ETHICAL ISSUES IN HP.pptxhpublic healthy

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1. TOPIC : ETHICAL ISSUES IN HEALTH PROMOTION F. KASISI MSc DATE: 8 TH AUGUST, 2016

2. OUTLINE OVERVIEW PHILOSOPHY OF HEALTH PROMOTION DUTIES IN HEALTH PROMOTION ETHICAL PRINCIPLES CONCLUSION

3. OVERVIEW HP involves working to improve people’s health This requires a series of value judgements: About what better health means for the individual & society; And about whether, when & how to make a health promotion intervention.

4. What are the practitioners role & aims in HP. What are the prevailing problems for a health promoter from a philosophical perspective. What are the limits to individual freedoms & how these are balanced against the health of the community. Finally, we discuss the key ethical principles in HP.

5. PHILOSOPHY OF H.P Seedhouse (1988) states that the philosophy of health is an essential part of the way in which we understand the world. HP involves decisions & choices that affect other people which require judgments to be made about whether particular courses of action are right or wrong

6. There are no definite ways to behave. H.P is according to Seedhouse (1988), ‘ a moral endeavour ’.

7. Philosophical debate helps to clarify what it is that one believes in most & how one wants to run one’s life. In addition, Philosophy can and does help practitioners to reflect on the principles of practice , and

8. Thus to make practical judgments about whether to intervene & which strategies to adopt.

9. THREE (3) MAIN BRANCHES OF PHILOSOPHY 1. LOGIC - The development of reasoned argument 2. EPISTEMOLOGY - the debate & discussion of truths such as the meaning of health 3. ETHICS - the formal study of the principles on which moral rule & values are based.

10. MORALS Morals refer to those beliefs about how people ‘ought’ to behave. This results in debates about right & wrong, good & bad, and duty are part of everyday discussion.

11. EXAMPLES: DEBATABLE ISSUES Is it wrong to tell a lie? Is it justified to kill another person? Is it our duty to look after ageing parents?

12. SOURCES OF OUR JUDGEMENT Judgment about the morality of these actions may derive from our personal values & moral beliefs which derive from: Religion, Culture, Ideology,

13. Professional codes of practice or social etiquette, The law, or Our life experience

14. FUNCTION OF ETHICAL THEORY Its important to note that the function of ethical theory is not to provide answers but to inform these judgements & help people work out whether certain courses of action are right or wrong, and Whether one ought to take a certain action.

15. TWO (2) TYPES OF ETHICAL THEORIES 1. DEONTOLOGICAL 2. CONSEQUENTIAL

16. DEONTOLOGICAL Deontology comes from the Greek word deonto meaning duty Deontologists hold that we have a duty to act in accordance with certain universal moral rules.

17. CONSEQUENTIAL Consequential ethics are based on the premise that whether an action is right or wrong depends on its end result.

18. DUTY & CODES OF PRACTICE Deontologist hold that there are universal moral rules that it is our duty to follow. Many of the philosophical discussions about the nature of duty are based on the theories of Immanuel Kant.

19. KANT’S THEORY The major features of Kant’s theory are: 1. Act as if your action in each circumstance is to become law for everyone, yourself included, in the future. In other words, if everyone always behaved this way, would the overall effect be good?

20. 2. Always treat human beings as ‘ends in themselves’ and never merely as ‘means’. A moral rule then is one that respects all people.

21. Deontological theories make decision-making apparently easy because, as long as we obey the rules , then we must be doing the right thing, regardless of the consequences.

22. CODES OF PRACTICE Many health care workers have codes of practice which set out guidelines for the fulfilment of duties.

23. DOCTORS For example, doctors take the Hippocratic oath which requires them as a first principle to avoid doing harm.

24. NURSES & HEALTH VISITORS The 1992 code of practice from the UK Central Council for Nursing, Midwifery & Health Visiting states: The to respect life, The duty to care, and The duty to do no harm.

25. SOCIETY OF HEALTH EDUCATION & PROMOTION SPECIALISTS (SHEPS) The Society of Health Education & Promotion Specialists includes these principles in its code of conduct: Practitioners have a: Duty to care Duty to be fair Duty to respect personal & group rights

26. Duty to avoid harm Duty to respect confidentiality Duty to report ( SHEPS 1997)

27. CONSEQUENTIALISM & UTILITARIANISM: the individual & the common good. The other classical school of ethics is known as consequentialism of which utilitarianism is its best-known branch. Consequentialism differs from Deontological theories because it is concerned with ends & not means.

28. The utilitarian principle is that a person should always act in such a way that will produce more good or benefits than disadvantages. Utilitarians such as John Stuart Mill & Jeremy Bentham aimed for the greatest good or pleasure for the greatest number of people.

29. CRITIQUE TO UTILITARIAN One of the main problems with utilitarianism is that, if the aim of all actions is to achieve the greatest good, does this justify harm or injustice to a few if society benefits? Smoking restrictions offer an example where the health of society takes precedence over those of the individual?

