Ethical issues in Health

Promotion
Naushaba Khatoon
 Learning Objectives
• By the end of session, students should be able to:

 Define health promotion related ethical issues

 Classify ethical theories in health promotion and its critiques

 Identify certain main ethical principles during public health

project implementation

 Describe the ethical principle in Health Promotion strategies with

reference to local culture
 What is Ethics
• What come in your mind when you heard the
word “Ethics” with reference to Health
Promotion.
•Write word, phrase or sentence individually
•Discuss it with your neighbor
•Mention it in front of class
 Brain storming
•Making policies for every one
•Beyond discrimination
•Adoptable for every one including minorities
•Certain rules and regulation with boundaries and
limitation
•It provides ground via which healthy practices in
the community are provided by keeping care for
the people in certain boundaries
 What is Ethics
•Defined as set of morals.
•The science of morals in human conduct; moral
principles or code.
•The body of moral principles or values governing
or distinctive of a particular culture or group
•The basic concepts and fundamental principles of
decent human conduct.
•It includes study of universal values such as the
essential equality of all men and women, human
or natural rights,

HP is the application of these principles to improve the

health of communities.
 Difference between ethical & moral
Ethics
• Greek word "ethos" meaning
"character“
• Social system – External
• The rules of conduct recognized • Principles or habits with respect to
in respect to a particular class of
human actions or a particular
group or culture.
• Because society says it is the
right thing to do.
• Ethics are governed by
professional and legal
guidelines within a particular
time and place
Moral
• Latin word "mos" meaning
"custom“
• Individual – Internal
right or wrong conduct. While
morals also prescribe dos and
don'ts, morality is ultimately a
personal compass of right and
wrong.
• Because we believe in something
being right or wrong.
• Morality transcends cultural norms
 Why ethics in Health
Promotion
Health Promotion aim is to:

1. Reduce the risks of ill health by regulations that

ensure environmental conditions that sustain good
health

2. Reduce health inequalities -Pay special attention

to the health of vulnerable people
 Why ethics in Health Promotion
3. promote health/ help people to overcome
addictions and other unhealthy behaviors
through:
- information
- Advice
- Project/programmes

4. ensure that it is easy for people to lead a healthy

life (for example by providing convenient and
safe opportunities for exercise)
 Health Promotion & its Philosophy

• “A moral attempt” (Seedhouse-1988)

• It can and does practitioners to reflect on the

principles of practice and thus to make practical
judgments about whether to intervene and
which strategies to adopt.
Philosophy

Ethics- the enquiry into how we ought to act

and conduct our selves
• Can be done or should be done
 Ethical Theories
1. Utilitarianism/ Consequentialism
– Actions are good to the extent they produce the most
good or the least bad
– Consequences trump intrinsic virtue

2. Kantianism
– Morality generates intrinsic principles that constrain
and guide all
– Kant’s categorical imperative

3. Virtue ethics
 Consequentialism
•Judges people, things and issues on the basis of
their outcomes or consequences.

•Attain happiness, compare the outcome of an

action with the beliefs and taboos of the society.

•Our morality is all about producing good results or

consequences.
 Consequentialism
•This is a view that has been a subject of debate
for long as it expects people to be respectful,
obedient, following rules and regulations, God
fearing, and not poking their noses in the affairs of
others just because of good consequences these
actions would bring along.
•Consequentialists make it binding upon human
beings to engage in activities that bring good
consequences
 Utilitarianism
• Emphasize on the fact that we should engage in acts that
do maximum good to the maximum number of people.

•Believes that all of us want to be happy but at the same

time try to avoid pain to most of us around us.

•Emphasis on goals and the manner in which they are

required to be attained. Whether an act is right or wrong, is
dependent upon what and how much good the act has
produced for people.

•Well being of human beings is at the centre of utilitarianism

with the theory suggesting of engaging in acts that
maximize human welfare.
What is the difference between Consequentialism and
Utilitarianism?
• Utilitarianism was the term
that was used to refer to
consequentialism till
1960s, but today it is seen
more of as a special type of
consequentialism.
• Utilitarianism stresses on
maximizing the good for
the maximum number of
people.
• Utilitarianism combines
the aspects of self-
satisfaction and
consequentialism.
• The greatest good alone
is stressed by
Consequentialists,
utilitarian stresses on
greatest good for the
greatest number of
people.
• Consequentialism says
that the rightness of any
conduct is based upon
its consequences.
Ethical question:
•What means are justifiable to promote population
good health? Should the interest of the majority
always prevail?( Women mental health and tap
water, Machines, Dam, Roads, Houses demolish).

•Those who adopt unhealthy behaviors be refused

treatment?
2. Kantianism – Deontology (Means)

A. Act as if your action in each circumstance is

become law for every one. (every one always
behave this way)

B. Always treat human beings as ends in

themselves’ and never merely as ‘means, respect
all people.
 Kantianism – Deontology (Means)
3. Actions always judged independently of their
outcome. An act can be morally bad but may
unintentionally lead to a favorable outcome
4. Highest virtue comes from doing what you
are supposed to do –
-following the law, policies, rules.
- It matters little whether the act leads to good
consequences; what matters is "doing your
duty."
 Examples: Code of Ethics

•The duty to respect life, the duty to care and the

duty to do no harm.

