AMA Journal of Ethics^®

In making decisions about allocating scarce organs, undocumented immigrant status should not be used as a proxy for the legitimate criterion of likelihood of success because uncertainty about future ability to pay or insurance coverage applies to almost everyone listed for transplant.

Protecting one’s moral integrity may require a conscience clause that protects positive conscience claims by permitting individuals to perform actions that are otherwise prohibited by legal or institutional rules.

Society is best served by an approach to conscience that combines a progressive understanding of patients’ needs, a nuanced determination of when those needs translate into claims, and a limited role for conscientious refusal.

Cultural sensitivity training, language assistance, and diversity-oriented hiring policies can help medical organizations integrate immigrants into the American health care system.

An undercurrent in all debates about allocation of health care resources to the poor is the matter of access to and coverage of health care for immigrants, particularly low-income and undocumented ones.

We must not pit immigration policy and health care needs against one another. We need better policy on immigration, and that policy should confront immigration at the workplace and at the border—not in the hospital emergency room.