Date of Award


Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Ashley Hagaman


Access to health insurance remains limited for children who are undocumented in most of the United States. Care for these children often necessitates resource allocation decisions, but how hospitals reconcile competing interests and ethical principles remains elusive. To better understand how care provision questions are approached and deliberated ethically, this study examined the experiences of ethics committees at major pediatric hospitals in the United States. In-depth, semi-structured interviews with 12 ethicists were qualitatively analyzed to identify themes within the domains of existing policies and practices, key ethical arguments, barriers to decisions, and strategies for resolution. Major findings were: (1) Informal processes, often without an ethics consultation, governed care decisions; (2) Differences in considerations of the hospital’s mission, the salience of documentation status, and the definition of justice led to nuanced differences in ethical deliberations; (3) Financial factors served as formidable barriers to decisions; (4.1) A standardized ethics consult process was employed by each ethicist, albeit with different strategies, to resolve ethical dilemmas; and (4.2) Ethicists agreed on the need for a systems-level policy solution. These findings describe the challenges to achieving transparent and consistent ethical decisions for undocumented children, highlighting the importance of a systems-level solution, such as a national policy.


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