Philosophy and Ethics Dr George Lazarashvili

of Health Promotion Lecture 2

 • Ethics deals with the “rightness” or “wrongness” of
human behavior
• Concerned with the motivation behind the behavior
Ethics • Bioethics is the application of these principles to life-
and-death issues
Ethics in PH
• Moral imperative of PH to ensure and protect the
health of the population and the individual
• Ethical foundations traditionally implicit in PH
• The right to health
• Responsibility for population health
• Renewed awareness of and accountability
• Conflict between individual and community rights
• Effects of doing or not doing public health
interventions or “best practices”
• New issues all the time – disasters, genocide
 • Many issues of conflict between good of the individual
and good of society
• Immunization, chlorination, fluoridation
• Food fortification
• HIV/AIDs, MDRTB, DOTs vs. DOTS Plus
Why Study • Aging and chronic diseases

Ethics in PH • Genetically modified foods

• Technology and resource allocation
• Stem cell research
• The Case-for-Action
 • Responsibility to protect society
• Responsibility to the individual
• Individual vs. community rights
• Government responsibility
• Corporate responsibility
PH Ethical • Right to health care

Issues • Personal responsibility - self care

• Quality of care
• Freedom of choice
• Acting on evidence vs. not acting
 Autonomy
Nonmaleficence
Beneficence
Justice
Ethical Principles
Fidelity
Confidentiality
Veracity
Accountability
 Occur when a problem exists between ethical
principles

Deciding in favor of one principle usually violates

Ethical Dilemmas
another

Both sides have “goodness” and “badness”

associated with them
Values, Thoughts
and Actions
• A quote from Mahatma Ghandi
(no date) describes the process.
• “Your beliefs become your
thoughts. Your thoughts become
your words. Your words become
your actions. Your actions become
your habits. Your habits become
your values. Your values become
your destiny”.
 Here are some values and approaches about the appropriate way to treat service users.

promoting anti-discriminatory practice

maintaining confidentiality of information

promoting and supporting individuals’ rights to dignity, independence and safety

recognizing individuals’ personal beliefs and identity

protecting individuals from abuse

promoting effective communication and relationships

providing individualized care

Cont…
 • Cragg et al (2013, p.58-9), indicates four principles that
have been fundamental to medical approaches:
• Non-maleficence has a long tradition. It sounds a
complex term, but basically it means 'do no harm'. So, in
Ethical ethical terms a doctor should not cause any problems
for a patient or make any existing condition worse.
Attitudes in • Beneficence takes the argument form the first principle
Medicine and further. A doctor who does no harm is unlikely to be
meeting all the expectations of the patient or the
Healthcare issues within any disease. So, beneficence means
taking positive steps to improve the condition of a
patient. Alongside this is the idea that positive outcomes
need to be weighed against risks to health.
 • Justice implies that the way healthcare is distributed and used has a 'moral'
dimension.
• Are patients receiving the treatment they deserve?
• Is the treatment fair?
• (Arguably this point has clear reflections in the views that health promotion is
partly about policy, but also about policy having a concern for similarity of rights
to care. In this context, very marked social inequalities may result in people not
receiving what they deserve, in treatment that is not just.)
• Respect for patient autonomy is perhaps more straightforward.

Cont…
• It distinguishes the kind of care that is appropriate from that of paternalism -
where doctor decide what is best.
• In that sense, medical professionals are expected to work in accordance with the
wishes and choices - freely given - of patients.
• If this principle appears rather more straightforward, it is not always in practice.
• What about a patient who does not want a medical procedure, even if it will
secure life, does the doctor have the right to intervene.
• And again, conditions linked to end of life or dementia cloud the sense of
autonomy of the patient?
 • Different ethical dilemmas: Here are some of them:
• First-There is an issue of whether control of health promotion resides at the level
of the individual or the population.
• Scriven raises the general issue about whether individuals themselves are
seeking changes to their lifestyle or whether this arises because of a

Ethical Issues government policy.

• Second-Following on from the first point, Scriven talks about empowering

in Practice people.
• This she argues is the purpose of health promotion.
• As such those engaged in health promotion may encourage certain choices, but
they do so with the intention of allowing individuals to have greater control over
their own health and decisions taken to achieve it.
 Ethical dilemmas

• Third-Not all people are equally able to meet the expectations of health promotion.
• This is evident if we consider nothing more than health education.
• Certain foods, for example, may be better for health, but not all will have equal access to such foods.
• Similarly, we have noted that pollution is likely to fall unevenly across the nation as those with greater access to alternative accommodation
find moving easier.
• In sort, it is possible that health promotion may result in greater inequalities in terms of health.
• Fourth- Bringing some of these points together, Scriven (2010) says the intention of increased autonomy that lies within health promotion
may not always provide an adequate response to the view that those in health promotion are interfering in decisions people make.
• But reminding us of the arguments in the Ottawa Charter, Scriven argues health promotion seeks to increase wellbeing across individuals and
communities within which they live.