Divided Loyalties: Fire and ICE

This essay explores the challenges of dual loyalty in the emergency setting. The author, an emergency room psychiatrist, finds himself caring for a patient who has been detained by U.S. Immigration and Customs Enforcement for potential deportation under circumstances that the author finds unjust. He also recognizes that the patient's reported psychiatric symptoms are likely not of the nature or severity to justify a psychiatric admission that might forestall deportation. While the author has taught the subject of dual loyalty in medicine for many years, he struggles with the question of how to balance his duties to further his patient's welfare with his legal obligations to the state and the rule of law.