Hospitals Should Not Collect Citizenship Info: Ethicist

This transcript has been edited for clarity. 
Hi. I’m Art Caplan. I’m at the Division of Medical Ethics at NYU’s Grossman School of Medicine in New York City. 
Recently, hospitals in Texas were put on notice that the governor wants them to collect information on the immigration or citizenship status of their patients. Furthermore, the governor recently issued an executive order in Texas, saying data should be collected on the cost of caring for people who are identified as being here without their papers, colloquially sometimes referred to as illegal immigrants.
I think this is a terrible idea. It risks public health, and it is offensive to the ethical stance of medicine, which is to treat people regardless of citizenship and regardless of their status, to try to respond to serious medical emergencies. 
In fact, that’s what the federal law says is something that emergency rooms have to do — stabilize people and treat them without regard to their status, income, or anything else. The statute is called EMTALA, the Emergency Medical Treatment and Labor Act, and it is a piece of legislation that explicitly was enacted by Congress to stop hospitals from refusing people who couldn’t pay or dumping people outside the hospital, saying they never really got into the emergency room, so there was no duty to take care of them.
The position, and I think it’s the right one, is that doctors should not be paying attention to the citizenship status of someone who needs care. I’m talking about emergency hospital care. It’s hard to figure out how you would ever enforce something at the doctor’s office or in other healthcare settings.
As far as hospitals go, they have the duty to help the community and to really stand up for health. Why is that so? Really, there are two reasons. First, if you say the hospital is going to be collecting status on citizenship, there are definitely people who are not going to come in. They’re going to stay away from the hospital. They fear getting identified. 
They probably don’t want to contribute to the governor’s idea of totaling up the cost of healthcare and making that a political issue in terms of will they ever get citizenship or could they be removed from the US back to other countries. There’s every motive I can think of to not show up at the hospital and tough it out. That isn’t the stance I think we want the sick and the ill to take relative to trying to get healthcare. 
The other problem is that, from a public health perspective, you don’t want people afraid to show up at the hospital. If someone has a venereal disease, you want that treated so it is not spreading in the community. If someone has an infectious disease, you want them treated. If someone has a mental health problem, you don’t want them going out and committing a violent act against somebody else because their mental health crisis was not addressed. 
When you start to collect information on citizenship, you’re putting public health at risk because you’re starting to say, well, maybe we shouldn’t treat people who aren’t US citizens. If there are many people in Texas or other states who aren’t US citizens, it doesn’t mean they don’t have infectious diseases, health crises that can put others at risk, and so on. 
At the end of the day, there’s certainly plenty to say and debate about immigration and citizenship status, but I think that belongs in the political sphere. It doesn’t belong at the emergency room. It doesn’t belong with a hospital trying to figure out on admissions who’s qualified and who isn’t qualified, and taking, by the way, people’s word about their status in order to deliver care. 
Put public health first in Texas; have the immigration fight in a separate sphere.
I’m Art Caplan. I’m at the Division of Medical Ethics at the NYU Grossman School of Medicine. Thank you very much for watching.