By Tore Audun Høie, author of Health Management (Norwegian Helseledelse)
Nursing is an important profession, especially when a lack of nurses can become a fundamental problem in the future. Nursing is perhaps also a key example of virtue ethics.
Ethics is often divided into three forms, based on rules, utility or virtue. The virtue part has traditionally been a little unclear, but nurses choose a profession that is lowly paid, difficult and stressful despite good high school marks. Perhaps a driver is the wish to help?
More generally virtue ethics may be seen as “doing the right thing” instead of what is comfortable or giving personal advantages. A challenge is knowing what is the right thing to do.
Nurses have an ethical code outlining their tasks and social role, perhaps the best ethical code in Norway. The Norwegian Nurse Association had the following goals for 2012:
- Influence society to improve population health.
- Influence health development preparing for preventing and solving population health problems.
- Influence health services to satisfy population demands and needs regarding quality and availability.
- Work to realize the goal of similarity between women and men in all areas.
- Further international understanding and solidarity, and work for a society built on multicultural understanding and civil rights.
Professional codes are normally a bit high-flying and remote, but it is difficult to imagine a better set than above. Economists and lawyers have more difficulties explaining their societal role.
All three forms of ethics have advantages and drawbacks. Virtue ethics ensures that a person is addressing higher goals than own comfort, quality is a natural extension. A health reform in Norway ignored quality, but later quality came back to become a key health issue, especially patient security.
Central to quality is to report errors. That can cause resent in others. Sometimes you will be punished if you contribute to good health. Part of the Norwegian health system is in conflict with both good management and professionality. What some call fear culture has resulted in calamities, the last that 2.9 million patient journals were outsourced to a company convicted of cheating, in a country without overall privacy laws. Nobody protested till the national broadcaster started to investigate.
Social responsibility can be regarded as virtue ethics, an important part is human rights.
Unfortunately, these are not highly regarded in Norwegian health and seldom mentioned even in health ethics. Rather, an economical evaluation of patients has been suggested. This is partly a break with Norwegian law (rule ethics), but also a break with population views (virtue ethics).
A negative with virtue ethics is that subjective views become too important, even quality can be overdone. Some persons work so hard that they exhaust themselves, or the ignore that others can need help.
Since the three forms of ethics have advantages and disadvantages, professionality is needed to balance different views.
One view is utility ethics, then the utility or usefulness of an issue dominates. Health is basically useful. But if forced to choose, who is the utility for? For Corona some countries chose to vaccinate old people first to avoid deaths. Other countries chose to vaccinate health people first to enable them better to help.
Rule ethics is based on laws, guidelines etc. and is “always right” if you are some kind of conservative. But laws have difficulties following the rapid development of both health and technology. And laws have problems with complexity, a key issue in our modern society.
Ethical controversies are prominent in health. At the same time ethics means diversity, making clear goals and rules more difficult. Earlier Norwegian politicians argued for “more health for the money”, that is no more popular, The People’s Health System is perhaps better, but how shall the views of so many be interpreted and communicated? At least we want a health system addressing us.
Virtue ethics and nursing ethics is a way of adjusting to this new view of the health system. Other professions should read and learn.