When hospitals become hostile: The importance of cultivating trust and dignity within our healthcare systems

You can hear Supriya Subramani discuss the dignity of patients and the ethical obligations of healthcare with Waleed Aly and Scott Stephens this week on The Minefield.

There is something deeply unsettling about witnessing those entrusted with care violate the very ethical commitments and obligations that define their profession. Healthcare professionals are bound by a fundamental duty to uphold care and dignity, treating every patient with respect. When rhetoric that discriminates and dehumanises individuals or communities surfaces within healthcare settings, it is not merely an ethical lapse — it is a betrayal of the very foundation of medical practice.

As an investigation unfolds into a video in which two nurses at Bankstown Hospital allegedly “bragged about refusing to treat Israeli patients, killing them and saying they would go to hell”, the incident has sparked widespread condemnation, hate speech, public outrage and questions around ethical obligations of healthcare workers. To date, no evidence has been uncovered that Jewish patients at Bankstown Hospital have suffered actual harm or negligence as was claimed in the video.

However, the gravity of the claim does not rest solely on whether harm was enacted; it lies in the deep rupture of trust it creates. Care is not merely a procedural act; it is relational, built on the fragile, often precarious, assurance that one’s well-being is taken seriously. When health workers express — even hypothetically — a willingness to withhold care on the basis of identity, they erode that assurance, confirming for many what history has already taught them: that care is conditional, that belonging is fragile, and that the structures meant to heal can also harm. This video of nurses engaging in hate speech is thus more than an instance of individual misconduct — it is an ethical crisis that exposes the fragility of trust in healthcare institutions.

When healthcare professionals engage in speech or actions that are degrading, discriminatory or violent, the consequences extend far beyond the moment of utterance. It raises important questions about the nature of care, the meaning of dignity, and the responsibilities that come with holding power over vulnerable bodies.

Throughout history — and recently, whether during the COVID-19 pandemic or in the deliberate destruction of healthcare systems in Gaza — healthcare institutions have repeatedly demonstrated their susceptibility to larger social and political tensions. There is overwhelming evidence of systemic racism within Australian healthcare and public health institutions. For those who are marginalised — Indigenous, Black, refugee, migrant and minoritised communities — healthcare spaces can indeed be hostile rather than healing.

Care without discrimination

What, then, does it mean for a healthcare institution to care? Not in the bureaucratic sense, where “care” is reduced to efficiency metrics or standardised treatment protocols; but care in the deepest, most ethical sense: the kind of care that sees the patient not as an “other” or a “problem” to be managed, but as a person with true dignity. The very spaces designed to heal can also wound and harm, through exclusion, neglect, humiliation, shame and dismissal.

Healthcare workers — nurses, doctors, aides, social workers — enter the profession with an ethical commitment: to heal, to care, to do no harm, to respect with dignity the person before them. The ethical responsibility of medical professionals to provide care without discrimination is foundational. Any refusal to treat patients based on identity undermines the ethical values of practising medicine and the trust placed in healthcare institutions.

Yet, the speed and intensity of the response to the particular case of the video of the nurses at Bankstown Hospital also exposes deeper patterns in how moral transgressions are perceived, condemned and punished — particularly when they involve racialised individuals. These nurses must be held accountable in accordance with professional and legal standards, just as all healthcare workers should be. But accountability is not merely about individual punishment; it is also about understanding the conditions under which certain acts are disproportionately condemned, whose voices are amplified in moral and political debates, and how ethics itself is shaped by historical and political forces.

Moral clarity and courage in healthcare

One must be aware that public outrage is not neutral — it is shaped by racial and political forces that determine which acts of discrimination are met with swift condemnation and which are buried under institutional silence. Why do some violations trigger immediate consequences while others are normalised or ignored?

The racial and political economy of outrage demands closer examination. This selective response to hate speech and discrimination is not incidental — it reflects deeper, structural inequities within healthcare and society at large. Calls for accountability must address the systemic and historical conditions that enable such breaches of trust in the first place.

The statements from organisations like the Australian Islamic Medical Association (AIMA) and the Australian Nursing and Midwifery Federation (ANMF) underscore a collective insistence that healthcare workers must uphold the duty of care with dignity. The principle and practice of ethical care in medicine must extend to all, regardless of ethnicity, race, gender, nationality, or wider transnational politics.

