We’re Out of Seconds.
A reflection on societal betrayal, moral injury, and the courage required when authority obstructs care.
We were working on a different note until the events in Minnesota unfolded, but it is impossible to ignore the moral weight of what is happening there and the harm inflicted on patients, clinicians, and the community.
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“Just give us a second.”
A masked, armed Immigration and Customs Enforcement (ICE) agent cooed to a physician bystander, who was pleading to render aid to Renee Nicole Good as she lay slumped over her steering wheel, mortally wounded seconds earlier.
After watching countless videos of that tragedy in Minneapolis on January 7, the incident teems with moral harm. But, as physicians, when agents obstructed aid to a critically injured victim, it struck a visceral chord.
A Federal Emergency Management Agency (FEMA) training video declares, “. . . any first responder will tell you that it is rare, really rare, to show up on any scene . . .where someone isn’t trying to help.” Indeed, the instinct to help when another is suffering is a deeply compassionate and human response, more so when reinforced by a decade of education and training in a healing profession. It must have been excruciating to know what to do and yet, be rendered impotent by ICE as the victim, just steps away, lay alone and unaided for nearly ten minutes.
This goes against human nature, societal expectations, and both federal and international guidance during crises.
Even the US Department of Homeland Security (DHS), ICE’s parent agency, advocates for bystanders to intervene immediately in life threatening emergencies, like shootings. The DHS webpage notes:
“. . . uncontrolled bleeding, or hemorrhage, [is] the most common cause of preventable death in trauma.”
“. . . the average time for someone to bleed out after experiencing serious physical trauma from an injury, say a gunshot wound, is only 3-5 minutes.”
“When lives are on the line, every second counts, and as our colleagues at FEMA would say, “you are the help until help arrives.””
Yet ICE rejected a highly trained responder, as if believing the medical crisis would wait until Emergency Medical Services arrived. We know now that Renee Good survived for several long minutes after the ICE agent shot her. It is haunting to consider that following DHS’s own guidance might have changed the outcome. The callous disregard for human life, for compassion, and the out-of-hand dismissal of expertise in a crisis shook us.
As a reminder, the risk of moral injury arises when betrayal by an authority in a high stakes situation leads one to transgress deeply held moral beliefs.
The betrayal of moral injury hits at one of three levels of moral beliefs: personal moral codes, professional obligations, or, yet broader, at the societal level. Examples of betrayals at the first two levels have always been obvious. Directives that run counter to one’s family values or faith, for example, may be perceived as betrayals of one’s personal moral code. Those that preclude professional obligations to prioritize patient needs, like health systems steering referrals, setting admission or RVU targets and incentivizing inappropriate care, hit at the professional level.
Examples of societal betrayals were harder to find before 2025. Now, examples of federal authorities’ actions conflicting with societally agreed ethics and values are in the news almost daily – for example, ignoring the sanctity of human life, the rule of law, or decades-old international pacts. Refusing medical aid to a victim of violence is just one of a litany of betrayals.
The physician’s angst was inescapable in the video, both their body language and the pitch of their voice telegraphing urgency. We could feel them running the instantaneous calculation, familiar to every physician, of Ms. Good’s likely catastrophic injuries and the consequences of not responding: her death or irreversible disability. Simultaneously, we felt the competing calculation, utterly foreign, of their own risk were they to ignore the commands of armed agents. We have spent days trying to imagine what we would have done, in that situation, and the demoralizing conclusion each time is that there was no good outcome. The physician’s choice boiled down to one cold, hard question: would there be one body or two?
At a vigil for Renee Good, two days after the shooting, New Hampshire Episcopal Bishop, Rob Hirshfield, said, “. . . I’ve asked [Episcopal clergy] to get their affairs in order, to make sure they have their wills written, because it may be that now is no longer the time for statements, but for us with our bodies, to stand between the powers of this world and the most vulnerable.”
None of us imagined, when joining a health profession, that risking our own lives would be necessary to uphold our oaths. But since March 2020, that reality has hung heavy in healthcare as the risks of infection, workplace violence, and now, violent acts by federal authorities, have risen. This should not be the reality, and yet, here we are.
So, we must prepare.
Intellectualizing from a safe distance, we think we know how we would respond to a moral challenge. But it is easy to abandon what we “know” amidst the chaos, threats, anxiety, and fear in the moment when the amygdala overrides our frontal cortex. A physician in Minnesota posted on social media, “i thought i would be braver, but i am scared.” The first thing to know is that bravery is not the absence of fear, but the willingness to act in spite of it.
Deliberate, methodical reflection about potential moral challenges helps. Imagining these encounters in detail, step-by-step, and lingering in the accompanying discomfort and intense emotions offers practice in distress tolerance. It can help you remain clear and calm in the moment. Rehearsing responses – literally speaking the words of diplomatic defiance to build moral muscle memory, so to speak – increases the odds we will commit to voicing our values in a way others can hear, when seconds count.
The other essential of preparation is knowing who your supports will be. Citizens in Minneapolis are banding together and recording interactions, so no one stands up alone. Equally important is to know where the opportunities are for debriefing and decompressing when the moment is over, and the residue of moral harm remains. The resolution of societal betrayal will not happen in isolation; it happens in community, when we, collectively, reassert our societally agreed ethics and values.
Minnesota physicians held a press conference this week to denounce the myriad patient harms arising from ICE activities. This is a model of collective action and courage. State Senator Alice Mann closed by saying, “We are here today because we want the rest of the country to know about what is happening inside Minnesota hospitals and our clinics, because it will happen in your state . . . if it hasn’t already. And, we want the world to know that . . . Minnesota doctors will stand in solidarity and we will protect our patients.”
These are fragile, volatile times that beg for thoughtful, considered, community responses. It is time for contemplation, for conviction, and, especially, for courage.