Addressing Complex Hospital Discharge by Cultivating the Virtues of Acknowledged Dependence
​Annie Friedrich, Graduate Student, Saint Louis University

Every day in hospitals around the country, patients are discharged from the hospital without difficulty, as the interests of the hospital and the patient usually align: both the hospital and the patient want the patient to leave and go to a setting that will promote the patient’s continued recovery. In some cases, however, this usually routine process does not go quite so smoothly. Patients may not want to leave the hospital, or they insist on an unsafe discharge plan. In other cases, there is simply no good place for the patient to go. These complex hospital discharge situations often involve considerations of ethical, legal, financial, and practical issues, but the ethical and moral issues inherent in these dilemmas have received only sporadic attention from clinical ethicists at best, leaving patients, providers, administrators, and caregivers unsure about what to do. When the ethical issues are brought to light, analysis usually proceeds based on a consideration of the principles of autonomy, beneficence, nonmaleficence, and justice. However, principled analysis often leaves patients and providers without a satisfactory solution, as the patient’s autonomy (for example, wanting to stay in the hospital) inevitably conflicts with the principles of beneficence, nonmaleficence, and justice. In this paper, I argue that difficult discharges are ethical dilemmas worthy of scholarly attention that goes beyond principlism, and I argue that providers and those involved in discharge planning ought to cultivate what philosopher Alasdair MacIntyre calls “virtues of acknowledged dependence” in order to care for these patients and their families. By returning to a more robust, traditional understanding of both what it means to be dependent and what it means to care for others in that dependency, providers and discharge planners can push back against the dangerous individualism that characterizes modern medicine and can walk with patients and family members as they navigate the challenging issues of difficult discharge.