30. Many interventions are justified as being in the interests of a ‘ healthy society ’; yet they may not have been requested or desired.

31. EXAMPLES OF HEALTHY PUBLIC POLICIES Consider these examples of possible healthy public policies & whether, in your view, they are ethical. Fluoridation of tap water Ban on smoking in public places Complete ban on drinking & driving

32. Compulsory testing of all visitors to the UK for HIV infection Ban on the use of mobile phones in cars.

33. ETHICAL PRINCIPLES Ethical principles can help to clarify the decisions that have to be taken at work.

34. Ways That Can Guide Decision-Making 1. Sometimes decisions may be guided by trying to do the best for the most number of people. 2. At other times they may be guided by an overriding concern for people’s right to determine their own lives.

35. And sometimes decisions may be guided by other ethical principles or a professional code of conduct.

36. Four (4) Ethical Principles According to Beauchamp & Childress (1995), there are four(4) widely accepted ethical principles. 1. Respect for Autonomy (a Respect for the rights of individuals & their right to determine their lives

37. Ethical Principles Cont ’ 2. Beneficence (doing good) 3. Non-maleficence (doing no harm) 4.Justice (being fair & equitable)

38. Importance of E.P These principles provide a framework for consistent moral decision-making.

39. AUTONOMY Autonomy derives from the Greek word autonomous meaning self-rule. It refers to people’s capacity to choose freely for themselves and be able to direct their own life.

40. Autonomy: Limitations People do not exist in isolation from each other, there will be restrictions on individual autonomy. Autonomous people have a sense of responsibility: they cannot do entirely as they like.

41. Thus, people do not have complete freedom of choice. The limits to an individual’s autonomy are when that individual’s actions affects others in a negative way.

42. Autonomy must, therefore, be thought of not as an absolute but as attainable , to a greater or lesser extent. Not everyone has autonomy. E.g people with learning difficulties or mental illness, young people & older people.

43. Due to their incapacity for rationality, decisions are often taken on their behalf on the basis that ‘they do not know what’s best for them’.

44. Creating Autonomy & Respecting Autonomy Seedhouse (1988) makes a distinction between creating autonomy & respecting autonomy. He regards the two as the central conditions when working for health.

45. Creating autonomy is making an effort to improve the quality of a person’s autonomy by trying to enhance what that person is able to do. In health promotion work, this is often called empowerment.

46. It may involve information to enable clients to make choices or developing the clients’ skills in analyzing situations & making decisions through increasing self-awareness & assertiveness.

47. Respecting autonomy is agreeing to the wishes of the individual & respecting a person’s chosen direction, whether or not it is approved. Respecting autonomy involves respecting another person’ s rights & dignity such that a person reaches a maximum level of fulfilment as a human being.

48. In health promotion & health care this means that the relationship with patients or clients is based on a respect for them as a people, and with individual rights .

49. The Rights in relation to health care are usually taken to include: 1. the right to information 2. the right to privacy & confidentiality 3. the right to appropriate care & treatment

50. BENEFICENCE & NON-MALEFICENCE Frankena (1963) suggests that beneficence means doing or promoting good as well as preventing, removing & avoiding evil or harm. The common good is often put before individual good.

51. Arguably, the most important ethical principle is to do no harm. Here are some examples from the area of weight & obesity.

52. O’ Hara & Gregg (2006) have argued that the weight- centred paradigm has stigmatized overweight & obese, & that interventions to promote weight loss are not particularly effective & can produce psychological distress.

53. JUSTICE Philosophers suggest three versions of Justice: 1. the fair distribution of scarce resources 2. respect for individual & group rights 3. following morally acceptable laws. Thus, justice requires that people are treated EQUALLY.

54. BUT WHAT IS MEANT BY EQUAL? Does it mean according to equal need? Or according to merit? Or according to equal contribution? Or ensuring non-discriminatory practices?

55. Equal Distribution of Resources Can Mean Different Things It could mean that resources should be distributed equally in mathematical terms. Or should they be distributed according to how much was contributed- thus those that have & can put in most get out most?

56. Or Should W e Apply The Marxist Adage: ‘ From each according to his ability, to each according to his needs’?

57. TELLING THE TRUTH The process of health education & information giving in health promotion also involves complex ethical decisions. Seedhouse (1988) identifies truth-telling & promise-keeping as principles which the health promoter should hold on to when deliberating a course of action.

58. CONCLUSION Health promoters’ work involve decisions affecting the lives of others. They respect autonomy, try to be honest & fair, and avoid victim blaming. They try to achieve the best overall solution to any given situation.

59. Tools to enable clear thinking around ethical issues, such as the code of practice make the process more transparent . Whilst there may never be absolute answers in ethical decision-making, a way forward is to be clear about which principles & duties you value most, & to encourage an open debate about ethical principles & how these translate into health promotion practice.

60. Do you agree with the Adage: “ WORK HARD, PLAY HARD” THANK YOU FOR LISTENING