Honoring Alex Pretti’s Moral Courage and the Cost of Caring; The Hastings Center for Bioethics, February 17, 2026

 Connie M. Ulrich, Mary D. Naylor and Martha A. Q. Curley , The Hastings Center for Bioethics; Honoring Alex Pretti’s Moral Courage and the Cost of Caring

"The death of Alex Pretti, an ICU nurse who was killed last month in an anti-immigration protest in Minneapolis, is, first and foremost, a devastating loss for his loved ones. But it has also shaken the nursing profession to the core. 

People often encounter nurses at the bedside when they  are ill or someone close to them is ill. But nurses also have a long history of advocating for social justice in their communities, speaking out against unjust policies, challenging unsafe practices, and advancing public health reforms.

The 2025 Code of Ethics for Nurses reflects this activism. It calls on all nurses to be civically engaged and to work toward policies and systems that have positive ends for the communities in which we live and work. Alex met this call. 

Alex used his ICU training to help someone in need; it was second nature to him and reflected his primary obligation as a registered nurse to protect the rights and well-being of patients, families, and communities. He lost his life because he helped a woman during a protest against federal immigration action in Minneapolis. Pretti stepped in front of the woman, who was on the ground, to protect her from being pepper sprayed by U.S. Border Patrol agents. Agents then pinned Pretti to the ground and shot him.

Nurses are no strangers to conflict and moral turmoil. They take a professional and ethical oath to care for anyone — victim or perpetrator — regardless of their identity or ideological belief. But Alex’s death exposes a stark and troubling reality for every nurse and healthcare provider: Immigration enforcement agents are now occupying spaces that should be protected in hospitals, waiting rooms, lobbies, and clinics. These are places where patients must feel safe and trust that they will receive care without discrimination and be protected from intimidation. 

The presence of immigration enforcement agents in these places is creating profound moral distress and a climate of deep fear for all those who deliver care and for the people who need it most within these buildings. Nurses and other healthcare providers are caught in the age-old dilemma between what is ethical and what is legal: They question what they ought to do when faced with immigration enforcement agents standing outside hospital rooms and observing the care they are ethically and professionally obligated to protect.

When nurses and other healthcare providers cannot meet their ethical duties to protect the rights and welfare of their patients, this distress can intensify into a deeper wound with lingering residue of regret and a searing violation of their sense of integrity. 

For their part, patients may withhold critical health information, become afraid to ask questions, and mistrust health professionals when immigration enforcement agents are present. Patients who are immigrants are most vulnerable to these harms, but other patients may also experience them. The harms – to healthcare providers and patients – can ultimately compromise ethical decision-making, patient-and family-centered care, and the overall quality of care that all patients deserve, and healthcare providers are trained to deliver.

The patients and families cared for by Alex will always remember him. Nurses will remember Alex’s sacrifice – that his caring extended beyond the walls of his hospital to the stranger he protected in his community. 

Nurses can honor Alex’s moral courage through our individual and professional resolve. We must say no more to the infiltration of immigration enforcement into healthcare spaces that were previously off limits to them. We must speak out on re-establishing “safe zones,” hospital-wide policies that limit enforcement access, and confidential reporting mechanisms that reflect the humanity of the nursing profession towards those we took an oath to serve. 

May a better and more humane world prevail, reminding each of us that moral courage carries risk, but it also helps us rise to the occasion when change and moral repair are needed most. We are at that moment.

Connie M. Ulrich, PhD, RN, is a registered nurse and professor of nursing and of medical ethics and health policy at the University of Pennsylvania School of Nursing and a Hastings Center Fellow. LinkedIn: connieulrich1, X: @cm_ulrich

Mary D. Naylor, PhD, RN, is a registered nurse and professor of gerontology and nursing at Penn’s School of Nursing. LinkedIn: Mary_Naylor,  X: @MaryDNaylor

Martha A.Q. Curley, PhD, RN, is a registered nurse and professor of pediatric nursing at Penn’s School of Nursing.LinkedIn: Martha-a-q-curley, X: maqcurley, Bluesky: @maqc.bsky.social"

Audiey Kao, MD, PhD, on what physicians need to know about ethics in 2022; American Medical Association (AMA), January 5, 2022

 American Medical Association (AMA); Audiey Kao, MD, PhD, on what physicians need to know about ethics in 2022

"AMA's Moving Medicine video series amplifies physician voices and highlights developments and achievements throughout medicine.

Kicking off 2022 with the AMA's "Look Forward/Look Back” series, AMA Chief Experience Officer Todd Unger talks with Audiey Kao, MD, PhD, the AMA's vice president of ethics, about the AMA's critical work in medical ethics and what to expect in the months ahead.

Speaker

• Audiey Kao, MD, PhD, vice president, ethics, AMA...

Unger: One of the things I've learned, I know over the past year of talking to so many different physicians is, whatever was wrong with health care going into the pandemic certainly became a lot worse, exposed so many issues. When physicians make decisions on things like a prognosis, we have found that the cards are already stacked against patients who've been medically underserved. What ethical guidance did the AMA provide about responding to health inequities that we've seen during the pandemic?

Dr. Kao: Respecting human dignity is one of the core principles underlying the AMA Code of Medical Ethics. And so, the Code, for example, offers guidance to physicians in how to realize their ethical responsibility to address health disparities and inequities. That said, we have also seen how the COVID-19 pandemic has greatly affected historically marginalized and minoritized populations who have been long oppressed by racist policies and structures.

This past June, the AMA Journal of Ethics published an entire issue on the topic of transgenerational trauma and how clinicians can respond to individuals and communities to address the health inequities created by such trauma.

Unger: Dr. Kao, you have talked to a lot of physicians and other experts throughout the pandemic on ethics-based issues. I'd love to hear about any standout conversations, any meaningful stories that come to mind when you think about those conversations?

Dr. Kao: Yeah. As you know Todd, when the pandemic started, the journal got creative and developed a series COVID-related in interviews, and I had the privilege of interviewing many thoughtful and engaging individuals. Some that come to mind include Doctors Ceasar and Charles, who helped to start White Coats for Black Lives.

The interview I conducted with Professor Ibram Kendi about what it means to be an anti-racist also stands out in my mind. I also had the opportunity to interview physician poet, Rafael Campo and political cartoonist Matt Wuerker, about the pandemic through the lens of their respective art forms.

I'm particularly of our focus on the pandemic's impact on some of the most vulnerable among us, including individuals experiencing homelessness, those who are living in jails and prisons and those working in low wage jobs, who frankly didn't have the luxury working from home."