While we contextualise the reaction to this video, we must not overlook the larger moral and political conversations unfolding against the backdrop of the ongoing dehumanisation and destruction in Gaza. As moral exhaustion weighs heavily, the need for courage has never been more pressing. And we can draw strength and courage through people who uphold dignity at this moment — for instance, Palestinian healthcare professionals and healthcare workers in Gaza, along with Australian humanitarian workers providing aid, have demonstrated unwavering commitment under extreme conditions with moral clarity.

Moral clarity demands that we reject all forms of dehumanisation, including institutional silence, but it also requires that we recognise when condemnation becomes a tool for reinforcing existing hierarchies. If justice is to be meaningful, it cannot be selective — it must reckon with the full landscape of structural violence, rather than reducing it to individual failures. To engage ethically, we must ask not only who is punished but also whose suffering remains unseen.

Hate speech, fear and the erosion of trust

The practice of medicine and all forms of practice in healthcare rest on an unspoken promise: to do no harm, to care for those in need, and to uphold the humanity and dignity of every patient, regardless of their background, faith, beliefs, or identity. Dignity in healthcare is not merely an add-on; it is a core ethical value. It is what distinguishes ethical care from mere technical intervention or professional duty. It is what makes healing possible in a deeply social and relational sense.

In training our medical students, it is important that we emphasise and teach that humane care and clinical practice demand engagement with dignity and respect. Ethics is not a checklist or a tick-box exercise. When dignity is upheld, patients feel seen, heard and valued. When it is denied, the consequences are profound: mistrust, alienation and the deepening of already existing inequalities.

The outrage over the video of the nurses at Bankstown Hospital does not occur in isolation. It emerges in a moment of heightened racial anxiety, amid increasing antisemitic and anti-Muslim abuse. We must situate this within the broader context of rising right-wing extremism — both in Australia and across national borders — as well as Australia’s colonial history. We must also remain attentive to what has been described as the “perverse evacuation of the principles of antiracism” on university campuses and the mechanisms of white supremacy operating in this political climate.

Within this context, antisemitism and Islamophobia do not circulate as abstract prejudices but as embodied realities. Antisemitic speech does not simply appear; it carries the weight of a racial imaginary in which Jews have long been positioned as outsiders, threats and conspirators. Similarly, Islamophobia has long cast Muslims as bodies to be policed, surveilled and contained. These figures — “the Jew” and “the Muslim” — do not emerge from nowhere. As Sara Ahmed has argued, they are made “sticky”, accumulating layers of fear, suspicion and exclusion through histories of racial violence, colonial rule and white supremacy.

At this moment, with hate speech on the rise, it becomes necessary to critically examine how political projects and racialised violence are mobilised by the same structures. These are not merely individual acts of hate; they are the manifestations of racial logic at work within broader structures. Violence does not begin with the act of vandalism or the speech that wounds — it begins long before, in the air we breathe, in the stories told and retold, in the slow sedimentation of racial meaning that turns bodies into targets. It becomes moral necessity for us to reject the ways in which violence and capitalism thrives on division and fear, and recognise how antisemitism and Islamophobia are used to justify exclusion.

Instances of hate speech — including antisemitism, Islamophobia and anti-Asian racism — are particularly egregious in healthcare because they violate the foundational commitment to dignified and respectful care. Any kind of racism signals to patients and communities, directly or indirectly, that they are not fully human in the eyes of those who are meant to care for them. It erodes the very conditions that make ethical healthcare possible. In so doing, it threatens the legitimacy of institutions that claim to care for the vulnerable. The public’s attention to this, and the fear it generates, is justified because it breaks the very trust that healthcare professionals are supposed to uphold in their roles as caregivers and healers.

But fear is not only a private emotion — it is also political. It shapes how people navigate institutions, how they interact with healthcare professionals, and how they make decisions about their own care. For many, the fear generated by the video of the Bankstown nurses is not abstract. It confirms a long-standing suspicion on the part of many communities — particularly those that are minoritised — that healthcare is not always a space of safety and dignified care, making it morally urgent to prioritise the cultural safety and anti-racism strategies for which Indigenous, refugee and migrant communities, along with many social justice researchers and leaders, have been advocating.

