make clear that we will not be intimidated into compromising on our most fundamental ethical responsibilities.