Navigating discriminatory requests and refusals of healthcare workers: A Canadian-based inpatient hospital algorithm

TL;DR

This paper presents an updated algorithm to help healthcare leaders in Canada manage discriminatory patient requests while upholding ethical and human rights standards.

Contribution

A revised, practical, and rights-based algorithm for addressing discriminatory requests in healthcare settings.

Findings

The updated algorithm includes six key decision points to guide ethical and legal responses to discriminatory requests.

Stakeholder input from clinicians, leadership, and legal experts informed the revisions to improve accessibility and contextual sensitivity.

The tool supports consistent and ethical decision-making while protecting healthcare workers from undue pressure.

Abstract

Healthcare workers are increasingly subject to violence, aggression, and discriminatory requests from patients and families, reflecting broader societal biases within healthcare settings. In response, some institutions have developed policies and decision-making tools to guide leaders in addressing these situations ethically, consistently, and in accordance with human rights obligations.

This paper describes the revision of a previously published Caregiver Preference Algorithm to guide healthcare leaders in managing discriminatory patient requests. The goal was to create a more robust, accessible, and contextually sensitive tool to support decision-making.

The algorithm was revised through a multi-phase quality improvement project aimed at enhancing support for both frontline clinicians and leadership.

The project was conducted at a large, multisite tertiary care hospital in Ontario, Canada. Interviews were completed with 27 healthcare workers from various clinical areas. Stakeholder consultations included clinical and operational leadership, legal counsel, patient relations, equity offices, patient partners, and frontline staff.

This project was approved by the University Health Network’s Quality Improvement Review Committee [ID: QIRC 22-0378].

The updated algorithm is structured around six key decision points: (1) patient acuity and capacity; (2) consideration of religious, cultural, or trauma-informed needs; (3) relevance of trainee or learner status; (4) whether the request violates the Human Rights Code; (5) the identity of the requester; and (6) the clinician’s willingness to continue care.

The revised algorithm integrates legal and ethical principles to help healthcare leaders navigate complex situations. It offers structured guidance while allowing flexibility to respond sensitively to diverse clinical contexts.

This work contributes a practical, rights-based framework that can support healthcare institutions in ethically and consistently responding to discriminatory patient requests while protecting healthcare workers.

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