• Amanda M Gutierrez, Jacob D Hofstetter, Emma L Dishner, Elizabeth Chiao, Dilreet Rai, and Amy L McGuire.
• Amanda M. Gutierrez, M.P.H., is a Research Assistant at the Baylor College of Medicine Center for Medical Ethics and Health Policy in Houston, Texas. Jacob D. Hofstetter, M.G.P.S., is a Research and Policy Associate at the Massachusetts Appleseed Center for Law and Justice in Boston, Massachusetts. Emma Dishner, M.D., M.P.H., recently graduated from her Infectious Diseases fellowship from Baylor College of Medicine in Houston, Texas and will soon begin working with North Texas Infectious Diseases Consultants. Elizabeth Chiao, M.D., M.P.H., is a Professor of Medicine at Baylor College of Medicine in Houston, Texas. Dilreet Rai, M.D., is a hospitalist at the Michael E. Debakey VA Medical Center in Houston, Texas. Amy L. McGuire, J.D., Ph.D., is the Leon Jaworski Professor of Biomedical Ethics and Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. Dr. McGuire serves on the program committee for the Greenwall Foundation Faculty Scholars Program in Bioethics and is immediate past president of the Association of Bioethics Program Directors.
• J Law Med Ethics. 2020 Mar 1; 48 (1): 161-168.

AbstractRecently, John Doe, an undocumented immigrant who was detained by United States Immigration and Customs Enforcement (ICE), was admitted to a hospital off-site from a detention facility. Custodial officers accompanied Mr. Doe into the exam room and refused to leave as physicians examined him. In this analysis, we examine the ethical dilemmas this case brings to light concerning the treatment of patients in immigration detention and their rights to privacy. We analyze what US law and immigration detention standards allow regarding immigration enforcement or custodial officers' presence in medical exams and documentation of detainee health information. We describe the ethical implications of the presence of officers in medical exam rooms, including its effects on the quality of the patient-provider relationship, patient privacy and confidentiality, and provider's ability to provide ethical care. We conclude that the presence of immigration enforcement or custodial officers during medical examination of detainees is a breach of the right to privacy of detainees who are not an obvious threat to the public. We urge ICE and the US Department of Homeland Security to clarify standards for and tighten enforcement around when officers are legally allowed to be stationed in medical exam rooms and document detainees' information.

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