It’s no secret that the Trump White House has taken a different approach to immigration than past administrations. Previously, Immigration and Customs Enforcement prioritized deporting immigrants with a criminal background. Today, that is no longer the case. This new approach has generated fear in the immigrant community, and has become a looming public health concern: many undocumented patients aren’t sure whether they can trust healthcare professionals.

Immigration-related stress can impact health negatively, much like any long-term uncertainty and uncontrollable stressor,” wrote Mark G. Kuczewski, PhD, professor of medical ethics at the Loyola University Chicago Stritch School of Medicine in Maywood, Illinois, and colleagues. “[These] fears can cause patients to avoid medical care because they might not be sure if a hospital or clinic cooperates with immigration authorities and might place them in jeopardy.” The article appears in the AMA Journal of Ethics.

With 11 million undocumented immigrants in the United States, it is a public health concern if this population feels they cannot safely visit a physician’s office to receive care. For healthcare professionals who have undocumented patients in their practice, Dr Kuczewski and colleagues provide recommendations for sanctuary doctoring.

Continue Reading

Sanctuary doctoring supports and empowers patients, providing them with helpful action items. To encourage a safe space, the authors recommend creating an environment that makes it easy for undocumented patients to speak about their concerns, if they feel so inclined. This can be done using signs posted prominently throughout the office or on buttons that clinicians can wear.

The authors cite a brochure they developed for waiting rooms that says, “If you would like to talk with your doctor about problems having to do with immigration, take this sheet into the exam room and hand it to the doctor.” That would help make the patient feel more comfortable broaching the topic.

Related Articles

“Physicians should make clear to the patient that they are motivated by health concerns — that this kind of anxiety can influence your health,” the authors concluded. “Reassure the patient that they will not record the patient’s immigration status within the health record.”

Providing that peace of mind will help foster a safe space for patients to share their concerns and receive the care they need.


Kuczewski MG, Mejias-Beck J, Blair A. Good sanctuary doctoring for undocumented patients. AMA J Ethics. 2019;21(1):E78-E85.