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"

‘Good Place’ creator Michael Schur asks: How can we live a more ethical life?; The Washington Post, March 4, 2022

Michael Schur , The Washington Post; ‘Good Place’ creator Michael Schur asks: How can we live a more ethical life?

"For every conscientious citizen, there’s a whole bunch of cheaters and liars and Wolf of Wall Street maniacs who see ethical rules as annoying obstacles to getting whatever they want — not, you know, once a month, but literally all the time. Perhaps we can break down this whole confusing morass into four simple questions that we can ask ourselves whenever we encounter any ethical dilemma, great or small:

What are we doing? Why are we doing it? Is there something we could do that’s better? Why is it better?...

“Trying to do the right thing” means we are bound to fail. Even making our best efforts to be good people, we’re gonna screw up. Constantly. We’ll make a decision we think is right and good, only to find out it was wrong and bad. We’ll do something we don’t think will affect anyone, only to find out it sure as hell did, and man are we in trouble. We will hurt our friends’ feelings, harm the environment, support evil companies, accidentally help an elderly Nazi cross the street. We will fail, and then fail again, and again, and again. On this test, which we take daily whether we want to or not, failure is guaranteed — in fact, even getting like a C-plus often seems hopelessly out of reach. All of which can make caring about what we do seem pointless.

But that failure means more, and has more potential value, if we do care. Because if we care about doing the right thing, we will also want to figure out why we failed, which will give us a better chance to succeed in the future. Failure hurts, and it’s embarrassing, but it’s also how we learn stuff — it’s called “trial and error,” not “one perfect trial and we nail it and then we’re done.” Plus, come on — the alternative to caring about our ethical lives is really no alternative at all. We’re supposed to just ignore all questions about our behavior? Phone it in, morally speaking? I can’t believe that’s the right move. If we care about anything in this life, we ought to care about whether what we’re doing is good or bad."

Can the coronavirus make society more ethical?; The Times of Israel, April 24, 2020

Simona Weinglass, The Times of Israel; Can the coronavirus make society more ethical?

"Arizona State University Jewish Studies professor Hava Tirosh-Samuelson, by contrast, was optimistic, expressing hope that the coronavirus could usher in a new global spirit of generosity.

“We used to think that globalization would solve all our problems but now we see its ugly side. We realize that resources are ultimately distributed at the state level. Still, I’m going to quote none other than the singer Lady Gaga, who hosted this lovely Global Citizen Music Festival recently. She said ‘kindness is currency of the new world.’

Samuelson expressed the hope that we might see a greater worldwide emphasis on caring and ethical behavior after the coronavirus, as well as more urgent attention to climate change.

“Previously only profits were important. I don’t want to sound naive, but maybe now it will be different.”"