Mapping a normative terrain of an ethics of care – the case of psychiatry

Marit Helene Hem



(14.09.2009) The principal focus of this project is to explore the moral dilemmas interwoven in bed side rationing in acute psychiatry, with special regard to the conflict between particularized care/partiality, and justice. The study aims at integrating a philosophical and empirical analysis of the normative dimensions of care in health care prioritizations in acute psychiatry.

Psychiatry is a field where both care as relation, communication, empathic involvement and biomedical treatment, are complementary. The theoretical foundation for clinical care work is complex, and although some research has been done in this field in recent years there is still a considerable lack of knowledge. Furthermore, acute psychiatry is perhaps the area of medicine and nursing in which knowledge about actual priorities and conflicts of value in clinical situations is very scarce. We do know that high turn over of patients, few beds, and lack of qualified personnel are a constant challenge in psychiatric care. Moreover, psychiatric patients are particularly vulnerable and not that able to stand up for their rights. Their needs seem to far exceed the availability of caring resources. Hence, for health care workers their function as gate keepers and their decisions about admissions and refusals of care are particularly difficult, complex, and burdensome. However, we lack knowledge about how health care workers actually prioritize, what kind of value conflicts they are confronted with and how they solve various distributive dilemmas in their patient care in acute psychiatry.

This project is based on the assumption that increased knowledge about factual priority setting in clinical contact with patients will contribute significantly to the debate about priority setting in health politics in general. Further, it is presumed that a particular ethical perspective of care might provide important normative arguments to the benefit of individual and relational care in today’s psychiatric care. An ethics of care is an important ethical perspective, as it has fundamental implications on the way we perceive our professional moral responsibilities and prioritizations in health care based on values of care and empathy.

The purpose of the study is to (1) Acquire knowledge about how health care workers in acute psychiatric wards prioritize their care, and how they face the moral challenge/dilemma of particularized care versus various demands of distributive justice in their clinical work; (2) Illuminate the normative challenges and possibilities of an ethics of care as a useful theory in prioritizing in clinical bedside care in acute psychiatry.

Marit Helene Hem

PhD in Health Science

Post doctoral researcher
the Ethics Programme/Section for Medical Ethics


Phone: + 47 22 85 06 61 (w.)/ + 47 950 86664 (m.)

Mail address: Section for Medical Ethics
Department of General Practice and Community Medicine
Faculty of Medicine
PO Box 1130 Blindern
NO-0318 Oslo

Visiting address: Fredrik Holsts Hus
Kirkeveien 166

Former scholarships from the Ethics Programme:
Prequalification scholarship 2002
PhD scholarship 2003-2007

Hem’s CV