Reflections on Ethics Reading

This blog entry will include my reflections on some reading I have done in the field of ethics and narrow in on some questions we will want to ask and issues we must discuss as we move forward.

From Yeo, 1993:
Yeo describes two main areas of ethical concern in health promotion.

1. Distributive Justice (Equity in health)
2. Intervention ethics (Voluntary or coercive behaviour change)

Yeo also explains the importance of how health promotion defined in thinking about ethics.

1. What does health promotion mean?
2. What is it referring to?
3. Is it disease prevention or more salutogenic in its approach?
4. Are policy measure health promotion? Community development? Immunization? Fluoridisation of water? Prenatal education? Literacy programmes?
5. What is health?

How relevant is the debate of whether the onus of responsibility for health lies at the individual or community level?

Yeo, finally, lands on the Ottawa Charter, suggesting that it transcends the individual vs. community debate and promotes an ethic of empowerment that should be used to guide health promotion.

1. How much of the Ottawa Charter can help guide ethics for health promotion?
2. Is it sufficient?
3. What is missing from it, if anything?

From Buchanan, 2000:
Buchanan’s book is a very stimulating look at modern health promotion. Buchanan refutes the idea that positivist research should exclusively guide the field in its practice. While this strategy may work in strictly biological terms, he condemns the notion that human behavior should be controlled by such means. Health promotion interventions that seek to change behavior in populations who do not decide for themselves to change, Buchanan believes, are unethical. The medical approach to eradicating health problems involves a paradigm of mastery and control that while appropriate for small pox is not appropriate for drug abuse, violence, HIV/AIDS, obesity, or other modern health threats.

He believes that the modern world is preoccupied with what he refers to as “instrumental reason” at the sacrifice of “practical reason”. Instrumental reason focuses on how things are done—the means. Practical reason focuses on what should be done—the ends. This modern focus on technology has limited the kinds of questions which can be asked in modern science—it is only valid to ask questions which can be proven definitively and not to ask questions such as what is “good”?, what is “health”?.

He offers health promotion a virtue ethic which can guide practice. He believes the universal values on justice, caring and responsibility can direct and shape our work in an ethical way.

Questions that spring to mind:

1. What place does philosophy have in drafting a code of ethics?
2. Do we agree that there is too much focus on “instrumental reasoning” in health promotion?
3. What significance does that have on our work?
4. Is “informed consent” good enough to absolve health promoters from unintended affects of interventions?
5. What is the equivalent of Iatorgenesis in health promotion?
6. Is a virtues approach the best guide for a code of ethics in health promotion?

From Sindall, 2002:
Sindall reiterates the belief that there is too much focus on instrumental reason by stating: “Science and technology constantly serve to highlight the many things that can be done yet there is little opportunity to reflect on what should be done.”

Sindall suggests that the Ottawa charter could be used as a “statement of values and ethical commitments”.

He asks some relevant questions:

1. Do health promoters take for granted that they are doing the ethically right thing?
2. What model can bioethists provide us? Should we be similarly focused on doing no harm, doing good, justice, and respecting autonomy?

He also calls for certain actions which we are directly taking up including:

1. Developing conferences, discussion groups and other forums on Ethics in health promotion.
2. Encouraging conversations with other disciplines such as bioethics, human rights, and social philosophy.
3. Journals should call for papers on the topic.
4. Ethics should be incorporated into academic course work including case studies and materials should be developed to support the courses.
5. Finally, he asks the question which is the purpose of the group—Should IUHPE write a code of ethics?

References
Buchanan, D. R. (2000) An Ethic for Health Promotion: Rethinking the Sources of Human Well-being. Oxford University Press, New York.

Sindall, C. (2002) Does health promotion need a code of ethics? Health Promotion International, 17, 201-203.

Yeo, M. (1993) Toward an ethic of empowerment for health promotion. Health Promotion International, 8, 225-235.

late night reflections on a code of ethics for health promotion

I see the biggest challenge we face in working on a code of ethics for health promotion to be formulating an ethical code that speaks on behalf of all the people of the world, despite their religious or secular beliefs.

Codes of ethics are usually designed for specific professions and organisations, and while health promotioners are also professionals, I think that the holistic and universal nature of health promotion requires that we spend some time reflecting on what health promotion is.

Health promotion is founded on a set of principes and strategies for health for a whole world of people, but the philosophy of health promotion does not concern itself with the details of how things should be done. The principles and strategies of health promotion are "overarching", intended to be applied according to settings and needs, and I think we need a code of ethics that reflects this.

We can't make an ethical code that tells people what to do, but we can provide an ethical framework that guides people in thought and in action, no matter where in the world they live.

I think that a code of ethics for health promotion needs to be grounded in the Ottawa Charter, the Universal Declaration of Human Rights, and the document Towards a Global Ethic (there may also be others) that are universal and that have a view of humanity that is positive, caring and inclusive.

Looking forward to all that lies ahead in this exciting and challenging work.

Best wishes
Gabrielle