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.