February 17, 2026
Immigration enforcement tactics deployed in Minnesota have been and are affecting us all. They are also affecting the health of our communities. Many patients are afraid to seek care. Many healthcare workers are afraid to come to work. And we have all seen the videos that end in tragedy – the deaths of Renee Good and Alex Pretti.
Shocking and heartbreaking. Equally shocking is how a few minutes of graphic evidence can be interpreted so differently through different eyes and hearts. We are told to see with our ears and not with our eyes.
The world we are currently living in – one of political polarization, social upheaval, and 60-second news cycles – is one of unprecedented complexity and chaos.
As physicians, caregivers, and leaders, how do we navigate this? How do we navigate the assault on science, research, and vaccination schedules and whatever comes next? How do we provide the best care for all our patients, lead our teams, and communicate in our communities amid all this chaos?
All physicians are leaders, and physician leaders are no strangers to complexity. Medicine has always required navigating uncertainty, ethical tension, and high-stakes decisions. Yet today’s environment, marked by public health debates, political polarization, rapid media cycles, online anonymity, information overload, workforce strain, and rapidly evolving expectations of patients and employers, has placed physician leaders under unprecedented pressure.
So, what can we do to preserve our moral compass while navigating this volatility?
We must be honest with ourselves and with others. Much of what is happening causes moral injury – the psychological, emotional, and spiritual distress from committing, witnessing, or failing to prevent acts that violate one's core moral beliefs. We watch as new policies are implemented that seem to matter, for too many, only when they affect someone people personally care about. But as physicians, we are obligated to care for everyone.
We can see how disruption of scientific research will affect cancer care for generations. We can see how changes to vaccine schedules may harm or kill children. This is part of our moral injury. Pretending otherwise leads to burnout and cynicism.
Physician leaders often hope to “stay neutral” to preserve unity. But neutrality in the face of harm is itself a moral stance. The same is true of silence; sometimes, remaining quiet is a form of complicity. Physicians recognize this.
Balance does not mean avoiding discomfort. It means choosing how and where to speak; protecting clinicians so they can care for patients; and advocating in ways consistent with one’s role and institutional influence.
Moral leadership is quieter than activism, but it is not passive. This does not mean physicians should not be activists – many should be and are. It does mean physician leaders must thoughtfully weigh personal activism against the moral leadership required of their formal roles and the potential impact on their professional roles and organizations.
One of the most important leadership acts right now is creating space for clinicians to name their distress without forcing consensus. People are struggling, and leaders must be safe harbors.
Leaders should offer structured listening sessions, ethics consultations and peer support, and reflective forums. This acknowledges that the conflict is moral, not merely political, and helps prevent moral injury from becoming disengagement or exit. We lost too many medical professionals during the moral injury of the COVID pandemic. Let’s avoid repeating that loss.
Physician leaders cannot fix the political climate alone, but we can: protect patient access to care where possible; minimize harm within our systems; support clinicians facing ethical dilemmas; and use data, outcomes, and patient stories responsibly to inform policy discussions.
Small, consistent acts of advocacy often matter more than sweeping statements. This is where we can speak with local and state legislators, advocating for medical care for detainees, insurance protections for vulnerable populations, and maintaining coverage for medications, healthcare, and vaccine schedules recommended by professional and scientific organizations. And yes, as our colleagues did for both Pretti and Good, when we see someone who needs our help, we can step up and step in.
Leading in controversial times is among the most demanding challenges physician leaders – and physicians as leaders – will face. It requires navigating ethical tension, political chaos, organizational complexity, and human emotion – often simultaneously.
Physician leaders need not have perfect answers. What colleagues and team members look for is integrity, transparency, and steadiness. By grounding leadership in medical ethics, clinical credibility, and compassion, physician leaders can guide our communities through controversy without losing the trust of those we serve.
By Cindy Firkins Smith, MD, MHCI, FAAD. Smith is the chair of the MMA delegation to the AMA and, along with Corey Martin, MD, co-chairs the MMA’s Minnesota Physician Leadership Institute.
How You Can Help:
Contact your members of Congress and share examples of access to care issues.
How should healthcare providers prepare if ICE comes knocking?
References:
- American Medical Association. (2023). Code of Medical Ethics. Code of Medical Ethics | Ethical Guidance for Physicians | AMA.
- Heifetz, R. A., Grashow, A., & Linsky, M. (2009). The practice of adaptive leadership: Tools and tactics for changing your organization and the world. Harvard Business Press.
- Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146.
- Shanafelt, T. D., Ripp, J., & Trockel, M. (2020). Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA, 323(21), 2133–2134.
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