The Hippocratic Oath does not require citizenship as a condition of treatment. The oath, which serves as a foundational ethical guideline for physicians, emphasizes principles such as doing no harm, maintaining patient confidentiality, and practicing medicine ethically and with integrity. It focuses on the physician’s responsibilities to patients and the ethical practice of medicine rather than any conditions related to a patient’s citizenship or nationality.
So, why did this issue surface when a treatment team could not ascertain a patient’s citizenship status—his “green card” had expired—and hesitated to treat him? In my 40-plus years of practice, I have never encountered this as a problem, and I have treated many undocumented individuals.
Straying into unfamiliar territory, I decided to research this topic further. I discovered that it is not uncommon for issues related to a patient’s citizenship or immigration status to arise in health care settings due to administrative and legal considerations rather than medical ethics. One of the main reasons is related to insurance and payment. A patient’s citizenship or immigration status can influence their eligibility for certain types of health insurance or public benefits, which can affect their ability to pay for services and present administrative challenges for the treatment team.
Furthermore, health care facilities are required to comply with various state and federal regulations. Some of these regulations may necessitate verification of identity and legal status for certain types of care or services. Additionally, some services, particularly those funded by government programs, may require legal residency or citizenship status for eligibility. Lastly, maintaining accurate patient records is a crucial part of both medical and administrative processes, and uncertainty about a patient’s legal status can add a layer of complexity to clinical documentation.
Despite these concerns, it is important to note that the ethical obligation of health care providers, as outlined by the Hippocratic Oath and other ethical tenets, is to provide care to all patients regardless of their citizenship status. Therefore, health care providers must ensure that these administrative hurdles do not obstruct access to necessary medical care.
Will that still be the case under the Trump administration?
President Trump has implemented numerous immigration policy changes aimed at restricting entry at the border and increasing interior enforcement, including rescinding protections for sensitive areas like schools and health care facilities. These measures primarily target undocumented immigrants but have widespread effects on mixed-status families, including U.S.-born children. Enhanced enforcement, including raids and mass deportations, has raised fears among immigrant communities, potentially affecting their health, well-being, employment, and daily life.
Restrictive policies have led to increased stress and anxiety, particularly among children, and deterred immigrant families from accessing health care and social services. Family separations and detentions can result in long-term mental and physical health consequences. Detention facilities are already strained, with reports of poor conditions and inadequate medical care.
When an undocumented individual shows up at your health care doorstep, what will you do? The answer, of course, is: treat them. But soon afterward, you may find ICE agents knocking on that door requesting information about them, including protected health information (PHI), and may even seek to question or detain patients when they have been admitted to the hospital, come to a clinic to obtain treatment, or visit the facility. What is your course of action then?
According to one attorney firm, to prepare for potential ICE enforcement, health care providers should update policies, designate a legal point of contact, train staff on handling law enforcement inquiries, and establish protocols to verify agents’ authority. Staff should avoid sharing patient information without legal review, as HIPAA does not require disclosure of PHI except in limited circumstances. Health care facilities must balance patient privacy protections with legal obligations while ensuring compliance with law enforcement procedures.
No doubt physicians and other health care practitioners will be caught in the crosshairs. Once again, I strongly encourage doctors to provide treatment to undocumented immigrants. Providing therapy is firmly in keeping with the Hippocratic Oath and medical ethics, which support treating all patients without discrimination. We went to medical school to learn how to provide care based on medical need, not legal status. Besides, ensuring access to health care for everyone, including undocumented immigrants, helps prevent the spread of infectious diseases, reduces emergency room overcrowding, and improves overall community health.
And let’s’ not forget that in the U.S., federal law, specifically the Emergency Medical Treatment and Labor Act (EMTALA), requires hospitals to provide emergency care to all individuals, regardless of immigration status or ability to pay. Many undocumented immigrants face significant barriers to accessing care, leading to untreated chronic conditions, poor health outcomes, and higher long-term health costs. Providing care aligns with principles of compassion and justice.
While some argue that treating undocumented immigrants strains health care resources, research suggests that they contribute to the economy through taxes and labor. Additionally, preventive and routine care can reduce costly emergency interventions. Ultimately, doctors should focus on their role as healers, advocating for equitable health care access while leaving administrators to deal with laws and institutional policies.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of several books on narrative medicine, including Medicine on Fire: A Narrative Travelogue and Story Treasures: Medical Essays and Insights in the Narrative Tradition.