• The duty to be truth full in all declarations is a

sacred holly unconditional command of reason and
not to be limited by any expediency.
Example:

• Duty to care
• Duty to be fair
• Duty to respect personal group rights
• Duty to avoid harm
• Duty to respect confidentiality
• Duty to report
 3. Virtue ethics
1. Person who perform the action
2. The action
3. The out come of the action
4. Characteristics of a person that help him to become
perfect human being.
 Case Study
The manager of a retail store with a posted
merchandise return policy may choose to honor the
policy or to make exceptions, depending on the
circumstances of a particular return.
Managers with a strong duty-based ethic will typically
hold closely to the literal text of the policy and make
fewer exceptions, because she views upholding her
employer's policy as her job.

Ans: Consequentialists -- that is, people who favor

evaluating the outcome of an act rather than the act
itself -- may be more willing to grant exceptions to
keep customers happy.
 Activity
A pharmaceutical company releasing a drug that
has been governmentally approved with known side
effects because the drug is able to help more people
than are bothered by the minor side effects.

Ans:(An example of act utilitarianism -shows “the

end justifies the means” mentality.
 Case study
An accounts payable clerk is responsible for
reviewing invoices and expense reports,
ensuring that they conform to policy and then
issuing prompt payment. The company policy
required original receipts to justify the items on
the expense report, and the employee submitted
photocopies only, a clerk rejected the report and
asked for the originals.

Ans:(deontology)
 Principles approach: Values
Generic ethical principles:
• Beneficence (Do good) - act in the best interests
of others
• Non-maleficence (avoid doing harm)
• Respect for autonomy - act so as to maximize
the freedom of an individual or community
• Justice - act fairly
 Beneficence
•Do good

1) Prevent and remove harms

2) Weigh and balance possible benefits against
possible risks of an action.
3) Protecting and defending the rights of others,
rescuing persons who are in danger, and
helping individuals with disabilities.
 Non-maleficence
• “do no harm”
• Avoid ineffective strategy/ treatments or acting
with malice toward communities/ projects/
patients.
• Many beneficial therapies also have serious risks.
(The pertinent ethical issue is whether the benefits
balance the burdens. (Aids & std, nutrition
program, vaccination program, eye test, Hand
pumps- corporate social responsibility child labor,
Use of helmet in rural areas )
 Balancing Beneficence and Non-
maleficence
• Informed consent
• Potential risks and benefits in order to make a
decision
• Counter discrimination and be sensitive to the
needs of individuals and groups
• Working in partnership with individuals
• Promoting trust
 Respect for autonomy
•People with learning disabilities, children, prisoners.

•If an individual makes a choice that you consider

harmful, you may be torn between respecting that
person‟s autonomy, doing good and avoiding harm.

•Justify the action I am taking? Abortion, sectioning in

mental health and care orders are obvious examples.
 Justice

•Fairness
•Equality/Equity
•No discrimination
•No favoritism
 Ways of working

• Responsibility - including both social responsibility

for health and individuals. Responsibility for their
own health along with their collective concern for
the health of others
• Enable individuals and communities to have
control over their health, i.e. in ways which are
empowering and promote self-esteem
• Involving individuals and communities in
identifying and responding to their health needs
• Addressing the needs of disadvantaged and
marginalized groups of people
• Attempt to ensure that services have long-term
positive effects, by leaving individuals and
groups stronger and more empowered

• A commitment to sustainable development.

 Ethical Question to be asked
• Maintain equity, respect and further the creation of
autonomy?
• Is it avoiding harm?
• Will the consequences of the action be good and for
whom?
When planning interventions:
• What should we be doing?
• For whom should we be doing it and at what cost/risk to
others?
• Who should decide and how?
• How can you achieve the right balance between the rights
of the population and the rights of the individual?
 Discuss program on ethical ground
Justice, autonomy, do good, no harm
• Polio Eradication Program
• Vaccination program by EPI
• School nutrition program in girls school
• Free ORS distribution
• Force female sterilization
• Ban on use of mobile
• Ban on smoking and tobacco
• Water connections at home (Rural areas)
 Ethical Issues
• individuals can be held responsible for their own health
• Whether it is justifiable to institute health promotion
intervention which have not been sufficiently evaluated

• The extent to which health promotion should influence

on the legitimacy public to choose what is deemed to
be healthy (and by implication correct and good) choice

• The legitimacy of the state to influence the

environment to encourage healthy behavior.
 Issues in HP Ethics
Group Discussion
Understanding our
own ethical issues

Freedom & Source of Victim blaming Benefits of health

autonomy of collective goods and promotion
individuals or benefits stigmatization distribution
 Freedom & autonomy of individuals
•Empowerment is a means/ not target
•Ineffective harmful method
•Avoid negative freedom
•Activities by Social Marketing
•Ethically community should be well informed
about the intervention
•Community and individual have autonomy of
decision to choose from the alternatives available
•Individual should have informed choices
 Source of collective goods or benefits

•With Communities
•Plan with collective action to achieve collective
result
•Collective plan benefiting to individual (HIV
prevalence)
 Victim blaming and Stigmatization

•Focus individual rather then group

•Blaming individual
•Suggest change to individual not in environment,
workplace etc. (Social Marketing)
•Labeling of difference (mental health, obesity
etc)
•Focus local situation not standardize solution
Benefits of health promotion distribution
•Autonomous and living standards (Haves or not
haves)
•Improve health for poor or every one?
•Help those who want help