Ethics Dispatch November 2025 Beneficence

“Functioning as our better selves leads to better outcomes for patients and everyone.”

Tarris (Terry) Rosell, PhD, DMin, HEC-C

In recent months, I’ve written quite a bit about the bioethics principle of justice – how we work toward fairness, equity, and accountability in our healthcare systems. Many of you have engaged deeply with those reflections, and I’m grateful for that. But with so many things feeling uncertain and unsettled these days, another principle has been on my mind.

As we move further into the holiday season, a time that naturally centers on generosity and care, it seems fitting to examine the principle of beneficence. It calls us not only to prevent harm, but to actively do good, to ease suffering, and to show compassion even when the next step simply isn’t clear.

People with No Place to Go

A recent article by John Roszkowski in McKnight’s Long-Term Care News (2025) brought this into clearer focus. The article examines new research from the University of Michigan examining why nearly 150,000 people with serious mental illness – conditions like schizophrenia, bipolar disorder, and psychotic disorders – are living in nursing homes, often for far longer than their medical needs require.

As the article explains, the study identified “multiple intersecting barriers” that make community discharge extremely difficult (2025). Limited access to psychiatric care, the shortage of affordable housing, strained or absent family support, insurance constraints, and lengthy waiting lists all converge. For some residents, the structure of a nursing home feels safer than an uncertain future. For others, the system simply offers no viable alternative.

One finding was particularly striking: without adequate preparation and planning, residents were likely to “end up back in the hospital, on the streets, or in police custody” (Roszkowski, 2025). This is a harsh reality. And it highlights a deeper tension in healthcare ethics: environments built for care can, over time, become places where people remain not because it is best for them, but because the broader system has no place else for them to go. It represents a brutal catch-22 situation in which there is no option that doesn’t deeply negatively affect at least one – or in many cases – all parties involved. It is frustrating bureaucratic logic at its most inefficient, cold-blooded and short-sighted.

System-Level Beneficence

Against that backdrop, beneficence takes on an even more tangible meaning. When I think about beneficence at the individual level, I think of the social workers, nurses, administrators, and direct-care staff interviewed for the study. They are working hard, often against the odds, to do right by their patients. They advocate, plan, mediate family relationships, and navigate complex systems every day. Their efforts reflect beneficence in its most practical and human form: doing good within real-world constraints.

Yet the study also makes clear that individual dedication can only go so far. Beneficence has a structural dimension as well, and that part is shaped not only by resources but by legislation, regulations, and policy decisions that determine what support is available – and what isn’t. When affordable housing is nonexistent, when psychiatric access is scarce, when insurance doesn’t cover the right level of care (if it covers any at all), even the most committed team reaches a limit.

Roszkowski noted the researchers’ call for “collaborative community strategies” (2025). Greater investment in community mental health services, expansion of supportive housing, better transportation infrastructure and these are not simply operational tweaks. They are expressions of beneficence at the system level. They reflect a commitment to ensuring that our structures support the very people they are intended to serve.

Keep Pushing for Good

I know the people reading this care deeply about that commitment. You see every day how policies and systemic gaps shape the lives of residents and patients. Beneficence isn’t abstract for you; it’s embedded in the choices you make, the advocacy you do, and the work you lead.

As we move through this season of care, beneficence invites us to look honestly at what stands in the way of doing good – and to continue pushing, individually and collectively, for systems that make compassionate action possible. In a healthcare environment often defined by constraint, that can feel daunting or even impossible. But it’s also where our shared values matter most. Beneficence encourages us to look beyond what’s immediately possible toward what best honors the people we serve. To create conditions where both individuals and institutions can act with compassion, and where doing good becomes the standard, not the exception.

Source

Intersecting barriers create ‘unnecessarily long’ nursing home stays for mentally ill patients: study

Mr. Stone is a 44-year-old man who was admitted from a group home after experiencing dizziness and a fall. He has a long history of mental health conditions, diabetes, and chronic kidney disease. Staff at the group home describe him as combative, often threatening others, refusing treatment, and frequently declining his medications.

During his hospital stay, however, he has been consistently pleasant and cooperative with staff. The behavioral health consultant believes this stability is due to his regular medication adherence while inpatient. He is now medically
cleared for discharge, but placement has become a major barrier. His previous group home will not accept him back, and no other facilities are willing to take him due to his history of mental illness and combative or noncompliant
behavior. He has no friends or family involved in his care.

