Revised Algorithm for Managing Discriminatory Patient Requests

Healthcare workers in Canada are increasingly facing violent, aggressive, and discriminatory requests from patients and families, reflecting broader societal biases within healthcare settings. In response, institutions have developed policies and decision-making tools to guide leaders in addressing these situations ethically, consistently, and in accordance with human rights obligations. A revised Caregiver Preference Algorithm has been developed to support decision-making in managing discriminatory patient requests.

Key Takeaways:

• The revised algorithm is structured around six key decision points to navigate complex situations: patient acuity and capacity, consideration of religious, cultural, or trauma-informed needs, relevance of trainee or learner status, whether the request violates the Human Rights Code, the identity of the requester, and the clinician's willingness to continue care.
• The algorithm integrates legal and ethical principles to provide structured guidance while allowing flexibility to respond sensitively to diverse clinical contexts.
• The project was conducted at a large, multisite tertiary care hospital in Ontario, Canada, involving 27 healthcare workers and stakeholder consultations with clinical and operational leadership, legal counsel, patient relations, equity offices, patient partners, and frontline staff.
• The revised algorithm offers a practical, rights-based framework to support healthcare institutions in ethically and consistently responding to discriminatory patient requests while protecting healthcare workers.
• The research has been peer-reviewed and published in the journal Nursing Ethics.

Statistics:

• The revised algorithm was developed through a multi-phase quality improvement project.
• The project involved 27 healthcare workers and 13 stakeholder consultations.
• The algorithm integrates six key decision points to navigate complex situations.
• The research has been published in the journal Nursing Ethics, with a total of 12 authors listed.

Sources:

• NewsRx. Investigators at University Health Network Report New Data on Nursing Ethics (Navigating discriminatory requests and refusals of healthcare workers: A Canadian-based inpatient hospital algorithm). Health & Medicine Week. September 26, 2025; p 2277.
• Navigating discriminatory requests and refusals of healthcare workers: A Canadian-based inpatient hospital algorithm. Nursing Ethics, 2025:9697330251374153. Nursing Ethics can be contacted at: Sage Publications Ltd, 1 Olivers Yard, 55 City Road, London EC1Y 1SP, England.