Hate speech within healthcare institutions does not just harm those who are directly targeted; it ripples outward, creating an atmosphere of suspicion and alienation. When patients hear healthcare professionals engage in harmful rhetoric, it does not matter whether they themselves are the target of the speech — what matters is that the very people entrusted with care have demonstrated a capacity for disregard and dehumanisation. The fear that follows is rooted in histories of exclusion, persecution and violence. When healthcare professionals engage in speech that reinforces those histories, they are not simply making offensive remarks — they are participating in a broader structure of harm.

Which is to say, the violation is not only in the words themselves but in the trust that is shattered as a result. This moment demands that we remain clear about the key ethical concerns at stake: it is about the ethics of respect, recognition and dignity in care — about the responsibility of healthcare workers to uphold dignity, to ensure that every patient, regardless of identity, can enter a medical space without fear of discrimination, othering, disrespect or violence.

It is important to acknowledge, however, that not all breaches of dignity in healthcare generate the same level of public attention. Indigenous communities, refugee patients and other marginalised groups have long documented their experiences of neglect, racism and mistreatment in medical settings, yet these violations often fail to reach the level of crisis that the video of the Bankstown nurses has provoked. This does not mean that the outrage over this particular incident is misplaced — on the contrary, it becomes necessary for our moral consciousness. And it reveals the uneven ways in which harm is recognised and responded to within healthcare institutions and the broader public sphere.

At this moment, while larger systemic issues in healthcare — including working conditions and safety for health workers — demand urgent attention, we cannot ignore the deeper structures of exclusion shaping the system. To truly serve in public institutions, we must reject the normalisation of systemic racism and refuse to let care be fractured along racial, religious or political lines. If this moment is to have lasting meaning, it must go beyond an immediate response to the video. It must serve as an opportunity for a deeper reckoning with the structural inequalities and racial discrimination that shape healthcare every day. Otherwise, we risk treating this as an isolated event — “solved” by punishing the individuals at the heart of it — while distracting ourselves from the larger issue: the need for systemic change rather than mere condemnation.

Placing dignity at the centre

As those who have experienced caste, class, gender and racial discrimination know, discrimination is not confined to discrete acts or explicit expressions of hate. It lingers, it saturates, becoming normalised and sustained in patterns, and embodied. Racism, antisemitism, Islamophobia and casteism — each carries histories that shape institutions, the way care is structured, and the way some bodies are seen as more deserving of respect, dignity and care than others.

Care, when shaped systemic discrimination, ceases to be care. It becomes another mode of management, discipline and sorting — dividing bodies into those deemed legitimate and deserving and those marked as suspect. The minoritised and racialised patient who worries that their suffering will be dismissed due to long-standing tropes of exaggeration, who senses that their pain is being minimised, their complaint treated as an overreaction or an inconvenience — these quiet violences of discrimination in care are not reducible to interpersonal prejudice. They are embedded in the way institutions operate, how protocols are designed, and how histories of exclusion continue to shape futures of exclusion.

I often teach my students that institutions and programs — whether a hospital, a clinic, or a public health initiative — are not neutral sites. They are sites of encounter. And encounters are shaped by power. What does it mean to seek care and place trust in a system where one’s dignity is not assumed, but must be fought for, demanded, justified? Trust is not built in a single interaction, nor can it be conjured by mere words of reassurance. Trust requires structures.

A culture of respect, safety and belonging cannot be a checklist item or applied selectively. It must be woven into how institutional policies are made, how professionals are trained, and how the very architecture of care is conceived — from top-down policies to bottom-up signalling procedures and processes. Discrimination in care is not just about who is treated unfairly. It is about how entire ways of being are devalued.

A system that does not account for its own embedded exclusions will continue to harm, no matter how many individuals within it act with kindness. To place dignity, recognition and respect in care at the centre of our institutions is to reject the fiction that racism, antisemitism and Islamophobia are anomalies. It is to recognise that these violences are structural — that they operate at the level of policy, programs, institutional culture and ethos, shaping who is listened to and who is dismissed.

If healthcare workers and institutions are to uphold the principles of dignity and respect, they must do more than reject hate speech when it is exposed — they must actively cultivate a culture of respect, recognition and safety in which such speech is unthinkable in the first place. For healthcare, if it is to mean anything at all, must be a space where humanity is affirmed, without condition and without exception.

Supriya Subramani is a Lecturer at the Sydney Health Ethics, in the School of Public Health at the University of Sydney.