When duties collide: Navigating the competing commitments in the care of undocumented patients

Aliza Narva, JD, MSN, RN, HEC-C – • Hospital of the University of Pennsylvania

Abstract: The legal and social status of undocumented people in the United States has been a contentious and polarizing topic, particularly during the 2024 election cycle. Since January 2025, political upheaval and executive overreach has given rise to significant safety concerns not only for patients who are undocumented, but also for so-called Dreamers, and for those who hold birthright citizenship. Hospitals, which have historically been considered safe spaces, are no longer off-limits from raids by Immigration and Customs Enforcement, giving rise to uncertainty about the patient-based obligations of nurses who may find themselves confronted by law enforcement in the clinical setting.

In this paper, we examine the tension between nursing’s legal and ethical commitments in this context. While nurses have an ethical obligation, founded in the duty to care, to protect and advocate for the patient first and foremost, an ICE raid presents conflicting legal duties. Using the 2025 ANA Code of Ethics, we argue that nurses must work to minimize and mitigate harm to vulnerable patients and place a primacy on upholding the constitutional rights of those in their care, while also minimizing the risk of legal harms for everyone involved.

Keywords: nursing, law enforcement, immigration