Mr. Stone has expressed a strong desire to leave after being hospitalized for more than a month, and his frustration is beginning to escalate. The medical team has requested an ethics consultation to determine the hospital’s obligations to him and what is required when no safe or appropriate discharge options are available.

There is a big difference between knowing something and truly understanding it – between knowing what something is and knowing what something means. In common terms, this is the difference between knowledge and wisdom. Like many aspects of modern Western philosophy, we can trace this idea back to ancient Greece, and specifically to Aristotle. In his epistemology, “we find the basis for something like the modern opposition between epistêmê as pure theory and technê as practice.” (Stanford Encyclopedia, 2003).

The concepts do not always translate cleanly, and there have been many different interpretations – some more convincing than others – of the meaning behind the words. A helpful way to understand this distinction is to remember that “the relation between epistêmê and technê in ancient philosophy offers an interesting contrast with our own notions about theory (pure knowledge) and (experience-based) practice.” (Stanford Encyclopedia, 2003).

Three-Part Balancing Act

The field of clinical ethics struggles with the implications of these concepts, which is why it is called applied ethics. Unlike philosophical ethics, we cannot always focus solely on what is right for the patient; instead, we often must focus on what is best for the patient. Sometimes these limitations come in the form of laws and how we interpret and apply them. Do we follow the letter of the law, or its intent?

The mechanics of modern healthcare in the United States mean that most institutions follow the legal requirements rather than the intentions behind the laws. This benefits healthcare organizations but often comes at the expense of patients. Healthcare is a three-part balancing act involving quality, cost, and accessibility. Any change in one area inevitably affects the other two. In efforts to keep costs down and quality up, accessibility is often reduced.

EMTALA

According to the Centers for Medicare and Medicaid Services, “EMTALA requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition (EMC).” (CMS.gov, 2019).

The law was created because “thousands of patients, many of them Black or Latino, were arriving in very bad condition – and they were sent there by private hospitals in the city who refused to treat them. Most of them did not have health insurance.” As Republican Sen. David Durenberger of Minnesota explained, “Americans, rich or poor, deserve access to quality health care. This question of access should be the government’s responsibility at the federal, state, and local levels.” (Seitz, 2024).

These were patients in need who were turned away because hospitals were not required to provide care. The intention of EMTALA was to prevent this and to ensure that people in need receive proper medical treatment. However, this law only applies to participating healthcare settings, and as the continuum of care has stretched, more opportunities have arisen for patients to be denied treatment. Hospitals, where EMTALA applies, represent only one component in a much longer chain of care facilities. Many healthcare institutions – such as nursing homes and long-term care facilities – are not required to accept all patients.

Nowhere to Discharge

The intention of EMTALA was that patients would not be refused necessary treatment. The epistêmê of EMTALA is that patients are not denied the care they need. The technê – the practical application – is that this denial still happens every day. Patients are accepted and treated in hospitals, but then the hospital bears the responsibility of finding an appropriate discharge location. They cannot discharge the patient until an accepting facility is found, and many patients have complex medical needs that cannot be met at home (e.g., mechanical ventilation, dialysis). These patients often remain in hospitals for extended periods until placement can be arranged.

With the increase in patients experiencing mental illness, cognitive decline, and other complex medical conditions, this strain on the healthcare system will only intensify (Miller, 2022). It is necessary to meet the needs of these patients, but without social support and with numerous barriers to discharge, many become effectively abandoned in hospitals or nursing facilities. There is no easy solution, as there are many compounding factors – limited social resources, loneliness, and over-medicalization among them. We need to rediscover the epistêmê of medicine so that its technê – its practice – once again truly meets patients’ needs.

Sources

What’s EMTALA, the federal law at the center of the Supreme Court’s Idaho abortion case? | PBS News

Episteme and Techne (Stanford Encyclopedia of Philosophy)

Dementia on the rise worldwide: An explainer and research roundup

SOM – Appendix V

Written By Ryan Pferdehirt, D.Bioethics, HEC-C, Vice President of Ethics Services, Rosemary Flanigan Chair & Cassie Shaffer Johnson, MA, Program Coordinator